Volume 17, Issue 2, April 2021-June 3021
Guest Editorial
Global Epidemic of Hearing Loss: Challenges and Opportunities for Pakistan
Author: Sher T. MD.
DOI: https://doi.org/10.51273/esc21.25172-ge1
Hearing is a special sense that across the lifetime allows us to engage with environment, communicate with fellow beings, express our thoughts, gain
education, seek employment and opportunities to improve quality and standard of lives for ourselves, our families and the communities we live in. It is not surprising that hearing loss, an invisible disability, can be devastating not only for the individual suffering from it but for their families, communities and society at large.
Click to Read Full Guest Editorial in PDF
Guest Editorial
Global Burden of Obesity and its Association with Cancer Among Young Adults in Pakistan
Author: Saira Afzal, Amber Arshad
DOI: https://doi.org/10.51273/esc21.25172-ge2
Obesity is considered a growing problem in this modern era due to acceptance of the modernization of lifestyle that led to increased consumption of a diet rich in fatty acids and carbohydrates, sedentary lifestyle, and decreased life expectancy. According to the Center for Disease Control and Prevention, a person is obese if the BMI ³30, and extreme obesity is labeled if the BMI ³40. An overweight person has a BMI ³ of 25.
Click to Read Full Guest Editorial in PDF
Original Article
Association of Various Subtypes of Renal Cell Carcinoma with Smoking, Grading and Staging
Author: Saniah Bashir, Afifa Rizwan Virk, Syed Mujtaba Haider, M. Fayzan Mehmood, Rahat Sarfraz, Samina Qamar
DOI: https://doi.org/10.51273/esc21.251721
Abstract
Objective: To determine the association of various subtypes of Renal Cell Carcinoma with smoking, grading and staging.
Methods: Adescriptive cross-sectional study was conducted in the Pathology and Oncology departments of King Edward medical University, Lahore from April 2019 to June 2020. Atotal of 226 cases were included in the study using purposive consecutive sampling. Association of tumor subtype with smoking, grade and stage of tumor was studied with the help of cross tabulation of these variables in SPSS 22.
Results: Out of the 226 cases, 57(25.2%) presented with high grade and 169(74.8%) with low grade RCC. Out of these, there were 98(43%) male smokers and 22(9.7%) female smokers.When subtype was cross-tabulated against smoking (p=0.013) there were 74(32.7%) cases of clear cell carcinoma (including its subtypes sarcomatoid and rhabdosarcomatoid), 43(19.02%) cases of papillary RCC
and 3(1.32%) cases of chromophobe RCC. When subtype was cross-tabulated against stage (p=0.018), 62 (27.43%) cases of clear cell, 25(27.7%) cases of papillary and 3 (3.3%) cases of chromophobe variant presented at the T4 stage.
Conclusion: Chromophobe carcinoma of kidney is associated with smoking, higher grade and higher stage. We found no significant association of any other specific subtype with gender, smoking and grade of RCC.
Key Words: Renal cell carcinoma, grade, smoking, subtype stage.
How to cite: Bashir S., Virk R. A., Haider M.S., Mehmood F.M., Sarfraz R. Association of various subtypes of Renal Cell Carcinoma with smoking, grading and staging. Esculapio 2021;17(02):116-120.
Click to Read Full Article in PDF
Original Article
Patterns of Abnormalities and Yield of Electroencephalograms in Young Adults in a Tertiary Care Medical center in Saudi Arabia
Author: Nasser BenOmran, Abdullah Alubied, Afrah Al Sehali, Abdullah Al Bishi, Hazza Al Otaibi, Emad Masuadi, Ali AlAnazi, Ismail A. Khatri
DOI: https://doi.org/10.51273/esc21.251722
Abstract
Objectives: To determine the yield of electroencephalograms (EEG) in various clinical scenarios, including epilepsy, in young adults.
Methods: EEGs performed on adults of both genders aged between 18 and 50 years between January 2009 and December 2013 at King Abdulaziz Medical City, Riyadh were included. Clinical indication and EEG findings were determined and correlated.
Results: Of 2,631 EEGs, 1,351 (51.3%) were for females. The mean age was 29.9 ± 9.4 years. Atotal of 1,928 (73%) EEGs were outpatient. Indications included seizure/epilepsy, status epilepticus, altered level of consciousness, brain death, other indications, and unclear indications. Electroencephalograms were normal in 56.2% of the cases for seizure/epilepsy, 69.3% for altered consciousness, and 65.4% for other indications. When the indication was not clear, 50.6% of EEGs were normal. Epileptiform abnormalities were found in
22.3% of the EEGs for seizure/epilepsy (p < 0.001). Slowing with or without epileptiform abnormalities was found in 23.1% of the EEGs for altered consciousness. Electroencephalograms for brain death confirmed diagnosis in 46.7% of the cases (p < 0.001). The highest frequency of abnormalities was seen in EEGs performed in the intensive care unit (91.2%), followed by wards (66.3%) and the emergency room (49.4%). Outpatient EEGs were abnormalonlyin36.8%ofthe cases.Overall,43%ofEEGsshowedsome abnormality.
Conclusion: Electroencephalograms had a higher yield of abnormalities when appropriate clinical questions were asked. The greatest number of confirmatory EEGs was observed in brain death evaluations. Almost half of the EEGs for patients with suspected epilepsy were normal, with only 1 in 5 confirming it. Approximately 2 in 5 EEGs showed some abnormality regardless of the indication.
Key words: Electroencephalogram, abnormal patterns, yield, epileptiform discharges, young adults, SaudiArabia
How to cite: BenOmran N., Alubied A., AlSehali A., AlBishi A., AlOtaibi H., Masuadi E., AlAnazi A., Khatri A.I. Patterns of abnormalities and yield of electroencephalograms in young adults in a tertiary care medical center in SaudiArabia. Esculapio 2021;17(02):121-126.
