Publications by authors named "Tehreem Fatima"

30 Publications

  • Page 1 of 1

Remdesivir-Induced Extreme Sinus Bradycardia in COVID-19.

Cureus 2022 Jul 26;14(7):e27307. Epub 2022 Jul 26.

Internal Medicine, Jersey Shore University Medical Center/Saint Francis Medical Center Program, Trenton, USA.

During the COVID-19 pandemic, there was an urgent need for any medication to help reduce the high death rate experienced during this deadly surge. Remdesivir is an FDA-approved drug for COVID-19 treatment, given its anti-inflammatory properties. Upon extensive literature search, we found two studies and four cases of COVID-19-induced pneumonia treated with remdesivir who were developing bradycardia. In most of these cases, the bradycardia resolved within one-to-two days of holding remdesivir, which correlated with the half-life of remdesivir. Remdesivir was shown to have benefits in COVID-19-induced pneumonia during the COVID-19 surge; however, its use has been controversial. According to the studies, the sinus bradycardia following remdesivir administration does not impact patients' prognosis in terms of ICU admission and in-hospital mortality. There are multiple case reports noted to report several remdesivir-induced cardiac side effects. In our case, prolonged use and high dosages may induce cardiotoxicity, manifesting as severe bradycardia. Several possible mechanisms for cardiac adverse effects with remdesivir need further investigation and research as COVID-19 remains an active global issue. We present a 53-year-old man hospitalized with COVID-19-induced pneumonia who experienced extreme sinus bradycardia that is likely attributable to remdesivir.
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http://dx.doi.org/10.7759/cureus.27307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329595PMC
July 2022

Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Shocks Secondary to Cardiac Remodeling: A Unique Case of T Wave Oversensing.

Cureus 2022 Jun 20;14(6):e26129. Epub 2022 Jun 20.

Cardiology, Saint Francis Medical Center, Trenton, USA.

Implantable cardioverter defibrillators (ICD) are used for the primary and secondary prevention of sudden cardiac death (SCD). Currently, two different modalities of ICDs are in use: transvenous (TV) and subcutaneous (S-ICD). The use of S-ICDs has been driven by several potential benefits of this technology: preservation of central venous vasculature, no risk of vascular or myocardial injury during implant, easier explanation, and lower risk of systemic infections. Inappropriate shocks are defined as shocks delivered for non-life-threatening arrhythmias or because of oversensing. Here, we present a case of a 58-year-old man who began experiencing inappropriate shocks three years after S-ICD placement. Careful analysis of the ICD showed T wave oversensing with no malfunction of the device. The shocks persisted even after reprogramming, leading to subsequent ICD removal and loop recorder implantation. The onset of shock episodes coincided with the improvement of left ventricular ejection fraction (LVEF). To the best of our knowledge, this is the first published report of cardiac remodeling leading to uncorrectable T wave oversensing that subsequently required S-ICD explant. This represents a potentially important limitation of S-ICD technology, especially as S-ICD use rises and medical therapy for cardiomyopathy continues to improve.
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http://dx.doi.org/10.7759/cureus.26129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299751PMC
June 2022

Electrolyte Abnormalities Associated With the Use of Atezolizumab - A Systematic Review.

J Community Hosp Intern Med Perspect 2022 12;12(2):35-44. Epub 2022 Apr 12.

Department of Internal Medicine, McLaren Flint Michigan State University, Flint, MI, USA.

Background And Objectives: In recent years, immune-checkpoint inhibitors (ICIs) particularly atezolizumab is on the rise in treating advanced malignancies. With its increased clinical use, various electrolyte abnormalities have been reported in the literature. In this review, we have addressed the question of significant electrolyte abnormalities associated with atezolizumab.

Materials And Methods: Following PRISMA guidelines, we performed a thorough literature search in four databases including PubMed, Cochrane Library, Embase, and Clinicaltrials.gov. We included only randomized controlled trials from 2010 till March 2021. After a comprehensive screening of 1587 articles, we selected 14 articles for our review and tabulated the results. Following MeSH terms were used: "electrolyte abnormalities", "immune checkpoint inhibitors", "atezolizumab".

Results: Non-small cell lung cancer (n = 1270) and metastatic urothelial carcinoma (n = 1164) were the most common malignancies among 3160 patients. The most common electrolyte abnormality was hypomagnesemia (4.7%). Hyponatremia, hypophosphatemia, hypercalcemia and hypokalemia were found in 2.3%, 0.63%, 0.25% and 0.06% patients respectively. For patients taking atezolizumab, hypomagnesemia was most frequently found in non-small cell lung carcinoma patients (9.4%), while urothelial metastatic carcinoma patients most commonly had hyponatremia (5.15%). Hypokalemia though insignificant was observed only in patients with metastatic renal cell carcinoma (2.85%).

Conclusion: Since the use of atezolizumab is on the rise for the treatment of various cancers, more studies need to be conducted to better understand its safety and toxicity profile.
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http://dx.doi.org/10.55729/2000-9666.1037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9195059PMC
April 2022

Hepatocellular Carcinoma With Cardiac Metastasis Presenting as Presyncope.

Cureus 2022 May 11;14(5):e24926. Epub 2022 May 11.

Cardiology, Seton Hall University/St. Francis Medical Center, Trenton, USA.

