Esculapio Journal of SIMS

Trends and Patterns of Cancer Incidence in Women - A Single Center Experience

Afia Sarwar, Atiya Begum, Rozina Jaffar, Zonaira Rathore, Fatimah, Sonia Zafar — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determining the common malignancies affecting our female population.
Materials & Methods: The Study design was descriptive and cross-sectional. Study was conducted over a period of one year (January 2022 to December 2022) Citilab and Research Center, Lahore. The study was approved by the ethical committee of the organization (Letter No. CRC/MISC/958) and was based upon malignancies diagnosed in female patient population during the year 2022. All specimen(s) from female patients above 16 years of age were included. All the patients being diagnosed with a malignant tumor for the first time were included in this study. Patients who have already been receiving some therapy for previously diagnosed malignancies were excluded. Histological diagnosis by a competent Histopathologist and verified by another consultant Histopathologist was taken as confirmatory diagnosis. The collected data was analyzed with SPSS version 25.
Results: During a period of twelve months, a total of 264 cases of malignant tumors from female patients were studied. Maximum number of cases (75) 28.4% belonged to the age group of 51 to 60 years followed by 41 to 50 years of age that constituted 23.8%. Most frequent tumor found in the study group was Breast carcinoma (112.) It constituted 42.4% of total cases, followed uterine carcinoma (28) that constituted 10.6 %. Cervical (15) and Ovarian (15) cancers contributed equally to cancer burden in this study population each constituting 5.7% of total.
Screening and early diagnosis can help precancerous lesions and reducing the burden of invasive malignancies.
Conclusion: Breast carcinoma is the most common malignancy diagnosed in our female population
followed by gynecological malignancies. Most of the patients belong to 51-60 years of age. Media campaigns
regarding the risk of malignancy, its early diagnosis and high possibility of treatment, importance of self-
examination and easy availability of screening programs can contribute to decreasing the incidence and
improving life expectancy in our female population.

Harmonizing Teaching Pedagogy: Advancing Best Practices in Forensic Medicine & Toxicology Education amidst Academic Challenges

Sun, 28 Apr 2024 00:00:00 -0500

Objectives: The study focuses to examine the challenges and tensions encountered in teaching Forensic Medicine & Toxicology while exploring strategies to enhance teaching practices in this specialized subject.
Materials and Methods: The article utilizes a diverse range of sources ensured a thorough exploration of teaching practices in Forensic Medicine & Toxicology extracted though renowned sources such as PubMed, Elsevier, SpringerLink, Wiley Online Library, and other reputable databases. Additionally, textbooks and reference materials in the fields of Forensic Medicine, Legal Medicine, and clinical forensic medicine were consulted to gather comprehensive insights into teaching practices within these disciplines.

Comparison of Outcome in Patients Undergoing Cesarean Section with Wound infiltration with Local Anesthetic Versus Narcotic Analgesia

Qura Tul Ain Nauman, Shamila Ijaz Munir, Uzma Batool — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To compare the outcome of wound infiltration plus local anesthetic agent versus narcotic analgesia in females undergoing cesarean section
Material & Methods: This was a comparative study and study place and period was Unit 3, Department of Obstetrics & Gynecology, Services hospital, Lahore from july 2016 to January 2017. Patients were segregated
into two groups. Group A was bupivacaine group. Group B was control group. During the immediate postpartum
period, a 100mg dose of intravenous tramadol was administered. Patients were transferred to the postoperative
wards and were monitored there for duration of 24 hours. During the next 24 hours patients were asked for pain >4 on VAS and tramadol was given. After 24 hours, pain score was measured.
Results: The average age of patients was 26.98±4.87 years, with the mean gestational age in group A being 39.52±1.14 weeks and in group B being 39.62±1.14 weeks. The mean tramadol consumption was 74.53±13.21mg.
A significant difference was observed between the study groups in terms of tramadol consumption, with a p- value of 0.000.
Conclusion: The patients undergoing caesarean section with wound infiltration with local anesthetic agent showed significantly less tramadol consumption as compared to narcotic analgesia

Insights into Wisdom Tooth Eruption Patterns Among the Student of Sahara Medical College Narowal: A Comprehensive Comparative Analysis

Sun, 28 Apr 2024 00:00:00 -0500

Objective: The time of eruption of wisdom tooth predicts the age of the person.
Material and Methods: Study holds a comparative analysis of 293 students regarding wisdom tooth eruption status was categorized into fully erupted, partially erupted, un-erupted or surgically maneuvered. Statistical analysis, including descriptive statistics and correlation analysis, was performed to establish relationships between age and eruption status.
Results: Preliminary findings suggest a statistically insignificant relationship between the age of the students and the eruption status of their wisdom teeth. The majority of students aged 19-23 years exhibited various stages of wisdom tooth eruption.
Discussion: The results suggestion indicate that there is a discernible correlation between the age of individuals (within the age group of 19-23 years) and the eruption status of their wisdom teeth.

Conclusion: Estimation of age based on the eruption time of wisdom teeth holds promise as a non-invasive and easily accessible method. Within the specific age range of 19-23 years the wisdom tooth is inconclusive.