Click to Read Full Article in PDF
Original Article
Assessment of Geriatric Depression through GDS-SF Scale in Residents of Old Age Homes of Lahore, Pakistan
Author: Iram Manzoor, Tanzeela Zafar, Noor ul Ain Liaqat, Rameen, Sajjad Anwar
DOI: https://doi.org/10.51273/esc21.251723
Abstract
Objective: The objective of this research was to find out the prevalence of depression and associated factors among geriatric population living in elderly homes in Lahore Pakistan.
Methods: An analytical cross-sectional study was carried out from 1st March – 30th August 2019 among residents of five different old age care homes in Lahore. Asample of 133 inhabitants, both males and females were included using non-probability, purposive sampling technique. After getting IRB approval and informed consent from the participants, data was collected via pre-designed questionnaire using Geriatric Depression Scale through interview technique. Data was analyzed via SPSS version 22 and was presented in form of frequency tables. Chi-square test was applied and p-value was fixed at ≤ 0.05 to declare results
significant.
Results: The mean age of inhabitants was 70.36 years ± 8.61. Majority of them, 70 (52.6%), were males and 48 (33.83%) were widowed. Of the studied, 47 (35.3%) inhabitants were diabetic and 40 (30.0%) were hypertensive. Based upon GDS-SF scoring almost 1/3rd i.e 50 (37.6%) participants were categorized to had mild depression while 19 (14.7%) and 18 (13.5 %) had moderate depression and severe depression respectively. Significant difference was observed in memory loss among female participants (p= 0.001).
Conclusion: Depression was common among residents of old age care homes, where 65.71% of the male residents and 65.07% of the females were depressed. The major themes related to cause of depression were dissatisfaction with life, staying indoor and memory problems.
Keywords: Depression, Geriatric population, Elderly homes
How to cite: Manzoor I., Zafar T., Liaqat A.ul N., Rameen., Anwar S. Assessment of geriatric depression through GDSSF scale in residents of old age homes of Lahore, Pakistan. Esculapio 2021;17(02):127-131.
Click to Read Full Article in PDF
Original Article
Effectiveness of Intrauterine Balloon Tamponade in the Control of PPH due to Uterine Atony
Author: Madiha Afzal, Uzma Aziz, Hadia Shabbir
DOI: https://doi.org/10.51273/esc21.251724
Abstract
Objectives: To evaluate the effectiveness of uterine balloon tamponade using a condom catheter in the management of primary postpartum haemorrhage due to uterine atony.
Methods: This prospective study was done in the department of obstetrics and gynae unit II at Arif memorial teaching hospital, Rashid Latif Medical College from 1st March 2020 till 28th February 2021. Fifty patients either booked or unbooked, between age 20 to >35 years, either primipara, multipara or grand multipara, at 34-36+6 weeks or 37-39+6 week of gestation, suffering from primary postpartum haemorrhage due to uterine atony following vaginal delivery or Caesarean section, refractory to medical management were included. The main outcome measure was to check for the effectiveness of balloon tamponade to arrest bleeding within first 20 minutes of its insertion. The data was analyzed using SPSS version 20.
Results: The mean age of study participants was 28.3±2.79 years. The mean gestational age of patients was 37.79±1.49 weeks. 30(60%) patients out of 50 were multipara. 34(68%) patients were unbooked. 35(70%) Patients having Primary PPH delivered vaginally while 15(30%) patients delivered by caesarean section. 30(60%) patients delivered vaginally and 13(26%) patients having caesarean section responded to balloon tamponade within 20 minutes of its insertion making it effective in total 43(86%) patients. While in 5(10%) patients of SVD and 2(4%) patients of LSCS, Tamponade failed to control bleeding in first 20 minutes of its placement in uterine cavity and labelled as ineffective in total 7(14%) of the patients.
Conclusion: Intrauterine balloon tamponade is an effective means of controlling primary PPH as it is easily available, easier to practice and inexpensive treatment modality to treat PPH due to atonic uterus.
Key Words: Primary postpartum haemorrhage (PPH), Balloon tamponade, Condom catheter, Effectiveness.
How to cite: Afzal M., Aziz U., Shabbir H. Effectiveness of intrauterine balloon tamponade in the control of PPH due to uterine atony. Esculapio 2021;17(02):132-136.
Click to Read Full Article in PDF
Original Article
Prevalence of Smoking Among Prison Population in Punjab, Pakistan: A cross Sectional Study
Author: Muhammad Rehan Mian, Khalid Mahmood, Bushra Faiz, Uzma Intisar, Aslam Pervaiz
DOI: https://doi.org/10.51273/esc21.251725
Abstract
Objective: The study was conducted to assess the prevalence of active and passive smoking among prisoners
confined in Punjab Prisons.
Methods: A cross-sectional study was conducted during 15th January to 15th March, 2017. A total of 301 male adult prisoners were enrolled through proportionate random sampling from 29 prisons of Punjab. Trained medical staff administered a structured pre-tested questionnaire to collect data on tobacco consumption, exposure to secondhand smoke and demographic variables. Data was analyzed by Epi Info software and chi-square test at 95% level of confidence applied.
Results: Mean age of participants was 40 years (range; 16 – 90 years). Prevalence of smoking among prisoners was 43% (95% confidence interval [CI]: 37.2 – 48.7). Out of nonsmokers, 84% (95% CI: 77.34 –88.90) prisoners were exposed to secondhand smoke. High education was protective against smoking (27% versus 45% with below college degree; OR: 0.45; (95% CI: 0.2 – 0.96). Higher prevalence trend was observed with increasing age (39% up to 25 years, 42% among 26 to 45 years and 47%, > 45 years). Prevalence was high among single as compared to married (46% versus 41%) males.