Hepatocellular carcinoma (HCC) is a common primary tumor of the liver that is highly invasive and can even invade the portal and hepatic veins in later stages. In this report, we present one such rare case of HCC invading the right atrium. A 69-year-old male patient recently diagnosed with HCC secondary to hepatitis C presented to the hospital after experiencing an episode of near syncope. On examination, he had a distended abdomen consistent with ascites with positive fluid shift, elevated jugular vein distention (JVD), and bilateral pitting lower extremity edema. He had an elevated alkaline phosphatase of 298 U/L (34-104) with a total bilirubin of 2.7mg/dL (0.3-1) and a D-dimer of 1.67ugFEU/mL (<0.5). On admission, CT scan of the chest and abdomen showed extensive invasion of the liver by neoplasm and a large 7 cm mass extending from the intrahepatic inferior vena cava to the right atrium. A transthoracic echocardiogram confirmed this, which also better visualized the cardiac anatomy. Due to the extent of the disease, the patient ultimately opted for palliative care. The prognosis for patients with HCC who have an invasion of the right atrium remains dismal, with a median survival of only five months. Surgical extraction of the thrombus with resection of the tumor, liver transplantation, and systemic chemotherapy are some of the treatment modalities employed in such patients; however, historically, the median survival has remained only a few months. With the advent of new techniques and a better understanding of the disease, this seems to be changing and a curative approach can now be considered.
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http://dx.doi.org/10.7759/cureus.24926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187145PMC
May 2022

Effectiveness of preoperative stretchings on postoperative shoulder function in patients undergoing mastectomy.

J Pak Med Assoc 2022 Apr;72(4):625-628

School of Rehabilitation Sciences, The University of Faisalabad, Faisalabad, Pakistan.

Objective: To analyse the effects of pre-operative stretchings of shoulder muscles on post-operative shoulder function in patients undergoing mastectomy.

Methods: The comparative study was conducted from January to May 2019 at Allied Hospital, Madinah Teaching Hospital and the District Headquarter Hospital, Faisalabad, Pakistan, and comprised mastectomy patients. The subjects were randomised to treatment and control groups. The treatment group received static stretching with range of motion, while the control group received routine post-operative care. Data was collected using Numeric Pain Rating Scale, Universal goniometer and Groningen Activity Restriction Scale at post-op day 1 and day 3. Data was analysed using SPSS 20.

Results: Of the 30- patients, there were 15(50%) in each of the two groups. The overall mean age was 46±10.75 years. The treatment group showed significant difference (p<0.05) in pain, range of motion and Groningen Activity Restriction Scale scores for activities of daily living compared to the control group. The treatment group also showed better results in terms of shoulder flexion and abduction range of motion (p<0.05), but showed non-significant difference (p>0.05) in external rotation and Groningen Activity Restriction Scale scores.

Conclusion: Pre-operative stretching of shoulder muscles proved to be safe and effective in reducing post-operative pain and functional restriction in patients undergoing mastectomy.
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http://dx.doi.org/10.47391/JPMA.0475DOI Listing
April 2022

Outcome Of Short And Long Duration Steroid Therapy In Childhood Nephrotic Syndrome In Terms Of Frequency Of Relapse Rate.

J Ayub Med Coll Abbottabad 2022 Apr-Jun;34(2):300-303

Children's Hospital, Lahore, Pakistan.

Background: Nephrotic syndrome is a clinical syndrome defined by massive proteinuria (greater than 40 mg/m2/hour) responsible for hypoalbuminemia (less than 30 g/L) resulting in oedema and hyperlipidaemia. Objective of the study was to compare the frequency of relapse rate with short and long duration steroid therapy in Nephrotic syndrome. It was a Quasiexperimental control group design, conducted at the Department of Paediatric Nephrology, The Children's Hospital and Institute of Child Health, Lahore. Duration of study: One year.

Methods: The data of 150 patients with steroid sensitive nephrotic syndrome was included with clinical presentation and diagnostic investigations. The children were randomly divided into long and short duration steroid treatment groups. Outcome was determined in terms of relapse rate after achieving remission with both treatment strategies. Independent sample t test was applied to compare the outcome in both groups with p≤0.05 considered as significant. Data was stratified for all the effect modifiers like age and gender and poststratification chi square test was applied to see the effect on the outcome, taking p≤0.05 as significant.

Results: The relapse rate of the disease was 0.8±0.72 per year in short-duration group and 1.28±0.61 per year in subjects receiving long-duration steroids, and difference between the two groups was found to be statistically significant (p<0.001). The relapse rate was less in the short duration therapy group as compared to the long duration therapy 62.7% (n=47) patients in group A had one or more relapses of the disease within one year of follow up in contrast to 94.7% (n=71) children in group B (p<0.001).

Conclusions: Patients receiving short duration steroid therapy showed a lower relapse rate as compared to those who were administered long term steroids.
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http://dx.doi.org/10.55519/JAMC-02-9324DOI Listing
May 2022

Deep Demosaicing for Polarimetric Filter Array Cameras.

IEEE Trans Image Process 2022 25;31:2017-2026. Epub 2022 Feb 25.

Polarisation Filter Array (PFA) cameras allow the analysis of light polarisation state in a simple and cost-effective manner. Such filter arrays work as the Bayer pattern for colour cameras, sharing similar advantages and drawbacks. Among the others, the raw image must be demosaiced considering the local variations of the PFA and the characteristics of the imaged scene. Non-linear effects, like the cross-talk among neighbouring pixels, are difficult to explicitly model and suggest the potential advantage of a data-driven learning approach. However, the PFA cannot be removed from the sensor, making it difficult to acquire the ground-truth polarization state for training. In this work we propose a novel CNN-based model which directly demosaics the raw camera image to a per-pixel Stokes vector. Our contribution is twofold. First, we propose a network architecture composed by a sequence of Mosaiced Convolutions operating coherently with the local arrangement of the different filters. Second, we introduce a new method, employing a consumer LCD screen, to effectively acquire real-world data for training. The process is designed to be invariant by monitor gamma and external lighting conditions. We extensively compared our method against algorithmic and learning-based demosaicing techniques, obtaining a consistently lower error especially in terms of polarisation angle.
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http://dx.doi.org/10.1109/TIP.2022.3150296DOI Listing
February 2022

Platelet-Rich Fibrin Used in Regenerative Endodontics and Dentistry: Current Uses, Limitations, and Future Recommendations for Application.