Diagnostic Accuracy of Transvaginal Sonography in Adenomyosis Taking Histo- pathology as Gold Standard in Infertile Women

Iram Iqbal, Shahzad Saeed, Uzma sarwar, Ameenah Khan, Sana Rehman, Yasir Qavi — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess the accuracy of transvaginal sonography in the detection of adenomyosis, with histopathological examination serving as the gold standard, among a population of women struggling with infertility.
Material and Methods: In this study, a group of 193 women with infertility & suspected adenomyosis was included. Each subject was examined using transvaginal ultrasound, followed by surgical interventions such as dilatation and curettage, accompanied by detailed follow-up assessments. The effectiveness of transvaginal sonography in identifying adenomyosis was evaluated by comparing it to the histopathological diagnosis.
Results: Histopathological analysis confirmed adenomyosis in 162 (83.9%) of the 193 patients, whereas transvaginal sonography identified 151 (78.2%). The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of transvaginal sonography in diagnosing adenomyosis were calculated to be 90.74%, 87.10%, 97.35%, 64.29%, and 90.16%, respectively.
Conclusion: Transvaginal sonography demonstrates considerable sensitivity and specificity in diagnosing adenomyosis, obviating the necessity for supplementary diagnostic investigations.

Assessment of Self-Medication Practices among Undergraduate Students Before and During COVID-19

Javaria Arshad, Uffaq Syed, Syed Nosherwan Ali, Sehrish Zaffar, Momina Khalid — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess self-medication knowledge, prevalence, reasons, and conditions among undergraduate medical students.
Material and Methods: A survey was conducted among 329 undergraduate healthcare students in tertiary care hospitals & IOD using a self-administered questionnaire. Descriptive statistics were used to summarize the data, and categorical variables were analyzed with Chi-square and logistic regression tests at a significance level of p < 0.05.
Results: Self-medication was prevalent among 202 (61.4%) participants: 54 (26.7%) before COVID-19, 16 (7.9%) during COVID-19, and 132 (65.3%) both periods. Knowledge levels varied: 179 (54.4%) with poor knowledge, 150 (45.6%) with good knowledge regarding self-medication. Painkillers 176 (87.1%) were commonly self-administered class of drug, with fever 166 (82.6%) being the most treated condition. Individuals often used their own prior prescriptions 125 (62.5%) as a source of information for self-medication. The predominant reason for self-medication was fear of contact with the infected person during the pandemic, along with fear of quarantine or isolation.
Conclusion: In conclusion, this study reveals concerning self-medication practices among undergraduate healthcare students, particularly with painkillers for common ailments. Field of study, academic year, and personal background influenced self-medication tendencies, while highlighting knowledge gaps. The COVID- 19 pandemic exacerbated these behaviours, necessitating immediate attention. Healthcare education must adapt to equip future professionals with decision-making skills amid rising self-medication practices.

Correlation of Stature with Head Circumference of Male Adults of Upper Punjab

Sun, 28 Apr 2024 00:00:00 -0500

Objective: This study aimed to find how head circumference and stature related to males in Upper Punjab between the ages of 21 and 30.
Material and Method: The investigation was conducted using a quantitative methodology. The 382 adult male residents of Kharian City provided the data. The program SPSS 25 was used to conduct the analysis.
Results: The average stature, as determined by descriptive data, was 170.4 cm. 56.45 cm was the average head circumference. The height and head circumference have a 0.518 Pearson correlation. The value of r shows a statistically significant positive correlation. After the regression analysis was completed, the regression equation was used to label the regression curve.
Conclusion: The results of this investigation showed a correlation between head circumference and stature. Measuring head circumference will help forensic experts determine stature, especially when only the head is exposed due to a natural or artificial calamity

Post-traumatic Stress Disorder in Women in Post-Natal Period

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess and evaluate the presence of post-traumatic stress disorder and its associated factors affecting the women in post-natal period.
Material and Methods: Data was collected through a cross-sectional survey from February 2023-July, 2023 at the Department of obstetrics and gynaecology, Ghurki Trust Teaching Hospital Lahore and 101 women fulfilling various diagnostic criteria for post-traumatic stress disorder in post-natal period were included in the study. PTSD symptoms were assessed using the “City Birth Trauma Scale” (CBTS) questionnaire including various stratification of events. SPSS 27.0 software was used for data analysis.
Results: The results showed the possible outcome of several factors such as mode of delivery, family system, support and terms with partner or any previous psychiatric illness/PTSD or PTSD following child birth. Women with partner support had a significantly lower incidence of distress & impairment symptoms (33.3%) compared to those without support (81.8%) as p<.05.
Conclusion: Our study depicted statistically significant link between PTSD criteria for distress and impairment and partner support and good terms with partner. Given that, partner support ought to be more than what is provided to lower the incidence of PTSD in women following child birth.