Conclusion: Prevalence of smoking and exposure to secondhand smoke among prisoners was high which indicates an epidemic like situation. Being single, illiteracy and age were the associated factors with high prevalence of active smoking. There is an urgent need for health promotion and anti-tobacco education campaign in prisons.
Keywords: Smoking, Prevalence, Prison population, Punjab, Pakistan
How to cite: Mian R.M., Mahmood K., Faiz B., Intisar U. Pervaiz A. Prevalence of smoking among prison population in Punjab, Pakistan: Across-sectional Study. Esculapio 2021;17(02):137-142.
Click to Read Full Article in PDF
Original Article
Knowledge of Male Partners of Pregnant Females Presenting in Services Hospital Lahore Regarding Contraception
Author: Muhammad Usman, Madeeha Rashid, Asifa Noreen, Hira Naeem, Maria Khalid, Rubina Sohail
DOI: https://doi.org/10.51273/esc21.251726
Abstract
Objectives: To determine knowledge of male partners of pregnant ladies regarding contraceptive methods coming to services hospital Lahore.
Methods: A cross sectional study was carried out in Obstetrics & Gynecology department of Services Hospital, Lahore over a period of six months from 05-05-2018 to 04-11-2018.We interviewed 400 men accompanying their wives in Services Hospital, Lahore to determine their knowledge regarding contraceptive methods and use.
Results: Age of study participants ranged between 20-30 years of age with mean age of 25.4±6.1.There were 145 participants who don’t have any children (36.3%) and 199 (49.7%) were having 1-2 children and 56 (14%) were having 3 or more children.189 (47.3%) participants had education of matric or above,152 (38%) were primary and 59 (14.7%) were uneducated. Majority of the patients were earning Rs.10,000-50,000 monthly. Mean number of children were 1.2±.1.1. Adequate knowledge of contraception was reported 113 (28.2%). Stratification with regard to age, parity, education status, socioeconomic status was also carried out.
Conclusion: In conclusion, limited adequate knowledge of male partners about method of contraception was found. Services of family planning in Pakistan can be strengthened significantly by continuous efforts to focusing on knowledge, fears, and misconceptions of men about contraception. Moreover, as this study found, Knowledge of the male partner regarding contraception can be significantly increased by increasing education and socioeconomic status. Involvement of Media and Religious bodies in promoting contraception can also increase knowledge of contraception. Increasing knowledge about contraception can lead to increased contraceptive prevalence rate.
Key Words: Male partner, adequate knowledge of contraception, contraceptive methods
How to cite: Usman M., Rashid M., Noreen A., Naeem H., Khalid M., Sohail R. Knowledge of male partners of pregnant females presenting in Services Hospital Lahore regarding contraception. Esculapio 2021;17(02):143-146.
Click to Read Full Article in PDF
Original Article
Effect of Moringa Oleifera Leaves Extract on Bisphenol-A Induced Changes in Venous Drainage of the Liver of Albino Rats
Author: Attya Zaheer, Anum Basit, Rukhsana Jabeen, Afifa Waseem, Zafar Iqbal, Rifat Shamim
DOI: https://doi.org/10.51273/esc21.251727
Abstract
Objectives: To observe the effects of Ethanolic extract of Moringa Oleifera leaves on Bisphenol –A (BPA) induced changes in diameter of central vein and venous drainage (central vein, portal and sinusoidal) in liver of albinorats.
Methods: This was an experimental study conducted at the animal house of Anatomy Department, PGMI, Lahore. Thirty two albino rats of both sex, weighing 170-200 gms were divided equally into 4 groups as A (control), B, C and D (other groups were experimental). Group A, received corn oil only. Group B, received BPA only 50mg/kg/body weight (wt)., Group C and D received BPA 50mg/kg along with Moringa Oleifera leaves extract (MoLE) 250mg kg/body wt and 500mg kg/body wt respectively. BPAand MoLE was given in single dose through oral route. At the end of seven weeks, rats were dissected, liver was removed and slides were made by using H&E stain. The effect of MoLE on BPA induced venous changes was observed under light microscope. The statistical analysis of results was done by using SPSS 21.
Results: BPA increased the diameter of central vein and produced vascular congestion in group B, which was then reduced by administration of MoLE in group C and D. The healing effect of MoLE was augumented as dose was increased.
Conclusions: Moringa Oleifera leaves prevented the vascular congestion and dilatation induced by BPA in liver of rats . The preventive effect improved as dose was increased.
Key Words: BPA: Bisphenol-A; MoLE: Moringa Oleifera leaves extract.
How to cite: Zaheer A., Basit A., Jabeen R., Wasim A., Iqbal Z., Shamim R. Effect of Moringa Oleifera Leaves Extract on Bisphenol-Ainduced changes in Venous drainage of the Liver of Albino Rats. Esculapio 2021;17(02):147-151.
Click to Read Full Article in PDF
Original Article
Clinical Spectrum and Risk Factors of Penile Fracture in a Tertiary Care Hospital, Pakistan
Author:Ghulam Ghous, Safia Bano, Shahjehan, Athar Mahmood, Azfar Ali, Irfan Sharif, Muhammad Shahzad Anwar
DOI: https://doi.org/10.51273/esc21.251728
Abstract
Objectives: To determine the clinical spectrum, operative findings, and determination of potential risk
factors responsible for penile fracture.
Methods: A prospective, cross-sectional, observational study was done in the Department of Urology, Services Hospital Lahore. Study duration was two and half years from January 2018 to June 2020. A total of 18 patients were enrolled in study. Informed written consent was obtained from patients. Detail history, demographic data, presentation, risk factors and operative findings were recorded. No invasive investigations were done as the diagnosis was made clinically. Surgical repair was done in all patients.