Int J Dent 2021 15;2021:4514598. Epub 2021 Dec 15.

Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia.

Regenerative endodontics has introduced numerous procedures such as pulp implantation, revascularization, and postnatal stem cell therapy. Revascularization has been successfully implemented clinically nowadays, thus providing dentists with outrageous results. Platelet-rich fibrin (PRF) used either alone or along with bone graft promotes bone growth and vascularization. This matrix promotes migration, cell attachment, and proliferation of osteoblast that leads to bone formation. PRF consists of a packed fibrin complex consisting of leukocytes, cytokines, and glycoproteins such as thrombospondin. The usage of PRF has reported high success rates in surgical cases such as sinus lift procedures, healing of extraction sockets, and management of periapical abscesses. Compared to platelet-rich plasma, PRF is more economical, easy to prepare, and feasible to use in daily clinical practices. Revascularization compromised the induction of a blood clot into the root canal space, which emerged as a clinical triumph. This further led to platelet concentrates as an autologous scaffold on which revascularization could occur. The applications of PRF in regenerative endodontics are numerous, such as an agent for repairing iatrogenic perforation of the pulpal floor and for the revascularization of immature permanent teeth with necrotic pulps. It acts as a matrix for tissue ingrowth. Evidence of progressive thickening of dentinal walls, root lengthening, regression in the periapical lesion, and apical closure was reported. Further studies are needed to clarify the precise mechanism of action of PRF for dental pulp regeneration both in vitro and in vivo. The current review aims at the present uses of PRF in regenerative endodontics dentistry and its application with future recommendations and limitations.
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http://dx.doi.org/10.1155/2021/4514598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8695013PMC
December 2021

Will I speak up or remain silent? Workplace ostracism and employee performance based on self-control perspective.

J Soc Psychol 2021 Sep 9:1-19. Epub 2021 Sep 9.

Institute of Business, Management and Administrative Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.

Drawing on the self-control perspective, this study investigated the buffering effect of emotional suppression in reducing the harmful influence of workplace ostracism on employee performance. The research also studied the mediating role of employee silence and voice behaviors based on social exchange theory. We performed moderated mediation analysis on responses received from 159 employees working in the financial industry of the Southern Punjab region of Pakistan. The results showed that workplace ostracism harms employee performance via employee silence and voice behaviors. Furthermore, emotional suppression moderated the mediated relationship between workplace ostracism and employee performance. The results indicated that if ostracized employees adopt voice behavior, emotional suppression cannot aid them in performing better as compared to those who remain silent and regain their self-esteem. Our findings highlight the importance of emotional suppression capability in reducing the damaging outcomes of ostracism in organizational settings.
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http://dx.doi.org/10.1080/00224545.2021.1967843DOI Listing
September 2021

Investigating the role of export product diversification for renewable, and non-renewable energy consumption in GCC (gulf cooperation council) countries: does the Kuznets hypothesis exist?

Environ Dev Sustain 2022 29;24(6):8397-8417. Epub 2021 Aug 29.

School of Statistics and Applied Mathematics, Anhui University of Finance and Economics, Bengbu, 233030 China.

This study explores the effects of renewable and nonrenewable energy demand on export product diversification, economic growth, natural resources, human capital, and trade in GCC (Gulf Cooperation Council) countries using data of six countries from 1990 to 2019. The empirical analysis integrates the panel unit root tests (IPS and CIPS), panel quantile regression, and fully modified OLS models. The empirical results confirm that there exists a significant negative relationship between renewable energy and export diversification; signifying that diversification of products will reduce renewable energy. Similarly, when compared to the square of export product diversification, it shows a positive and significant correlation. The empirical findings highlighted the presence of Kuznets's hypothesis between export product diversification, renewable, and non-renewable energy consumption. Furthermore, the findings suggest that natural resources and economic growth may increase overall energy consumption in GCC countries. It implies an important policy suggestion that encouraging export diversification will reduce GCC countries' reliance on oil to meet energy demand.
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http://dx.doi.org/10.1007/s10668-021-01789-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403254PMC
August 2021

Asymmetric and time-varying linkages between carbon emissions, globalization, natural resources and financial development in China.

Environ Dev Sustain 2022 17;24(5):6702-6730. Epub 2021 Aug 17.

School of Economics and Management, Guangdong University of Petrochemical Technology, Guangdong, China.

In the real world, economic covariates follow asymmetric and time-varying patterns. Therefore, it is imperative to integrate these effects while estimating environmental and economic relationships. Although prevailing literature reveals various emissions-deriving and eliminating factors, however, there is a dearth of empirical evidence that estimates the asymmetric and time-varying effect of globalization, natural resources, and financial development from a multidimensional perspective in China. In doing so, we employ the nonlinear autoregressive distributed lag (NARDL) and cross-wavelet modeling framework to explore the long- and short-run nonlinear and time-variant association between globalization, natural resources, financial development, and carbon emissions from 1980 to 2017. The NARDL method has the benefit of discriminating the long-term and short-term asymmetric carbon emission responses due to a positive and negative shock in our primary variables of interest. Mainly, the findings of NARDL estimations confirm that positive shocks in globalization and financial developments have a significant positive impact on carbon emissions, whereas negative shock in natural resources has a significant positive impact on carbon emissions. Similarly, the outcomes of continuous wavelet transformation and wavelet transformation coherence confirm the causal linkages between covariates; however, this effect varies across different time and frequency domains. These results imply that environmental researchers should consider asymmetric transmission channels and time-frequency associations among variables to devise long-term sustainable policies.
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http://dx.doi.org/10.1007/s10668-021-01724-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369448PMC
August 2021

Follow-up of COVID-19 recovered patients with mild disease.