Role of Diffusion Weighted Imaging in Localization of Non-palpable Undescended Testes Taking Laparoscopic Finding as Gold Standard

Rukhsana Nasim, Abeer Yasin , Muhammad Kaleem — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To ascertain the accuracy of diffusion-weighted imaging (DWI) in the localization of undescended testes.
Material & Methods: This prospective cross-sectional study was conducted in the radiology department of a tertiary care hospital from 01-06-2022 to 15-12-2023. Total of 150 patients were included in the study. Two experienced radiologists independently examined, one observing conventional MRI alone and the other observing DWI-MRI. Following that, all of the patients underwent laparoscopic examination. The data was entered into a proforma. The findings of conventional MRI alone and DWI-MRI were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of DWI in comparison to laparoscopy.
Results. The average age was 10.37 +/- 5.663. Conventional MRI imaging localized 50.6 % of the cases in our study, 55% of cases via DWI-MRI and 60% by laparoscopy. Sensitivity, specificity, PPV, NPV, and accuracy of conventional MRI were 72 %, 83 %, 86 %, 66 % and 76 % respectively, while for DWI-MRI was 82 %, 86 %, 93 %, 89 %, and 78 % respectively.
Conclusion: The detection of undescended testes is improved by DWI-MRI. DWI-MRI is a recommended imaging tool for improving MRI's preoperative diagnostic accuracy in localization and identification of nonpalpable undescended testes.

ACL Reconstruction with Peroneus Longus Autograft Using Endobutton & Bioabsorbable Interference Screw and Brace Free Rehabilitation

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess the functional outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with Peroneus longus tendon autografts using endobutton and interference screw at one-year follow-up post- operatively and brace-free rehabilitation.
Material and Methods: A prospective study included 53 patients with clinical and radiological ACL deficiency. Arthroscopic ACL reconstruction was performed using Peroneus Longus double bundle autografts with sub- sequent brace-free rehabilitation. Pre- and postoperative assessment at one-year follow-up utilized the International Knee Documentation Committee (IKDC) score. Graft length and diameter were measured perioperatively, and donor site morbidity was evaluated using The American Orthopedic Foot and Ankle Score (AOFAS).
Results: The study included 51 (94.4%) males and 2 (3.7%) females, mean age 27.3±7.2 years. Majority were left-sided procedures (64.8%). Peroneus Longus graft mean length and diameter were 116.8±5.3mm and 8.2±0.2mm respectively. At one-year follow-up, ankle joint movement at the graft site was preserved (mean AOFAS 98±0.8). There was a significant improvement in IKDC score postoperatively (p < 0.05).
Conclusions: ACL reconstruction with Peroneus longus autograft offers knee stability and facilitates early rehabilitation. Utilizing endobutton and bioabsorbable interference screw fixation supports graft strength until sufficient graft-to-bone healing occurs. Patients regain pre-injury activity levels, including stair climbing, sitting cross-legged, and squatting without difficulty.

Socio-Economic Impact of COVID-19 Pandemic Among Lower Income Group of People in Pakistan

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the Socio-economic Impact of COVID-19 Pandemic among lower income group of people in Lahore, Pakistan
Material and Methods: An analytical cross-sectional study design was used for conducting this research from April 2021 to September 2021 in Lahore and a self-structured questionnaire with multiple variables was filled by 274 participants. Non- Probability type of convenience sampling technique was used for data collection after informed consent. This paper was structured into two sections: The initial part addressed the socio-economic challenges experienced by impoverished individuals amidst the coronavirus pandemic. The subsequent section assessed the current state of Pakistan's healthcare system. Chi-square test was used for qualitative data analysis and p-value <0.05 was taken as significant.
Results: Most of the participants (65.7%) in this survey were males and had an income of up to Rs.20,000/ month (70.1%).Out of total, 254 (92.7%) respondents had profound impact of Covid-19 on their lives economically. Majority of them 152(55.5%) visited public places while 133(48.5%) avoided social gatherings like marriages, funerals, religious events etc. during pandemic. More than half of the participants agreed that hospital beds and oxygen were neither available nor it was affordable during their stay at hospital. A significant association was found between family income of respondents and financial crisis faced by respondents when sick with covid-19(p-value=0.05), monthly income suffered due to lockdown or decrease in economy (p-value=0.04) and loan was taken to fulfill their household needs during pandemic (p-value=0.00).
Conclusion: The study showed that 254 (92.7%) respondents had profound impact of Covid-19 on their lives economically. A significant association was found between family income of respondents and financial crisis faced by respondents when sick with covid-19, monthly income suffered due to lockdown or decreases in economy and loan taken to fulfill their household needs during pandemic.

Comparing Carotid Artery Stenting and Carotid Endarterectomy in Symptomatic and Asymptomatic Carotid Stenosis

Sun, 28 Apr 2024 00:00:00 -0500

Objective: In patients with symptomatic and asymptomatic carotid artery stenosis, this retrospective observational
study compared the clinical outcomes and side effects of carotid endarterectomy (CEA) with carotid artery stenting (CAS). The study took patient-specific risk variables into account and concentrated on major adverse cardiovascular events (MACE), such as myocardial infarction (MI), stroke, readmission, and death.
Material and Method: This was a retrospective observational study carried out at Vascular Surgery Department and Interventional Radiology department of two tertiary care hospitals in Rawalpindi, from Jan 2022 to March 2023. With a 30-day follow-up, 60 patients from two Pakistani tertiary care centres underwent either carotid end arterectomy and carotid artery stenting were included. Patient having asymptomatic and symptomatic carotid disease were selected for the procedure. The impact of risk factors on procedural success and development of major adverse cardiovascular events (MACE) was examined in the study. Data regarding 30-day postoperative parameters of the procedure were collected and evaluated. p< 0.05 is considered significant.
Results: The majority of patients in our series were males 46(77%) compared to 14(23%) females in the study. There were no intraoperative mortalities in our patients. The mortality rate of CAS alone was 1(1.66%). Four patients developed complications. Three in CAS group and 1 in CEA group. Comorbidities were present in 46(77%).
Conclusion: Compared to CEA, CAS is linked to a greater risk of stroke or mortality in patients with symptomatic carotid stenosis within 30 days of treatment. Patients' unique characteristics, age, comorbidities, and previous surgical experiences should guide the choice of treatment.