Results: Patients age was 25-56 years (mean 33.78.6). All patients were married 18(100%). Majority of patients (61.1%) belonged to rural versus 7(38.9%) urban area. Mean time to present in urology was 7 hours +5.5(range 2-24). Few 3(16.7%) went to general practitioner before urologist. 50% (9) reported heard a snap. Unilateral versus bilateral corporal injury was observed in 10 (55.6%) and 8(44.4%) respectively. Midcorporal injury was observed in 6(33.3%), shaft in 4 (22.2%) and root of penis in 3 (16.7%). Urethral injury was reported in 4 (22.2%). Half of patients had eggplant deformity. Rolling sign was positive in 10(55.6%) followed by detumescence post-coitus (72.2%) of patients. Missionary style sex was common 12(66.6%) and one (5.6%) did not disclose information. 2(11.1%). penile fractures were due to masturbation and 3(16.7%) forceful blows to erect penis. Early presentation was in 14 (77.8%) varuses late in 3 (16.7%). 4 (22.2%) had delay due to behaviour. 10(55.6%) patients lived near to Hospital while 8(44.4%) lived far away. No use of medication for erectile dysfunction was reported. Mostly patients were middle -income class 6(33.3), low
10(55.6%) and 2(11.1%) higher income. 13 patients (72.2%) presented during summer as compared to 1(5.6%) in winter.
Conclusion: Missionary position was the most precarious position observed. The unilateral and mid corporal injury was the most common operative finding.
Keywords: Penile fracture, corporal injury, urethral injury, eggplant plant deformity, detumescence, rolling sign
How to cite: Ghous G., Bano S., Shahjehan., Mahmood A., Ali A., Sharif I., Anwar S.M. Clinical Spectrum and Risk Factors of Penile Fracture in a Tertiary Care Hospital, Pakistan. Esculapio 2021;17(02):152-156.
Click to Read Full Article in PDF
Original Article
Diagnostic Accuracy of Cardiotocography in Determining Good and Poor Apgar Score After Fetus Delivery
Author: Saba Irshad, Sadia Ghafar, Muhammad Kalim Akhter, Tayyeba Komal, Sami Ullah Mumtaz, Muhammad Furqan Saeed
DOI: https://doi.org/10.51273/esc21.251729
Abstract
Objective: To determine the diagnostic accuracy of Cardiotocography in determination of good and poor Apgar score after delivery of fetus at term.
Methods: This was a cross sectional study done at Obstetrics & Gynecology department, Lady Atchison hospital, Lahore for 6 months, after ethical approval of study. 448 cases were included through nonprobability consecutive sampling method. Initial CTG monitoring was done and normal and abnormal CTG was labeled. After delivery of baby, assessment for Apgar score was done. The good and poor Apgar score was labeled and the findings were co-related with the CTG findings. A proforma was specifically designed to record findings of this study. Data was analyzed by using SPSS 16. The sensitivity, specificity, Positive & Negative Predictive Values and diagnostic accuracy of abnormal CTG were calculated by taking Apgar score at birth as gold standard.
Results: The mean age of the patients was 30.42±5.73 years. The mean gestational age was 38.20±1.10 weeks. The mean Apgar score after 5 minutes of birth was 6.67±1.67. There were 183 (40.8%) females who had abnormal CTG while 265 (59.2%) females had normal CTG. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of CTG at birth were 65.9%, 51.4%, 67.9%, 49.2% and 60.3% respectively.
Conclusion: CTG is a good screening tool to assess mother & fetus wellbeing but it is not a diagnostic tool for fetal surveillance in females undergoing delivery at term.
Key words: Cardiotocography, Apgar score, Birth, Gestational Age, Diagnostic Accuracy, Third Trimester.
How to cite: Irshad S., Akhter K.M., Komal T., Saeed F.M., Mumtaz U.S., Waheed I., Kausar S., Hamid H.M. Diagnostic Accuracy of Cardiotocography in Determination of Good and Poor Apgar Score After Delivery of Fetus at Term. Esculapio 2021;17(02):157-160
Click to Read Full Article in PDF
Original Article
Mean Platelet Volume, Immature Platelet Fraction and Beta Thromboglobulin in Acute Coronary Syndrome Patient
Author: Sadia Ijaz, Muhammad Muzammil Bajwa, Hafiz Ather, Faiza Wattoo, Tabinda Roheen, Khadija Saleem
DOI: https://doi.org/10.51273/esc21.2517210
Abstract
Objectives: Conventionally troponin and iso-enzymes of creatinine kinase are used for risk stratification and diagnosis of cardiac diseases. Our objective is to compare the levels of mean platelet volume (MPV), immature platelet fraction (IPF) and beta thromboglobulin level (BTL) in healthy individuals and patients of acute coronary syndrome to discover parameters which can be used to design strategies of risk stratification, early diagnosis, timely management and prophylaxis.
Methods: The 170 study participants were divided into two groups, Cases (85) and Controls (85). The required parameters MPV and IPF were evaluated using sysmex XN 1000 where as BTL were assessed using ELISA technique. Mean ± Standard Deviation and Median ± Inter Quartile Range was used for quantitative data. Independent sample t-test was applied to compare mean of normally distributed data. Mann Whitney U test was applied to compare median of non-normal data. P-value ≤0.05 was considered significant.
Results: Mean IPF in cases and control was 8.716±6.2834 (%) and 3.83±1.63% respectively with statistically significant high levels in cases. MPV (fL) in cases was 11.65±1.53 and in controls was 10.74 ± 1.04, with statistically significant higher value in cases. Mean BTL (ng/ml) in cases was also statistically higher i.e. 28.35±17.83 versus 14.28±5.80.