Sci Rep 2021 06 28;11(1):13414. Epub 2021 Jun 28.

Medicine, CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan.

COVID-19 may manifest as mild, moderate or severe disease with each grade of severity having its own features and post-viral implications. With the rising burden of the pandemic, it is vital to identify not only active disease but any post-recovery complications as well. This study was conducted with the aim of identifying the presence of post-viral symptomatology in patients recovered from mild COVID-19 disease. Presence or absence of 11 post-viral symptoms was recorded and we found that 8 of the 11 studied symptoms were notably more prevalent amongst the female sample population. Our results validate the presence of prolonged symptoms months after recovery from mild COVID-19 disease, particularly in association with the female gender. Hence, proving the post-COVID syndrome is a recognizable diagnosis in the bigger context of the post-viral fatigue syndrome.
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http://dx.doi.org/10.1038/s41598-021-92717-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239036PMC
June 2021

Emollient Therapy in Preterm & Low Birth Weight Neonates: A Randomised Clinical Trial.

J Coll Physicians Surg Pak 2021 Mar;31(3):298-301

Department of Paediatric Medicine, King Edward Medical University, Lahore, Pakistan.

Objective: To assess the impact of emollient therapy on gain in weight and length among preterm and low birth weight babies.

Study Design: Randomised controlled trial.

Place And Duration Of Study: Department of Pediatric Medicine, KEMU / Mayo Hospital Lahore, from January till June 2018.

Methodology: Infants with birth weight between 1.5 and 2.5 Kgs or preterm neonates born between 28 and 37 completed weeks of gestation were included in the study. Neonates with genetic syndrome, infection or with a history of admission in NICU due to any reason, were excluded. They were randomly divided into two groups-A and B, by lottery method. Mothers of the neonates in group A were advised massage with sunflower oil; while mothers of the neonates in group B were advised massage without any emollient. Babies were closely followed up and their weight and length were measured at two months of age and were analysed using SPSS version 23.0.

Results: For 140 neonates, the mean increase in weight was 489.84 ± 297.48 grams among group-A neonates (emollient therapy group) and it was 373.43 ± 276.31 grams among group-B neonates (p = 0.018). The mean increase in length was 6.5 ± 1.1 cm, among group-A neonates and 4.8 ± 1.3 cm in group-B neonates (p ˂0.001).  Conclusion: Massage with emollient therapy leads to significantly more increase in weight and length compared to massage alone, among preterm and low birth weight neonates. Emollient therapy is an effective non-pharmacological intervention for increasing weight and length in low birth weight and preterm neonates. Key Words:  Emollient, Massage, Low birth weight, Preterm neonates, Weight, Length.
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http://dx.doi.org/10.29271/jcpsp.2021.03.298DOI Listing
March 2021

Environmental quality, climate indicators, and COVID-19 pandemic: insights from top 10 most affected states of the USA.

Environ Sci Pollut Res Int 2021 Feb 25. Epub 2021 Feb 25.

Business School, Central South University, Changsha, (410083), Hunan, People's Republic of China.

In the current context of the COVID-19 pandemic, researchers are working with health professionals to inform governments on how to formulate health strategies. In this study, we examine the correlation between environmental and climate indicators and COVID-19 outbreak in the top 10 most affected states of the USA. In doing so, PM, temperature, humidity, environmental quality index, and rainfall are included as crucial meteorological and environmental factors. Kendall and Spearman rank correlation coefficients, quantile regression, and log-linear negative binominal analysis are employed as an estimation strategy. The empirical estimates conclude that temperature, humidity, environmental quality index, PM, and rainfall are significant factors related to the COVID-19 pandemic in the top 10 most affected states of the USA. The empirical findings of the current study would serve as key policy input to mitigate the rapid spread of COVID-19 across the USA.
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http://dx.doi.org/10.1007/s11356-021-12646-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906571PMC
February 2021

Efficacy of Tacrolimus Versus Clobetasol in the Treatment of Vitiligo.

Cureus 2020 Dec 8;12(12):e11985. Epub 2020 Dec 8.

Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Introduction Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes which is characterized by circumscribed depigmented macules and patches. Vitiligo is a progressive disorder in which some or all of the melanocytes in the affected skin are selectively destroyed. Around 0.5-2% of the world population is affected by vitiligo and the average age of onset is 20 years. The objective of the study was to evaluate the efficacy of tacrolimus versus clobetasol in the treatment of vitiligo. It is an open randomized control trial conducted in the Department of Dermatology, Nishtar Hospital, Multan for six months.  Methods One hundred sixty-two patients of vitiligo were included in the study. The disease was diagnosed on basis of clinical features and the Standard Assessment scale proposed by Hossain which was used to monitor and grade the response. Patients were randomly allocated into two groups by lottery method having 81 patients in each group. Group A was given tacrolimus whereas Group B was given clobetasol. Patients were followed up every four weeks. On the 12 week of treatment, effectiveness was assessed by measuring the Assessment scale proposed by Hossain. The results of the two groups were then compared. Results Sixty-three patients (38.9%) were males whereas 99 patients (61.1%) were females. The mean age of the patients included in the study was 29.68 + 8.162 years. The mean weight of the patients was 62.25 + 9.529 Kg. Out of 162, treatment was effective in 89 patients (54.9%) whereas in 73 patients (45.1%) the treatment was ineffective. In Group A (tacrolimus), 42 patients (51.9%) had effective treatment (on the complete resolution of symptoms) whereas 39 patients (48.1 %) had ineffective treatment. In Group B (clobetasol), 47 patients (58%) had effective treatment, and the rest (34, 42%) had ineffective treatment. A Chi-Square test was applied to compare the efficacy of the two groups. There was no statistically significant difference in both the groups in terms of efficacy. Group B was numerically superior in terms of effective treatment (47 versus 42) but not superior statistically. Conclusion Comparison of tacrolimus and clobetasol in patients of vitiligo showed no significant difference in the efficacy of the two groups. It can be concluded that tacrolimus may be considered superior to corticosteroids as its local and systemic adverse effects are less.
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http://dx.doi.org/10.7759/cureus.11985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793363PMC
December 2020

COVID-19 and Its Psychological Impacts on Healthcare Staff - A Multi-Centric Comparative Cross-Sectional Study.

Cureus 2020 Nov 28;12(11):e11753. Epub 2020 Nov 28.

Oncology, Cleveland Clinic, Cleveland, USA.

Background Since the first case of coronavirus disease-19 (COVID-19) in Pakistan was reported in February 2020, the medical and paramedical staff has been working on the frontlines to deal with this disease. They have been facing significant strain and stress due to the pandemic, affecting their social, mental, and personal life. The purpose of this study is to investigate the psychological effects of the COVID-19 pandemic, etiology, personal coping mechanisms, and the strategies that are being adopted to reduce stress by the healthcare workers (HCWs) working in COVID-19 dedicated wards (group 2) and compare it with staff working in other departments but not in COVID-19 wards amid this pandemic (group 1) in various hospitals of Lahore, Pakistan. Methods The comparative cross-sectional study was designed which included doctors, nurses, and allied health professionals from various hospitals of Lahore, Pakistan. A questionnaire was designed which consisted of five sections, and 51 questions. A Chi-square test was used to compare the responses between these two groups. Results The study questionnaire was submitted by 200 participants, 100 responses for each group (see the Appendix). In group 1, HCWs not working in COVID-19 dedicated floors were afraid of getting infected, transmitting the infection to their families and concerned about using personal protective equipment (PPE) improperly. They reported a lack of concentration and tense muscles. The coping mechanisms of this group were exercise, strict precautions at work, and social distancing measures. While HCWs serving in COVID-19 dedicated wards were concerned and afraid of putting their families at risk by working in the high-risk environment; the major stresses in this group were: lack of knowledge about proper strategies for treatment, they faced insecurity due to physical and verbal violence by caretakers of COVID-19 patients, and lack of concentration. The coping mechanism was the support of their families and taking strict precautions, with self-isolation if required, to avoid any disease transmission to their families. The proposed strategies to be implemented included teaching skills for self-rescue as well as the implementation of policies at the administrative level to reduce working hours and frequent shift rotation. Conclusion The COVID-19 outbreak posed a great deal of mental stress among HCWs working on the COVID-19 floor as well as those serving in other departments of the hospital. The HCWs from group 1 were most afraid of getting infected and putting family members at risk, experienced tense muscles and lack of concentration, coped their stress by exercise and being more vigilant, and suggested the strategies of teaching skills for self-rescue and better community awareness. While the staff from the second group were most afraid of being the source of infection and violence from the caretakers of patients, experienced tense muscles, used family support, and strict isolation measures as coping mechanisms and suggested the strategies of self-rescue and increase in wages of directly exposed healthcare workers to deal with such pandemics in future in a better way.
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http://dx.doi.org/10.7759/cureus.11753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773302PMC
November 2020

Patterns of Hepatocellular Carcinoma After Direct Antiviral Agents and Pegylated-Interferon Therapy.

Cureus 2020 Nov 19;12(11):e11565. Epub 2020 Nov 19.

Gastroenterology and Hepatology, Holy Family Hospital, Rawalpindi, PAK.

Introduction:  The impact of direct-acting antiviral agents (DAAs) on the development of hepatocellular carcinoma (HCC) is controversial and a part of the scientific community believes it as a biased interpretation of data. Many studies have reported an aggressive pattern of HCC after DAA use. In this study, we attempted to assess the changes in the pattern of HCC after treatment with DAAs or PI (PEG, pegylated-interferon).

Methods:  A total of 37 HCC patients after DAA treatment and 21 HCC patients after PI treatment were included. The diagnosis of HCC was made and information about demographics, HCC infiltrative pattern, portal vein thrombosis (PVT), time at initial presentation, Child-Turcotte-Pugh (CTP) score, and Barcelona Clinic Liver Cancer (BCLC) stage were compared in the two groups.

Results:  The total number of male patients in the DAA group was 62% while either gender was almost equal in PI. The age group of 40-60 was more prevalent in the DAA group while the PI group comprised more patients who were above 60 years. Patients in the DAA group presented after 3.35 years on average while patients in the PI group presented after about seven years. Most of the patients presented with the CTP stage of A. That is true for both groups. For BCLC staging, most of the patients had stage C, which means multiple lesions. At the initial presentation, most of the patients presented with multifocal lesions.