Assessment of Understanding And Perception of Undergraduate Medical Students Regarding Medico-legal Autopsy

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To address the declining interest in forensic medicine and contribute to curriculum improvements by identifying knowledge gaps and exploring perceptions of undergraduate medical students in Pakistan regarding autopsies. It seeks to investigate the impact of autopsy exposure on students' attitudes toward pursuing forensic medicine as a career.
Material and Methods: A cross-sectional study based on a questionnaire was conducted among 272 third and fourth-year MBBS students at a private medical college, over a six-month period.
Results: According to the results of this study, most of the of students correctly understand the basic purpose of forensic postmortem examination, which is to determine the cause of death. However, there are knowledge gaps in understanding the legal and procedural aspects of autopsy. Additionally, the study highlights the students' perception of autopsy, with a substantial portion feeling uncomfortable or considering it disrespectful to the body.
Conclusion: The findings provide insights into how the curriculum can be enhanced to prepare medical students for the ethical, emotional, and professional aspects of forensic pathology.

Does Colchicine Prevent Progression to Artificial Ventilation in Covid-19 Positive Patients? A Study from Lahore, Pakistan

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To find out the effect of colchicine in prevention of progression to artificial ventilation in Covid-19 patients including young and elderly patients.
Material and Methods: Study was conducted from 1st April 2020 till 30th September 2020 in a private, tertiary care hospital of Lahore. A retrospective cohort study was conducted on conveniently selected 179 PCR or radiologically confirmed Covid-19 positive adult and elderly, male and female patients admitted in Covid ward and Intensive care Unit (ICU) using the electronic as well as paper-based record. Amongst these patients, 33 patients were given colchicine, 137 recovered and 20 progressed to invasive ventilation.
Result: Total 179 patients were included int the study and 96 (53.6%) were males and 83 (46.4%) were females. 52.5% had Diabetes mellitus, 58.7% had hypertension, 27.9% had ischemic heart disease, 8.4% had renal disease, 6.7% had lung disease/smoker. The average length of stay in hospital was 6.569±6.355 days. The outcome and progression to artificial ventilation in the patients who were given colchicine as compared to those who were not given colchicine were not statistically significant with a p value of 0.053 and 0.619, respectively.
Conclusion: Colchicine has not shown a significant improvement in the outcome of Covid-19 and does not help in prevention of progression to invasive ventilation irrespective of age, gender, and co-morbidities.

Effect of Ficus Carica Fruit Versus Atorvastatin on High Fat Diet Induced Hepatic Steatosis

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To evaluate the effect of Ficus carica fruit (fig) and atorvastatin on high fat diet induced hepatic steatosis histologically.
Material and Methods: During this experimental study forty male Sprague dawley rats were randomly divided into five equal groups and were acclimatized for a duration of one week. Throughout the course of 12 week, normal control (NC) group was provided normal rat chow. The remaining four groups were induced hyperlipidaemia in 4 weeks duration. These rats were fed with high fat diet containing 1.5gm cholesterol, 8ml coconut oil and 1gm sodium cholate added per 100gm of standard rat chow diet. Disease control group (DC) was offered high fat diet continuously during the 12 weeks study period. On completion of 4 weeks Ficus carica ethanolic extract (FCE) and pulp of Ficus carica fruit (FCP) and standard hyperlipidemic agent, atorvastatin (ATO) were incorporated to the diet of three experimental animal groups respectively for next 8 weeks. All the animals were sacrificed at the end and their liver parenchymal slides were subsequently analysed for histopathology.
Results: Histopathological evaluation using (NASH) scoring showed that both pulp and ethanolic extract of Ficus carica fruit induced significant decrease in the fatty change of liver parenchyma.
Conclusion: This experimental study concludes that pulp of Ficus carica fruit has evident anti hyperlipidemic activity by reducing hepatic steatosis.

Peripartum Hysterectomy in A Tertiary Care Hospital

Sadia Afzal Randhawa, Sarwat Nazir, Mahnoor Ahsan Bhoon — Sun, 28 Apr 2024 00:00:00 -0500

Objective: To identify the indications and risk factors associated with EPH so they can be timely diagnosed and managed to help to improve the maternal morbidity and mortality.
Methods: The study design opted for the present research was observational retrospective, where the pregnant women were assessed for various demographic characteristics, indications, high risk factors and maternal and fetal outcome. All the pregnant women who underwent caesarean hysterectomy were included in the study period from oct 2010 to oct 2014 and January 2017 to December 2017. All the data was filled on a predesigned Performa after taking consent from the patient. This study was carried out in Gynae unit 1, Sir Ganga Ram Hospital Lahore.
Results: The mean age of the women was 25.8 years.59 (66.29%) of the females were in the age category of 21 to 30, whereas 23 (25.84%) belong to 31-35 years of age and 7(7.86) were in the age group 36 to 40. The maximum number of parity was of 4 to 6 ,61.19%. Majority of the deliveries 92.13 were done by cesarean section (CS).
Conclusion: EPH is very vital procedure that saves lives and manages life threatening obstetrical hemorrhage when other methods failed to control bleeding. This procedure most of time is unforeseen and compulsory, however the timely decision of EPH procedure may improve the maternal outcome and hence help in decreasing maternal mortality.