Conclusion: The study concluded that levels of MPV, IPF and BTLwere normal among controls while raised levels of IPF and BTLwere observed among cases.
Key Words: Mean platelet volume, immature platelet fraction, Beta thromboglobulin, Acute coronary syndrome.
How to cite: Ijaz S., Bajwa M.M., Ather H., Wattoo F., Roheen T., Saleem K. Mean Platelet Volume, Immature Platelet Fraction and Beta Thromboglobulin in Acute Coronary Syndrome Patients. Esculapio 2021;17(02):161-165.
Click to Read Full Article in PDF
Original Article
Induction of Labour with Isosorbide Mononitrate Versus Prostaglandin E2 (PGE2) in Primigravidas (PGs) at Term
Author: Rubina Waheed, Nadia Ashraf, Nadia Sabeen, M Ikram U Allah, Qaiser Javed, Ayesha khalid
DOI: https://doi.org/10.51273/esc21.2517211
Abstract
Objective: To compare the frequency of caesarean section due to fetal distress with Isosorbide mononitrate versus PGE2 for the induction of labour in primigravida at term.
Methods: It was Randomized Control Trial conducted in Unit I, Department of Obstetrics & Gynaecology, Lahore General Hospital, Lahore from 11th April 2015 to 10th October 2015. 230 primigravida were randomized into two groups i.e. Prostaglandin E2 and Isosorbide mononitrate for induction of labour. The difference in the frequency of caesarean section due to fetal distress with Prostaglandin E2 and Isosorbide mononitrate for induction of labour in the primigravidas at term was calculated as outcome.
Results: The mean age of 27.62 ± 3.909 ranging from 21 to 34 years. The frequency of cesarean section was 12.2%in Prostaglandin E2 group while 0% in Isosorbide mononitrate. There was no effect of gestational age, age of mother and number of doses on outcome.
Conclusion: There is no difference in frequency of cesarean section in primigravida groups induced by either Isosorbide mononitrate versus prostaglandin E2. Wherever applicable and feasible we should opt for Isosorbide mononitrate for induction of labour.
Keywords: Cesarean section, Prostaglandin E2, Isosorbide mononitrate, Dinoprostone, Induction of labour, Primigravida
How to cite: Waheed R., Ashraf N., Sabeen N., U Allah I.M., Javed Q., Khalid A. Induction of Labour with Isosorbide
Mononitrate Versus Prostaglandin E2 (PGE2) in Primigravidas (PGs) at term. Esculapio 2021;17(02):166-169
Click to Read Full Article in PDF
Original Article
Effect of Acute Aerobic Exercise on Diastolic blood Pressure in Preclinical Medical Students of Services Institute of Medical Sciences, Lahore
Author: Muhammad Shafiq, Miraa Qutab, Saqib Javaid, Rida Fatima, Maham Ijaz, Abdullah Shafiq
DOI: https://doi.org/10.51273/esc21.2517212
Abstract
Objectives: To evaluate the response of acute bout of moderate exercise on DBP in preclinical medical students of Services Institute of Medical Sciences (SIMS), Lahore and to compare it with gender, family history, lifestyle and waist-hip-ratio of the study participants.
Methods: This cross-sectional study was performed in the Department of Physiology, SIMS from May to December 2019. Ninety-three (93) healthy male and female MBBS students were recruited through nonprobability convenient sampling. Socio-demographic components were gathered using a ques-tionnaire. Anthropometric data (height, weight and waist-hip-ratio) and resting DBP was recorded before the exercise. All participants underwent exercise challenge on a treadmill. Post-exercise DBP was measured by taking serial recordings at zero minutes, 2 minutes and 5 minutes after exercise cessation. Data was analyzed using SPSSv20.
Results: Within the 93 participants, 87(93.5%) were physically inactive, with only 6(6.5%) were physically active. In comparison with the baseline DBP, the DBP at zero and 2 minutes post exercise was statistically significant (p<0.001) in study participants. There was no significant correlation between DBP immediately after exercise and gender (p = 0.751); family history of hypertension and diabetes mellitus (p = 0.603); and lifestyle (p = 0.954). A non-significant (p = 0.636) yet positive correlation was observed between post exercise DBPand waist-hip-ratio among males.
Conclusion: Our study revealed that an acute bout of exercise significantly raised the DBPimmediately after exercise. This rise in BP was not significantly related to gender, lifestyle and family history of diabetes mellitus and hypertension.
Keywords: Diastolic blood pressure, aerobic exercise, waist-hip-ratio, medical students, treadmill
How to cite: Shafiq M., Qutab M., Javaid S., Fatima R., Ijaz M., Shafiq A. Effect of acute aerobic exercise on diastolic blood pressure in preclinical medical students of Services Institute of Medical Sciences, Lahore. Esculapio 2021;17(02):170-174.
Click to Read Full Article in PDF
Original Article
Comparison of Alvarado Score and Paediatric Appendicitis Score for Diagnosing Appendicitis in Children
Author: Naeem Liaqat, Asif Iqbal, Wajeeh Ur Reham, Zulfiqar Ahmed, Fozia Bashir, Sajid Hameed Dar
DOI: https://doi.org/10.51273/esc21.2517213
Abstract
Objective: To compare diagnostic accuracy of Alvarado score (AS) and Paediatric Appendicitis Score (PAS)
for diagnosis of acute appendicitis in children.
Methods: This study was conducted at the department of Pediatric Surgery Children Hospital Lahore, over a period of 1 year. All the patients undergoing appendicectomy were included. Alvarado score and Pediatric Appendicitis score (PAS) was evaluated, compared and appendix specimen sent for histopa-thology. All findings were recorded in proforma. The collected data was analyzed by SPSS version 24. The mean Alvarado score and PAS was calculated, and stratified according to the histopathology reports. The sensitivity and specificity of both Alvarado score and PAS for three strata including score 3-5, 5-7 and 8-10 were also calculated.