Conclusion:  Our study found no significant difference in the initial presentation between both groups. However, HCC patients with prior DAA therapy presented early than those with PI therapy.
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http://dx.doi.org/10.7759/cureus.11565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749863PMC
November 2020

Immune thrombocytopenia associated with tuberculosis - A case report.

IDCases 2021 19;23:e01012. Epub 2020 Nov 19.

Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.

Tuberculosis can involve the hematological system and cause anemia, leucopenia, leukocytosis, thrombocytopenia, and thrombocytosis. Immune thrombocytopenia related to tuberculosis is rare. We present a case of a 54 years old male patient who was evaluated for isolated asymptomatic thrombocytopenia discovered on routine laboratory investigations. Work up was positive for disseminated tuberculosis. The patient responded to a tapering dose of steroids and anti-tuberculous medications with significant and persistent platelet count improvement.
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http://dx.doi.org/10.1016/j.idcr.2020.e01012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708927PMC
November 2020

Comparison Between Menstrual Migraine and Menstrual-Unrelated Migraine in Women Attending Gynecology Clinics.

Cureus 2020 Oct 16;12(10):e10976. Epub 2020 Oct 16.

Internal Medicine, Milton Keynes University Trust Hospital, Milton Keynes, GBR.

Background Migraine is amongst the top 10 most disabling conditions, and the disease burden is highest in young and middle-aged women. Another variant of the migraine headache, menstrual migraine (MM) is experienced by this cohort of patients. Former studies have done comparisons between various demographic and clinical features of MM versus menstrual-unrelated migraine (MUM) in patients presenting to various clinics with the primary complaint of headaches. We aimed to compare symptoms of migraine in women attending gynecology outpatient clinics, regardless of their presenting complaint. This would help lessen the selection bias and produce more generalizable results. Methods and materials A cross-sectional study was conducted in the outpatient gynecology clinics at a tertiary care hospital over six months. The clinic attendees were screened for sufferers of a primary headache of the migraine type. The migraineurs were then stratified into groups A, MM patients, and group B, MUM patients, using the International Headache Society (HIS) criteria. They were then questioned for the presence of various symptoms associated with their migraine attacks for comparison. Results One-hundred eighty-one women (between 12 years to 55 years) were found to have primary headaches; amongst these, 126 patients met the inclusion criteria and consented to participate; from these, 62 (49.2%) patients had MM and 64 (50.8%) patients had MUM. The symptoms of nausea (p=0.00269), photophobia (p=0.000088), and phonophobia (p=0.0281) were statistically higher in MM patients while vomiting was not a significant feature. Both groups had a predominantly unilateral headache. The average days of the attack had a significant difference between the two groups (p=0.000019), where the duration was longer for MM patients. Conclusions It was observed that patients with MM tend to experience more features associated with migraine headaches, including a longer duration of attacks, and have a worse experience overall.
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http://dx.doi.org/10.7759/cureus.10976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667617PMC
October 2020

Remitting seronegative symmetrical synovitis with pitting edema: a review.

J Investig Med 2021 01 29;69(1):86-90. Epub 2020 Oct 29.

Department of Family Medicine, Samaritan Medical Center, Watertown, New York, USA.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare benign rheumatological condition characterized by sudden-onset symmetrical distal extremity edema. It can present as an isolated disease process or could be associated with other conditions. Rheumatoid factor and anticitrullinated protein antibodies are negative by definition. In current literature, there is paucity of data about the disease process. We performed a literature search using the PubMed database to identify 38 articles that met our inclusion and exclusion criteria. Our literature review focuses on the clinical picture and its diverse associations. Role of various acute phase reactants has also been outlined. There is a generalized consensus among clinicians on using moderate dose steroids for treatment. Other management options for refractory cases have also discussed. Value of several imaging modalities in diagnostic evaluation of this disease entity is touched on. Since RS3PE can be associated with other diseases, specifically cancer, timely diagnosis of this condition is necessary.
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http://dx.doi.org/10.1136/jim-2020-001613DOI Listing
January 2021

Pituitary Stalk Interruption Syndrome.

Cureus 2020 Sep 17;12(9):e10518. Epub 2020 Sep 17.

Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Pituitary stalk interruption syndrome (PSIS) is a rare, congenital disorder characterized by a triad of a thin or interrupted pituitary stalk, aplasia or hypoplasia of the anterior pituitary, and absent or ectopic posterior pituitary (EPP) seen on magnetic resonance imaging (MRI). It can either present at birth or later in life. PSIS is very heterogeneous with respect to its hormonal, clinical, and radiological presentation. The patient described is an 18-year-old male who presented with complaints of short stature and underdeveloped secondary sexual characteristics with weight and height of less than three percentiles for his age. The secondary sexual characteristics were consistent with Tanner Stage II. Some of the pituitary hormones were also deficient. Wrist X-ray was compatible with a bone age of a seven- to eight-year-old. MRI confirmed the diagnosis of PSIS (pituitary stalk interruption syndrome).
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http://dx.doi.org/10.7759/cureus.10518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571781PMC
September 2020

Use of Sodium-Glucose Co-Transporter-2 Inhibitors in Type 1 Diabetics: Are the Benefits Worth the Risks?

Cureus 2020 Aug 27;12(8):e10076. Epub 2020 Aug 27.

Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

The mainstay of treatment for type 1 diabetes is insulin. The use of insulin for tight glycemic control is the key to preventing micro- and macrovascular complications, but it can also lead to hypoglycemic episodes. Therefore, there is a need for the introduction of a drug that can maintain glucose levels within a safe range without increasing the risk of hypoglycemia. For this reason, SGLT2 (sodium-glucose co-transporter-2) inhibitors has been a hot topic in the last couple of years. They have been proved very efficient in treating type 2 diabetes. Many trials on the safety and efficacy of SGLT2 inhibitors have been done on type 1 diabetics. Some other studies have also been done that prove their benefits in increasing arterial efficacy and reducing GFR (glomerular filtration rate). This review article discusses the benefits and risks. The literature search was performed using PubMed, and after applying the inclusion and exclusion criteria, 16 published papers were found. All relevant articles on the topic have been included. Our review has shown that the benefits of SGLT2 inhibitors outweigh their risks. Their benefits include good glycemic control, HBA1c (glycated haemoglobin) reduction, weight loss, and blood pressure improvement. Furthermore, improvement in GFR and arterial efficacy is also significant. Side effects such as UTI (urinary tract infection) and genital infection have been observed, but their incidence is low. However, DKA (diabetic ketoacidosis) and hypoglycemia are severe side effects that should be highlighted. Hypoglycemia can be prevented by strictly monitoring blood sugar levels. The patient must be educated and counseled about DKA and its symptoms. This will ensure the safety of the patient as euglycemic DKA can prove fatal if not diagnosed earlier. So, SGLT2 inhibitors can be used as an effective drug to control blood sugar levels in type 1 diabetes, especially in patients with a BMI higher than 30. It will not only achieve the treatment goals but can also decrease the morbidity and mortality of the patients. However, more studies need to be done to fully understand DKA caused by SGLT2 inhibitors.
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http://dx.doi.org/10.7759/cureus.10076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522056PMC
August 2020

Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article.

Cureus 2020 Sep 13;12(9):e10424. Epub 2020 Sep 13.

Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. OSA can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.
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http://dx.doi.org/10.7759/cureus.10424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494423PMC
September 2020

Evaluation of the Risk of Getting Peripheral Artery Disease in Rheumatoid Arthritis and the Selection of Appropriate Diagnostic Methods.

Cureus 2020 Aug 16;12(8):e9782. Epub 2020 Aug 16.

Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.

This study aims to review the evidence regarding the association between peripheral artery disease (PAD) and rheumatoid arthritis (RA), as well as influential underlying factors and diagnostic options. Eligible literature was searched in PubMed published up to June 1, 2020, in English. Case studies, case series, reviews, and meta-analyses were excluded. We also excluded non-human studies and those 20 years and older. A total of 44 studies were finally incorporated in the narrative review. The results indicated that compared to controls, RA patients are more prone to PAD. Traditional risk factors, disease-characteristics, vitamin D deficiency, therapy used, and other relevant conditions have a variable effect on overall PAD progression. Studies comparing diagnostic options revealed that vascular function and morphology are connected but are still distinctive processes. In early-stage disease, there are functional alterations in the endothelium that can be controlled by anti-inflammatory medications. Ankle-Brachial Index (ABI) <0.9 might not be quite susceptible to PAD evaluation. Supplemental diagnostic tools could detect vascular disease in the preclinical stage. Most risk factors are adjustable, and the management will have a good impact on vascular health. PAD is mostly subclinical when the therapeutic options have a better impact. Diagnostic modalities should be chosen depending on the features of RA. In addition, multiple diagnostic options increase the accuracy of PAD diagnosis. Future prospective studies with larger populations at different age groups and different disease activity duration are essential to make firm conclusions and better understand the phenomenon of RA and PAD.
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http://dx.doi.org/10.7759/cureus.9782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491681PMC
August 2020

Bubble Nasal Continuous Positive Airway Pressure (bCPAP) versus Control in Neonates with Respiratory Distress.

J Coll Physicians Surg Pak 2020 Aug;30(8):805-809

Department of Paediatric Medicine, King Edward Medical University, Lahore, Pakistan.

Objective: To compare the effectiveness of bubble continuous positive airway pressure (bCPAP) and oxygen inhalation via nasal cannula in neonates presenting with respiratory distress, using Silverman Anderson Retraction Score (SARS).

Study Design: Randomised clinical trial.

Place And Duration Of Study: Department of Paediatrics, Unit-1, KEMU/Mayo Hospital, Lahore, Pakistan, from April 2017 to June 2018.

Methodology: A total of 120 neonates fulfilling inclusion and exclusion criteria were enrolled and were randomly allocated in two groups: Group A and Group B. In group A, neonates were given bCPAP for respiratory support, while neonates in group B were given nasal oxygen as control group. Neonates in both groups were followed for 48 hours. The effectiveness was determined by the reduction in SARS, up to or less than score 3, at the end of a 48-hour period. Data were collected and analysed by SPSS version 20.0. P-value ≤0.05 was taken as significant.

Results: In Group A, effectiveness was found to be 93.3%, and in Group B effectiveness was 71.7% (p = 0.003). Median reduction in SARS from 00 to 48 hours, in group A (bCPAP) was 4 (4 - 5) while in group B (control), it was 3 (2 - 3); statistically significant (p <0.001).

Conclusion: Bubble CPAP was more effective than nasal oxygen alone, in treatment of respiratory distress among neonates. This study suggested that bCPAP should be used more frequently in NICUs of Pakistan to reduce burden of neonatal morbidity due to respiratory distress. Key Words: Bubble CPAP, Respiratory distress, Neonates, Silverman Anderson Retraction Score.
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http://dx.doi.org/10.29271/jcpsp.2020.08.805DOI Listing
August 2020

Automatic detection of parasites from microscopic blood images.

J Parasit Dis 2020 Mar 20;44(1):69-78. Epub 2019 Sep 20.

Punjab University College of Information Technology, University of the Punjab, Lahore, Pakistan.