Evaluation of Histopathological Changes in Aminoglycoside Induced Nephrotoxicity and Protective Role of Citrullus lanatus Seeds (Ethanolic Extract) in Animal Model

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess histopathological changes induced by aminoglycoside in nephrotoxicity and explore the protective role of Citrullus lanatus seeds in an animal model.
Material and Methods: The research, conducted from July 01, 2017, to December 31, 2018, at the Department
of Pharmacology, King Edward Medical University Lahore, and UVAS, Lahore, received approval from the Institutional Review Board (IRB). The Animal Experimental Study involved 40 healthy albino Wistar rats, divided into five equal groups. Group A served as the normal control, receiving oral normal saline once daily. Group B, the disease control, received intraperitoneal (IP) injections of Gentamicin at 80mg/kg/day in two equally divided doses, with a 12-hour interval, for 14 days. Groups C and D received oral doses of Citrullus lanatus seed extract (CLSE) at 400 mg/kg and 600 mg/kg/day, respectively, concurrently with Gentamicin at 80mg/kg/day IP in two equally divided doses for 14 days. Histopathological changes such as tubular dilatation (outer and inner), tubular inflammation and tubular necrosis were compared in Aminoglycoside and Citrullus lanatus seeds extract treated groups.
Results: Groups C and D exhibited a significant decrease in tubular inflammation, tubular necrosis, and tubular dilatation, with a p-value < 0.001 compared to Group B.
Conclusion: The administration of CLSE in aminoglycoside-induced nephrotoxicity in albino rats significantly mitigated nephrotoxic effects by reducing inflammation, tubular necrosis, and tubular dilatation.

Frequency of Contrast Induced Acute Kidney Injury in Patients Undergoing Cardiac Catheterization at Jinnah Hospital Lahore

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the frequency of contrast induced acute kidney injury in patients undergoing cardiac catheterization in Jinnah Hospital, Lahore.
Material & Methods: It was a cross sectional study conducted at the cardiology department of Jinnah Hospital. After taking ethical approval from Ethical Review Board (Ref No. ERB130/2/03-11-2022), the study was completed in six months i.e. from 04-11-2022 to 30-04-2023.Total of 217 patients of either sex who underwent cardiac catheterization were included in the study. CI-AKI was defined as increase of serum creatinine 0.5mg/dl or 25% increase from baseline creatinine within 48 hours after exposure to contrast material.
Results: Of total 217patients, 54.8% were male and 45.2% were female. 25 patients (11.5%) in study population developed CI-AKI . Risk of developing CI-AKI was clearly associated with old age, diabetes, hypertension, coronary artery disease and angioplasty.(p <0.05)
Conclusion: The conclusion of the study was that frequency of CI-AKI in subjects undergoing cardiac catheterization is 11.5% which is quite significant. Old age, history of diabetes mellitus, hypertension, ischemic heart disease and angioplasty were significantly related with higher risk of developing CI-AKI.

Efficacy of Bubble CPAP in Managing Respiratory Distress in Neonatal Intensive Care Unit

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the efficacy of BCPAP (bubble continuous positive airway pressure) in management of neonates presenting with respiratory distress.
Material and Method: This is a Descriptive Case series conducted in Neonatal Intensive Care Unit, Punjab Rangers Teaching Hospital, Lahore, over 6 months from 3rd August, 2022 to 3rd February, 2023. 60 neonates of both gender, received within 2 hours of delivery and symptoms of respiratory distress syndrome (as per operational definition). BCPAP (Bubble continuous positive airway pressure) was initiated at 5cm H2O to maintain pulse oximeter saturations above 90% in babies weighing over 1.5kg. Neonates were monitored for 48 hours, and Silverman Anderson Retraction Scores were assessed before and after this period. Efficacy, defined as a 3-point or greater reduction in the Silverman Anderson Retraction Score after 48 hours, was evaluated.
Results: 35 % (n=21) were male whereas 65% (n=39) were females. This study found that percentage of efficacy was 88.3% of BCPAP in management of neonates presenting with respiratory distress.
Conclusion: BCPAP has proven to be the choice of primary respiratory support in neonates with Respiratory Distress Syndrome due to its efficacy and cost-effectiveness in a limited resource setting.