Results: A total of 177 patients were included in the study. The mean age of the patients was 9.16 ± 2.386 years. Among these 118 patients (67%) were male. The mean duration of pain was 21.42 ± 19.05 hours. Biopsy report showed that 18 patients (10.1%) had normal appendix with no signs of inflammations while 159 patients (89.9%) had inflammation on histopathology. We stratified the histopathology reports according to Alvarado score ≤7 and >7 and P-value was found significant. Similarly PAS ≤7 and >7 was stratified and P-value was not significant. The difference in mean Alvarado score between having acute appendicitis and those with normal histopathology was significant (P= 0.000) while this difference in mean PAS was not found significant (P= 0.325).
Conclusions: None of the scoring system has adequate diagnostic accuracy and clinical judgment is
preferred.
Key Words: Alvarado Score; PAS; Appendicitis; Children
How to cite: Liaqat N., Iqbal A., Rehman ur W., Ahmed Z., Bashir F., Dar H.S. Comparison of Alvarado score and
Paediatric Appendicitis Score for diagnosing appendicitis in children” Esculapio 2021;17(02):175-178.
Click to Read Full Article in PDF
Original Article
Knowledge, Attitude and Practices Regarding COVID-19 among Postgraduate Trainees and House Officers
Author: Shandana Tarique, Shahid Sarwar
DOI: https://doi.org/10.51273/esc21.2517214
Abstract
Objectives: To assess the knowledge, attitude and practice among house officers and post graduate trainees towards COVID-19 in tertiary care hospitals.
Methods: An online questionnaire was used as research tool to collect data from 115 house officers and post graduate trainees working in tertiary care hospitals. Questionnaire was divided into three sections. Knowledge was assessed on basis of choosing the best option, attitude was evaluated with agree/disagree and practices were considered on yes/no format. Data was analyzed with SPSS 24®(Armonk NY:IBM corp).
Results: 115 doctors responded to online survey. Mean age was 26.92±2.92, 62(53.9%) were female and 53(46.1%) were male. Regarding the status of participants, 46(40%) were house officers and 69(60%) were post graduate residents. Considering the domain of knowledge, maximum score was 12 and minimum was4. Mean score was 8.75. It was observed that 82(71.3%) participants agreed that COVID-19 will be successfully controlled, while 114 (99.1%) of participants counselled patients and their attendants about preventive measures. Regarding practice domain, 110(95.7%) participants replied in affirmative that they wore mask when leaving home while 19(16.5%) had undergone training for nasopharyngeal sample collection. Only 45(39.1%) had undergone training for doffing and donning. Pearson correlation was applied between the three domains and status of doctors. It was observed that
postgraduate residents were significantly better in Covid-19 related knowledge (p<.05). Among the three domains, no significant relationship was observed.
Conclusion: Doctors have positive attitude though factors have been identified in knowledge and practice that need improvement.
Keywords: COVID-19, knowledge, attitude, practice
How to cite: Tarique S., Sarwar S., Knowledge, Attitude and Practices regarding COVID-19 among Postgraduate Trainees and House Officers. Esculapio 2021;17(02):179-182.
Click to Read Full Article in PDF
Original Article
Patient Denialism for COVID19 Pose Difficulty for Treating Physicians
Author: Rizwan Pervaiz, Muhammad Asim Rana, Mohammad Ahad Qayyum, Ali Munawar, Sana Tariq, Abdullah Ali Lashari
DOI: https://doi.org/10.51273/esc21.2517215
Abstract
Objective: As patients refusal has been a major issue in diagnosing the disease, we carried out this study to determine the magnitude of the refusal or denial of suspected COVID 19 cases.
Methods: All patients seen with COVID 19 symptoms in medical out doors and emergency in Bahria International Hospital, Lahore in two weeks period from April 15, 2020 to April 30, 2020 were included in study. COVID 19 symptoms were ascertained on WHO guidelines labelling patients as COVID 19 suspected through laboratory tests. Depending upon results individual consultation with each patient was arranged to convince them to carry out nasopharyngeal swab for SARS Co-V-2 PCR. Some patients refused despite counselling for follow up regarding symptoms and advised tests. The public fear was the main barrier for the suspected cases to get tested. Each patient who refused PCR test was labelled as in denial.
Results: Of the 40 cases diagnosed as suspected COVID 19. 21 refused to get tested. Majority (15) were male. Fever with chills was common among all with majority presented with shortness of breath (43%) followed by diarrhea (33%) and chest pain (9%).
Conclusion: Patients who remain in denial pose a great threat to society as by spreading the virus or deteriorating themselves. An effective campaign on government level should be run to overcome the fear which has made this infection a social stigma to help contain this pandemic in a resource scarce country like Pakistan.
Keywords: Coronavirus denial, COVID-19 denial, COVID in Pakistan, Public reaction to COVID 19
How to cite: Pervaiz R., Rana A.M., Qayyum A.M., Munawar A., Tariq S., Lashari A.A. Patient denialism for COVID19 pose difficulty for treating Physicians. Esculapio 2021;17(02):183-186.
Click to Read Full Article in PDF
Original Article
Comparison of 21 Days Versus 10 Days Bladder Catheterization after Hypospadias Repair
Author: Muhammad Abdullah, Muhammad Saleem, Ghulam Mujtaba Zafar, Farrukh Mehmood Sattar, Imran Hashim, Arslan Raza Wasti
DOI: https://doi.org/10.51273/esc21.2517216
Abstract
Objectives: To compare 21 days versus 10 days bladder catheterization after hypospadias repair.