Malaria is caused by parasite. It is transmitted by female bite. Thick and thin blood smears of the patient are manually examined by an expert pathologist with the help of a microscope to diagnose the disease. Such expert pathologists may not be available in many parts of the world due to poor health facilities. Moreover, manual inspection requires full concentration of the pathologist and it is a tedious and time consuming way to detect the malaria. Therefore, development of automated systems is momentous for a quick and reliable detection of malaria. It can reduce the false negative rate and it can help in detecting the disease at early stages where it can be cured effectively. In this paper, we present a computer aided design to automatically detect malarial parasite from microscopic blood images. The proposed method uses bilateral filtering to remove the noise and enhance the image quality. Adaptive thresholding and morphological image processing algorithms are used to detect the malaria parasites inside individual cell. To measure the efficiency of the proposed algorithm, we have tested our method on a NIH Malaria dataset and also compared the results with existing similar methods. Our method achieved the detection accuracy of more than 91% outperforming the competing methods. The results show that the proposed algorithm is reliable and can be of great assistance to the pathologists and hematologists for accurate malaria parasite detection.
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http://dx.doi.org/10.1007/s12639-019-01163-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046825PMC
March 2020

The Impact of Transformational Leadership on Nurses' Organizational Commitment: A Multiple Mediation Model.

Eur J Investig Health Psychol Educ 2019 Dec 9;10(1):262-275. Epub 2019 Dec 9.

Department of Management Sciences, University of Lahore, Sargodha 40100, Pakistan.

This study proposed that the transformational style of nursing staff supervisors inculcate commitment amongst nurses. Moreover, psychological empowerment and psychological well-being were posited as multiple meditators in the above-mentioned association, based on the tenant of conservation of resource (COR) theory. The authors have collected the survey data from the sample of (n = 299) hospital nurses working in Sargodha district of Pakistan. The bootstrap results have supported the direct, as well as indirect relationships. These findings imply that when the nursing staff perceives their leader as transformational, their psychological empowerment is enhanced, and they have higher well-being, which in turn increases their commitment to their hospitals. This study offers a better understanding of psychological states that mediate transformational leadership and organizational commitment linkage.
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http://dx.doi.org/10.3390/ejihpe10010021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314220PMC
December 2019

Decomposition analysis of energy-related CO emission in the industrial sector of China: Evidence from the LMDI approach.

Environ Sci Pollut Res Int 2019 Jul 27;26(21):21736-21749. Epub 2019 May 27.

School of Energy and Mining Engineering, China University of Mining &Technology (Beijing), Beijing, 100083, China.

Energy consumption and increasing CO emissions in China are mainly indorsed to the industrial sector. The objective of this study was to explore the main factors driving CO emissions in China's industry throughout 1991-2016. Based on the log-mean Divisia index (LMDI) method, this study decomposes the change of industry-related CO emissions into energy structure effect, income effect, energy intensity effect, carbon emission, and labor effect. The core results indicate that CO emissions in China's industry experienced a significant increase from 738.5 to 7271.8 Mt during 1991-2013, while it decreased to 6844.0 Mt in 2016. The income effect and labor effect are the top two emitters, which accounted for increases of 351.8 Mt and 57.8 Mt in CO emissions respectively. Additionally, the energy structure effect also played a role in increasing CO emissions. Energy intensity and carbon emission effects are the most important factors in reducing CO emissions. The policy suggestions about the different period-wise analyses in terms of economic growth, energy structure, and energy intensity are provided.
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http://dx.doi.org/10.1007/s11356-019-05468-5DOI Listing
July 2019

The effect of ICT on CO emissions in emerging economies: does the level of income matters?

Environ Sci Pollut Res Int 2018 Aug 31;25(23):22850-22860. Epub 2018 May 31.

School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.

In the modern era of globalization, the rapid increase in information and telecommunication technologies (ICTs) contributes in various sectors of an economy; however, the environmental consequences of ICTs cannot be ignored. Therefore, the study investigates the nexus between ICTs, economic growth, financial development, and environmental quality in emerging economies. The novel feature of the study is that the interaction term of ICT is introduced with economic growth and financial development. The empirical findings of the study are based on panel mean group (MG) and augmented mean group (AMG) estimation methods from 1990 to 2015. The following empirical results are established: first the ICTs significantly affect CO emissions. Second, the moderating effect of ICT and financial development stimulate the level of CO emissions. Third, economic growth contributes CO emission; however, the interaction between ICT and GDP mitigates the level of pollution. Policy thresholds with the R&D in ICT sector are required to mitigate the level of CO emission. Introduction of green ICTs projects in the financial sector is a better choice to improve the energy efficiency.
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http://dx.doi.org/10.1007/s11356-018-2379-2DOI Listing
August 2018

Laparoscopic resection of gastro-intestinal stromal tumour.

J Pak Med Assoc 2015 Nov;65(11):1228-30

Department of Anatomy, Services Hospital, Lahore, Pakistan.

Gastro-Intestinal Stromal Tumours are rare tumours, constituting less than 1% of gastrointestinal tumours. They are the most common mesenchymal origin tumours of gastro-intestinal tract. Tyrosine kinase c-kit oncogene mutation is found in all cases. These tumours are sensitive to imatinib. They are usually noted incidentally on endoscopy or present with haematemesis after ulceration. We are reporting the laparoscopic resection of GIST in a 67 year old male who had presented with haematemesis. He was found to have a gastric polyp on endoscopy. Endoscopic ultra-soundshowed the tumour to be arising from the submucosa. Histo-pathology showed the tumour to be GIST. Patient is currently undergoing chemotherapy.
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November 2015
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