The Diagnostic Accuracy of Sonographic Twinkling Artefact in Localization of Ureteric Stones Keeping Low Dose Computed Tomography as the Gold Standard

Sun, 28 Apr 2024 00:00:00 -0500

Objectives: To determine the diagnostic accuracy of color Doppler twinkling artifact in conjunction with grey-scale ultrasound for diagnosis and localization of ureteric stones, keeping low dose computed tomography findings as the gold standard in adult patients presenting with lumbar pain.
Materials & Methods: In this cross-sectional study, a group of 190 adult patients were enrolled for the diagnosis
of ureteric calculi. Each subject was examined using greyscale ultrasound, followed by color Doppler ultrasound for twinkling artifacts. The effectiveness of ultrasound in identifying calculi was evaluated by comparing it to the low dose computed tomography. Density of the stones in computed tomography was correlated with the outcome of shock wave lithotripsy. All the collected data was entered and analyzed on SPSS version 25.0.
Results: The mean age of the patients was 48.41±16.69 years. For diagnosing ureter calculi the sensitivity, specificity, negative predictive value , positive predictive value, and diagnostic accuracy of Doppler ultrasound
were 90.4%, 73.9%, 77.2%, 88.7% & 85.3% respectively taking computed tomography findings as gold standard.
Conclusion: Twinkling artifacts in conjunction with grey-scale ultrasound demonstrate considerable sensitivity
and relatively low specificity in diagnosing ureteric calculi.

Short Term Side Effects of COVID-19 Vaccination in Patients Presenting At a Tertiary Care Hospital, Lahore

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the frequency and factors associated with short term side effects of COVID-19 vaccination in patients presenting at Tertiary Care Hospital, Lahore
Material and Methods: This was a cross-sectional study with non-probability sampling conducted at the vaccination center of a tertiary care hospital, Lahore, among 381 adults from December 2021-Feburaray 2022. Data was collected through a semi-structured questionnaire and analyzed using SPSS version 23 whereas p-value ≤ 0.05 was taken as significant.
Results: Among 381 adults, 171 (44.9%) experienced short term side effects after COVID-19 vaccination. There were 163(42.8%) males and 218(57.2%) females with a mean age of 30.09±9.26 years. Among 171(44.9%), weakness 72 (18.9%) was the most reported side effect, followed by local swelling 69(18.1%), local pain 63(16.5%) and fever 52(13.6%).Female gender, fear about side effects, family member's experience of side effects, vaccination due to self-protection, media and government advice were significant factors associated with short term side effects.
Conclusion: Short term side effects were reported among 171 (44.9%) of patients. Health education and public awareness are required to remove the fear of side effects among public.

Knowledge and Practices of General Practitioners Regarding Differentiation of Dengue Fever From Dengue Hemorrhagic Fever: A Cross-Sectional Survey

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine Knowledge and Practices of General Practitioners regarding differentiation of dengue hemorrhagic fever (severe dengue) from Dengue Fever.
Material and Methods: A cross sectional study was conducted in Lahore city from June 2023 to August 2023. Using convenient purposive sampling technique, 370 general practitioners (GPs) of Lahore city were selected and questioned about how they differentiated DF from DHF. Responses about clinical signs (right sided upper abdominal tenderness, increased capillary refill time, narrow pulse pressure, tachycardia), evidence of fluid leak on ultrasonography of abdomen and worsening hematological parameters on serial complete blood count CBCs (decreasing platelets <50000, leukopenia and raised hematocrit) were recorded in structured questionnaire. Data was entered and analyzed using SPSS 20.
Results: 308(83%) were males and 62 (16%) were females with mean experience 16.74±7.65 years. 56.4% responded that they checked right sided upper abdominal tenderness to identify DHF, 41% mentioned used of tachycardia, 23% increased capillary refill time, 27% mentioned narrow pulse, 112/370 (30%) said Ultrasound abdomen and chest to check of fluid leak and thickening of gall bladder wall, 84% mentioned serial CBCs to look for worsening thrombocytopenia, 67% used worsening leukopenia and 67% used increasing hematocrit as sign of DHF.
Conclusions: Majority of general practitioners of Lahore city lacked necassary practices regarding identification of severe dengue fever. It is recommended that health authorities must take concrete steps to ensure dissemination
of standard protocols and guidelines as well as continuous medical education and capacity building for health care workers.

Crataegus Oxyacantha (Hawthorn) Fruit – Histopathological Safety Profile in “Brain, Bone and Joint Tissue” of Dyslipidemic Rats

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To evaluate the safety profile of ethanolic extract of Crataegus oxyacantha fruit in comparison with Atorvastatin om histological samples of brain, bone, and joint tissues.
Materials & Methods: A 2-month experimental study was conducted from July to September 2023 at Animal House of Akhtar Saeed Medical & Dental College on 48 male albino Wistar rats (aged 6 weeks) divided into 8 groups with 6 rats each, weighing 180-200 grams. Group 1 (Healthy Control) received a normal rat diet and 2 ml of Normal Saline for 2 months. Group 2 (Disease Control) was given a High-Fat Diet (HFD) and 2 ml of Normal Saline for 1 month, while 3-5 (Prophylactic Groups) received HFD along with Crataegus oxyacantha fruit's ethanolic extract, atorvastatin, and combination of them in doses of 40 mg/kg OD, 80 mg/kg OD and 20+40 mg/kg OD orally respectively for 1 month. Groups 6 to 8 (Therapeutic Groups) were given Crataegus oxyacantha fruit's ethanolic extract, atorvastatin, and in combination respectively after induction of dyslipidemia from the 30th to 60th day in the doses as mentioned above. Animals were sacrificed on the 30th day from Prophylactic Groups along with Group 2 and the remaining groups on the 60th day i.e., at the end of the study for the collection of brain, bone, and joint tissues. The histopathological results were analyzed by assigning percentages.
Results: Our study concludes that Crataegus oxyacantha which has hypolipidemic potential does not cause any organ damage in bone, joint, and brain tissue when compared to Atorvastatin.
Conclusion: Results show that Crataegus oxyacantha can be used as a safe alternative in treating hyperlipidemia
in comparison with Atorvastatin.