Methods: After approval from ethical committee, Randomised controlled trial performed, in which 196 male patients were enrolled in the study that was conducted at department of pediatric surgery, Children hospital, Lahore. All patients underwent Snodgrass procedure. Group-1 patients were considered for 10 days bladder catheterization for hypospadias repair and group-2 patients were catheterized for 21 days. Complications were documented on follow-up visits in group 1 at 1 week (17 days), 3 weeks (34 days), and 6
weeks (51 days) after catheter removal. In group 2 at 1 week (day 28th), 3 weeks (day 42nd), 6 weeks (day 63rd) after catheter removal.
Results: The mean age in group-1 and group-2 was 7.25 ± 3.22 years and 6.29±3.02 years. There were significantly less cases of urethrocutaneous fistula in group 2 when compared to group 1. Urethro-cutaneous fistulas (UCF) developed in 13(13.26%) ,11(11.22%) and 10 (10.2%) cases at 1, 3, and 6 weeks post catheter removal follow up in group 1. While in group 2 UCF developed in 4 (4.08%), 3(3.1%) and 2(2.04%) at 1, 3, and 6 weeks follow up. There were 5(5.2%) and 4(4.1%) cases of post-operative wound infection in groups 1 and 2 respectively (p-value = 0.500). Wound dehiscence was seen in 1 (1.02%) case in group 1 and was not
seen in group 2(p value =0.500). glans dehiscence was not seen in group 1 while 1 (1.02%) case seen in group 2 (p value 0.500).
Conclusion: We conclude that 21 days catheterization after hypospadias repair gives better outcome and fewer complications when compared to 10 days catheterization.
Keywords: Bladder catheterization; Hypospadias repair; Fistula formation.
How to cite: Abdullah M., Saleem M., Zafar M.G., Sattar M.F., Hasnain I, Wasti R.A. Comparison of 21 Days Versus 10 Days Bladder Catheterization for Hypospadias Repair. Esculapio 2021;17(02):187-190.
Click to Read Full Article in PDF
Original Article
Comparison Between Paracetamol Vs Voltral Suppositories For Post Operative Pain In Gynaecological Procedure
Author: Zeeshan Khan, Saadia Khaleeq, Abaid ur Rehman, Aasam Maan, Umer Farooq, Amjad Nadeem
DOI: https://doi.org/10.51273/esc21.2517217
Abstract
Objective: To compare intravenous paracetamol vs Voltral (Diclofenac) suppositories for post operative pain in gynaecological procedures.
Methods: This was a non randomized controlled trial that was carried out at Department of Anaesthesiology, Sheikh Zayed Hospital, Rahim Yar Khan during 01-07-2019 to 31-12-2019 in which all female cases with age range of 20 to 60 year undergoing any gynaecological surgery requiring general anaesthesia were included. The cases were divided into two equal groups and anesthesia was offered in standard doses. Just before reversal the cases in group Awere given intravenous paracetamol in a dose of 1 gm stat and then at 8-hour interval and those in group B were offered diclofenac suppositories in a dose of 50 mg twice a day, 12 hours apart. The pain was assessed at 4,8,12 and 24 hours and was labelled on visual analogue scale (VAS).
Results: In this study there were 62 cases (31 in each group). The mean age in group A and B was 45.41±10.21 vs 48.12±11.13 years with p= 0.47. Mean duration of surgery in both groups was 57.51±15.23 vs53.11±14.79 minutes with p= 0.81. There was no significant difference in mean pain score at 4 and 8 hours with p= 0.91 and 0.81 respectively in group A and B. Mean pain score was 4.43±1.67 vs 3.21±1.09 with p= 0.01 at 12 and 4.57±1.71 vs 3.34±1.27 at 24 hours in group A and B with p values of 0.01 each. Mean time taken for rescue analgesia was 9.13±2.11 in group Aand 13.11±1.23 hours in group B with p= 0.001.
Conclusion: Voltral (Diclofenac sodium) suppositories are better than paracetamol infusion in controlling pain after gynecological surgeries and this difference is significantly better at 12 and 24 hours.
Key words: Gynaecological surgery, Pain, Paracetamol, Voltral suppository
How to cite: Khan Z., Khaleeq S., Rehman Ur A., Maan A., Farooq U. Nadeem A. Comparison Between Paracetamol Vs Voltral Suppositories for Post-Operative Pain in Gynaecological Procedures. Esculapio 2021;17(02):191-194.
Click to Read Full Article in PDF
Original Article
Correlation of Depression, Anxiety and Stress with Quality of Life in COVID-19 Pandemic
Author: Aysha Rashid, Umair Mudassar, Ismail Tariq, Adil Zaheer, Mariam Iftikhar, Nauman Mazhar
DOI: https://doi.org/10.51273/esc21.2517218
Abstract
Objectives: Due to Covid-19 pandemic the psychological health of individuals is disturbed globally. There is a dire need of looking into details about the effects of mental health issues on quality of life (QOL).
Objectives: To determine correlation between depression, anxiety, stress, and quality of life among young adults in Covid-19 and evaluate the impact of demographics on quality of life.
Methods: It was a cross-sectional study carried out at a tertiary care hospital. Patients presenting in the psychiatry outdoor of age 18 to 60 years, of both genders and scoring ≥21 on Depression, Anxiety, and Stress Scale (DASS) were enrolled in the study and depression, anxiety and stress severity was assessed and Quality of Life Scale (QOLS) was applied on all to assess their quality of life. All findings were then subjected to statistical analysis.
Results: The mean age of the patients was 21.78±3.204, mean depression score on DASS was 8.58±4.510, mean anxiety score on DASS was 11.68±4.160 and the mean stress score on DASS was 14.84±3.192. There were 63.5% males and 36.5% females. Depression, anxiety and stress had a negative correlation with quality of life. Depression and stress were significantly correlated negatively with quality of life (p=0.000). No demographical factor was significantly associated with poor quality of life.