Comparison of Structural Alterations of Incus Bone Between Middle Ear Cholesteatoma and Temporal Bone Osteitis Among Patients Who Underwent Mastoid Exploration in Services Hospital, Lahore

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To compare the structural changes of incus bone between middle ear cholesteatoma and temporal bone osteitis among patients who underwent mastoid exploration in Services hospital, Lahore.
Material and Methods: An analytical and hospital based comparative study carried out at ENT- II Services Hospital Lahore during July 2023 to December 2023 for 6 months. Total 60 patients were selected. Random allocation of study participants were done in two groups, Group A and Group B. Each group had 30 patients. Patients with middle ear cholesteatoma were in group A, while all patients in group B had middle ear temporal bone osteitis. A mastoid X-ray displaying haziness of mastoid air cells and CT scan demonstrating the intracranial and extracrainal extrusion were carried out. SPSS 20 was used to analyze all data.
Results: The study's cases had an average age of 31.00±11.07 years. With a p-value of 0.322 (> 0.05), the mean age of two groups was statistically equal. In this study, there were 26 (43.3%) male cases and 34 (56.7%) female cases, with female to male ratio of 1.31 and 1. All groups had structural alterations in Incus bone. Long process was seen in 16(26.7%) cases, Lenticular process was seen in 25(41.7%) of the cases, there were 14(23.3%) cases who had short process and in 5(8.3%) cases all were eroded.
Conclusion: The results of this study demonstrated strong correlation between localized middle ear cholesteatoma and temporal bone osteitis and alterations in incus bone.

Attitude and Perception of Private Medical Students While Working in the Anatomy Dissection Hall

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To assess the attitude and perception of medical students towards anatomy learning while in the dissection hall
Material & Method: This was a cross-sectional study carried out at the anatomy department of Shalamar Medical & Dental College Lahore from Editor from 31st March 2019 to 11th December 2019. Responses from 272 MBBS students of 1st and 2nd year from private medical colleges of Lahore were obtained using a Google form through a questionnaire with questions relevant to their experience in the dissection hall & their satisfaction levels. Statistical analysis was carried out using SPSS version 20, and a p-value < 0.05 was taken as statistically significant.
Results: A significant percentage of students felt that dissecting cadavers by themselves helped them in a better understanding of anatomy. Most students (72 %) emphasized that the teaching of gross anatomy must be modified to fulfill the needs of clinical teaching. A total of 50% of the students felt that the time given for anatomy teaching in the dissection hall should be readjusted. Around 24% students were inclined to modernize anatomy by integrating it with other subjects.
Conclusion: Most students were in favor of cadavers being crucial for anatomy teaching, but with that readjustment of sub-specialties of gross teachings is the need of the day. Also, the use of 3D Anatomy in combination with cadavers is a helping tool for better understanding of anatomy concepts.

Factors Affecting Turnaround Time TAT in Clinical Laboratory at a Tertiary Care

Asim Mumtaz; Omair Farooq, Zainab Yousaf, Nazia Akbar, Atiq Arshad, Babar Yasin — Sun, 28 Apr 2024 00:00:00 -0500

Objectives: The present study was designed to evaluate the turnaround time (TAT) of indoor patient samples and the factors affecting TAT in the clinical laboratory at a tertiary care Hospital.
Materials and Methods: This cross-sectional, descriptive study was conducted at Farooq Hospital Westwood, Lahore. The data of TAT was collected between the period of 1st January to 31st July 2023. Requested tests were received in the Pathology laboratory along with test requisition forms. All were carefully screened for any mistakes. TAT analysis of ABGs, S/E, RFTs, Trop-I, amylase, and CBC of indoor patients was done for eight months.
Results: A total of 18282 indoor patient samples were included in this study. On analysis, it has been observed that the ABGs (n=3407, 99.5%), Trop-I (n=755, 85.40%), S/E (n=6497, 72.39%), CBC (n=16117, 88.15%), amylase (n=326, 86.47%), RFTS (n=7541, 78.07%) were reported within the defined TAT. This study also observed that the main reason for delayed TAT was hemolysed and clotted samples (14.22%), specimen dilution and re-run for the verification of result (12.96%), and incorrect patient registration (12.64%).
Conclusion: Monitoring TAT for laboratory reports is crucial and it plays a significant role in ensuring the effectiveness of the laboratory's operations. The factors influencing the TAT should be monitored and analyzed regularly for better patient care management

Frequency of Anemia in Women with Preterm Labour

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the frequency of anemia in women experiencing preterm labor, recognizing the critical association between anemia and adverse maternal and perinatal outcomes.
Materials and Methods: This cross-sectional study was done from September 2023 to November 2023 after approval from the Institutional Review Board IRB NO. MRC/1RB/23017. After informed consent 192 pregnant females were included after Institutional Review Board approval. A self-developed questionnaire gathered sociodemographic data, and hemoglobin levels were measured. Statistical analysis employed SPSS version 23, utilizing chi-square for comparisons.
Results: Among the 192 participants, 27.1% were anemic. Bivariate analysis revealed a significant association between anemia and rural residence (p=0.012). No significant correlation was found with other sociodemographic
factors.
Conclusion: The study emphasizes the high frequency of anemia in women experiencing preterm labor, supporting the need for heightened public awareness and early screening initiatives. Maternal anemia significantly correlates with preterm births, emphasizing the importance of managing gestational anemia to mitigate adverse outcomes. Public health interventions should target women of reproductive age and healthcare providers to ensure timely screening and management of maternal anemia, ultimately contributing to the reduction of preterm births and associated complications.

Effectiveness of Autologous PRP Versus Conventional Mechanical Fixation on Wounds in Terms of Skin Graft Adhesion & Complications

Sun, 28 Apr 2024 00:00:00 -0500

Objective: To determine the efficacy of autologous PRP on wounds in terms of skin graft adhesion and complications as compared to conventional fixation techniques.
Materials and Methods: This study was conducted at the Department of Plastic & Reconstructive Surgery, PIMS, Islamabad, over a period of six months from August 21, 2019 to February 28, 2020. The research was authorized by the Ethics Review Board and Committee ERB no. (F.1-1/2015/ERB/SZABMU/456). Patients were allocated into two groups: Group A received PRP-assisted graft adhesion, obtained through aseptic blood draw, centrifugation, and application to the wound area; Group B underwent conventional fixation with sutures or staples. Graft evaluation and dressing adjustments were performed with dressing changes on the 5th postoperative day.
Results: In Group A (mean age: 34.03±11.07 years) and Group B (mean age: 30.55±11.81 years), Group A exhibited significantly higher efficacy (89.7%) compared to Group B (66.7%) with a p-value of 0.000. Age and gender differences were minimal, except in the subgroup of patients aged 31-40 years and males.
Conclusion: Autologous PRP treatment (Group A) demonstrated superior efficacy in promoting graft adhesion compared to conventional fixation (Group B). The study recommends the clinical adoption of autologous PRP in wound resurfacing procedures to expedite healing.

Reducing the Burden of Neonatal Mortality in Pakistan

Tayyaba Khawar Butt — Sun, 28 Apr 2024 00:00:00 -0500

The chances of dying on the first day of life are second only to the last day of life. Newborns, thus, represent a very vulnerable subset of population. This is especially the case in low- and middle-income countries like Pakistan. Although our Neonatal Mortality Rate has declined during the last few decades, it failed to keep pace with the targets set in the Millennium Development Goals (MDGs). Pakistan continues to have one of the highest neonatal Mortality Rates in the world. As we enter the era of Sustainable Development Goals, every effort should be made to meet the new targets set in the SDGs.With the ever-increasing financial burden of healthcare (especially in a struggling economy like ours), careful thought should be given to adopting measures to save newborn lives and improve their health status. These measures should not only be efficacious but also cost effective and sustainable. Keeping in mind the mother newborn dyad, measures to improve neonatal outcome must address maternal health simultaneously. Reducing neonatal mortality in low- and middle income countries (LMICs) is thus a multifaceted challenge that requires a combination of strategies addressing various factors contributing to newborn deaths. Here are some effective approaches

Female Urethral Diverticulum: A Case Report

Nazli Hameed, Sadaf Mubeen — Sun, 28 Apr 2024 00:00:00 -0500

Background: A urethral diverticulum is an out pouching arising from the urethra. The prevalence is unknown.
Only 1-6 % cases are reported. Patrons present with recurrent urinary tract infections, urine dribbling and dysparunea. Case: A 60 year old patient presented with recurrent UTI, dysuria and urinary dribbling. On examination there was a urethral diverticulum. Excision and reconstruction of the urethra was done.

Conclusion: Proper examination is necessary in patients presenting with urinary complaints. Many cases of urethral diverticulum remain undiagnosed. Excision of the diverticulum must be done by an experienced urogynaecologist or urologist to prevent complications.

Demographics of Blood Donors at a Regional Blood Transfusion Centre in a Developing Country Pakistan

Sun, 28 Apr 2024 00:00:00 -0500

Objective: The study was aimed to gather demographic data from blood donors to develop strategies for improving voluntary blood donations.
Material and Method: This study utilized a cross-sectional descriptive design and was conducted at the Armed Forces Institute of Transfusion (AFIT), from November to January 2021.Demographic information of blood donors was collected using a pre-designed form. Statistical analysis was performed using SPSS 23, including calculations of frequency, percentage, and mean ± standard deviation. The blood donors were cate- gorized into different groups based on caste, education, how frequently they donate blood and type of donation. Chi-square test was used.
Results: The blood donors presenting at regional centre were 28.53 ± 7.25 years of mean age. Out of 1000 blood donors, there were 98.8% male and 1.2% were female. Most blood donations came from individuals of Punjabi ethnicity (72.4%). Among the various caste systems in Pakistan, the highest number of donors belonged to the Rajput caste (9.3%). The majority were directed donors (93.6%) and were donating for the first time (65%). There was a positive correlation between the frequency of blood donation and the level of education. Regular donors (50.4%) were mostly those who had qualification of graduation, with a p-value of 0.001.
Conclusion: We found that individuals with higher levels of education are more likely to be frequent voluntary blood donors.