Conclusion: Depression, anxiety and stress were negatively correlated with poorer QOL and depression and stress had significant association with poor QOL.
Key words: Anxiety, Depression, Covid-19, Quality of life
How to cite: Rashid A., Mudassar U., Tariq I., Zaheer A., Iftikhar M., Mazhar N. Correlation of Depression, Anxiety and Stress with Quality of Life in COVID-19 Pandemic. Esculapio 2021;17(02):195-199.
Click to Read Full Article in PDF
Review Article
Role of Ultrasound Guided Percutaneous Nephrostomy in Obstructive Uropathy Patients: Asystematic Literature Revie
Author: Abeer Zafar, Muhammad Nawaz Anjum, Nabeel Shafi, Mehreen Fatima
DOI: https://doi.org/10.51273/esc21.2517219
Abstract
Objective: 1. To conduct a systemic review on USG guided PCN in obstructive uropathy and review its efficacy and complication rate. 2. To conduct a systemic review of USG guided PCN and establish qol in patients with obstructive uropathy. 3. To conduct a systemic review of USG guided PCN and examine its success rate.
Methods: The materials and methods comprised of an extensive internet based article hunting with keywords of “Ultrasound(USG) guided PCN”, “Obstructive uropathy”, “Deranged renal function tests” and “Quality of life”. The main medical websites/databases which were implored for this systemic review included PubMed, Cochrane review database, Research gate, Emedicine, EBSCO’s, medScape, Science Direct, Google, PMC articles and multitude of scientific publications in international journals from 1945 to March 2020. A total of 146 articles were selected, out of them, 9 articles fulfilled final scrutiny and were reviewed for this study. All studies involving blockade of ureters by any pathology, benign or otherwise, were included. USG was primary interventional tool in all studies.
Results: Nine articles fulfilled all the pre-requisites for systemic analysis. The total data consisted of 630 people, having a mean age of 56 years (Variance: 3 – 70). Percutaneous nephrostomy catheter was placed to relieve blockade in both benign and malignant conditions. In 506 patients, one side was operated, while in 104 both sides were successfully attempted. There was attempted failure in placement of nephrostomy in remaining 20 cases. Out of 630, post-operative renal function improvement was shown in 575 patients, 55 patients showed no improvement. Overall a very negligible percentage of complications were reported in all studies (1–3%). The average stay in health care establishments was 14 days varying from 7 to 21 days.
Conclusions: PCN is a safe and effective urinary diversion. It gives prompt relief to obstructive uropathy in critically ill patients. PCN is useful therapeutic procedure for benign and malignant ureteric obstruction while helping in preserving renal function, with a low complication rate. Ultrasound guided PCN is safe in Obstructive uropathy patients. Due to no need of general anesthesia, a very negligible failure rate < 2 % and very low complication rate of 1-3%, ultrasound guided nephrostomy tube placement is safe and highly
effective in emergency decompression of kidneys.
Keywords: “Percutaneous Catheter”, “Ultrasound guided Nephrostomy”, “ Ureteric Obstruction”, “Renal Function Improvement”, “Complications of Nephrostomy”.
How to cite: Zafar A., Anjum M.N., Shafi N., Fatima M. Role of Ultrasound Guided Percutaneous Nephrostomy in Obstructive Uropathy Patients: Asystematic literature review. Esculapio 2021;17(02):200-206.
Click to Read Full Article in PDF
Perspective
Sedation in COVID-19 Patients & Limited Resources: A Challenge for the Developing Countries
Author: Mohsin Masud, Lala Rukh Bangash
How to cite: Masud M., Bangash R.L. Sedation in covid-19 patients & limited resources: a challenge for the
developing countries. Esculapio 2021;17(02):207-208.
DOI: https://doi.org/10.51273/esc21.25172-ps
In the early days of December 2019 in China, cases of pneumonia of unknown etiology emerged. On December 31 , the disease was identified to be caused by NOVEL CORONA VIRUS. On February 11, 2020, WHO named this disease as coronavirus disease 2019, briefly called as covid-19. The disease spread across the borders of China. It was declared as pandemic by WHO on March 11, 2020. The disease severity ranges from mild to severe. Most mild cases report having fever, myalgias, fatigue and dry cough while the severe cases develop pneumonia requiring supplementary oxygenation or even ventilatory support.
Click to Read Full Perspective in PDF
Case Report
A Rare Occurrence of Jejunal Diverticula in a 52-Year-Old Male on Barium Meal & Follow Through: A Case Report
Author: Khurram Khaliq Bhinder, Shaista Riaz, Ameena, Afaf Arif, Zouina Sarfraz, Azza Sarfraz
DOI: https://doi.org/10.51273/esc21.25172-cr
The small bowel pathology, namely jejunal diverticula has a worldwide prevalence of 0.5-1%. Jejunal diverticula mainly occurs as a pulsion diverticula secondary to intestinal dyskinesia. In most cases, diverticula are asymptomatic, but when symptomatic patients present with chronic symptoms such as pain, nausea, obstruction and peritonitis. We report a rare case of jejunal diverticula in a 51-year-old-male with presentation of severe epigastric pain, nausea, vomiting, abdominal fullness and absolute constipation, who
was surgically managed with good post-operative prognosis.
Keywords: Jejunal Diverticula; Barium Meal; Barium Follow; Obstruction; LMIC; Pakistan
How to cite: Bhinder K.K, Riaz S., Ameena., Arif A., Sarfraz Z., Sarfraz A. A Rare Occurrence of Jejunal Diverticula in a 52-Year-Old Male on Barium Meal & Follow Through: A Case Report. Esculapio 2021;17(02):209-211.
Click to Read Case Report in PDF