Volume 16, Issue 03, July 2020 – September 2020
ARTICLES
GUEST EDITORIAL
Seizing the Moment 2020
Authors: Khalid Saeed Khan, Shehnoor Azhar
Role of Zinc in patients presenting with Recurrent Hepatic Encephalopathy in Medical unit of tertiary care hospital Lahore
Authors: Asma Kamal, Asifa Kamal, Naeem Afzal, Shazia Siddique & Khadija Tahir
DOI: https://doi.org/10.51273/esc20.251631
Abstract
Objective: To observe the effects of zinc replacement on hepatic encephaopahty. To reducce hospital admission and heath burden by reducing episodes of recurrent hepatic encephalopathy.
Methods: This study was carried out on 160 patients presenting with hepatic encephalopathy in medical ward of services hospital Lahore. The aim of the study was to assess the role of zinc in the improvement of encephalopathy.
Results: The mean age of patients in group A was 55.78 and that in group B was 56.88years.There was significant difference in mean value of hepatic encephalopathy grade in both groups A and B after 3 months of follow up (p.value 0.027) indicating zinc is beneficial in treatment of hepatic encephalopathy.
Conclusion: Our study showed that zinc replacement improved outcome in patients with Hepatic encephalopathy.
Key words: Hepatic encephalopathy, zinc supplementation, chronic liver disease.
Prevention of Renal stone Recurrence: Knowledge and Practice Patterns among medical officers of DHQ hospital, Faisalabad
Authors: MUHAMMAD Saifullah, Hanan Noor, MUHAMMAD Waqas Iqbal, Nauman Khalid, MUHAMMAD Sohail, MUHAMMAD Akmal & Ghulam Mehboob Subhani
DOI: https://doi.org/10.51273/esc20.251632
Abstract
Objective: To assess the knowledge and practice patterns among medical officers of DHQ Hospital, Faisalabad in the prevention of recurrent renal stones. Cross sectional study. DHQ hospital, Faisalabad during 01-01-2019 to 30-09-2019.
Methods: In this study the medical officers of either gender and age more than 25 years and working in DHQ Hospital, Faisalabad were included. They were assessed on the basis of a designed questionnaire regarding their general practice and knowledge in order to prevent renal stone recurrence. The paper based questionnaire was circulated to medical officers in different departments of the hospital.
Results: In this study total 225 medical officers that were included. 135 (60%) of these participants were males and 90 (40%) were females. The mean age of the participants was 29.70±3.21 years. The mean working experience was 4.40±2.18 years. On assessment, 65.67% medical officers had adequate knowledge regarding recurrent renal stone prevention according to latest practice guidelines. Unfortunately 62.22% respondents were not practicing their knowledge adequately.
Conclusion: The knowledge regarding the clinical practices in light of recent guidelines was optimal, however the practice regarding the preventive strategies was below power.
Keywords; Renal stone, Recurrence, Medical officer, prevention.
A Morphological Study on Gross Anatomical variations of Embalmed Cadaveric Livers
Authors: Aliya Zahid, Brishna Khan & Saira Munawar
DOI: https://doi.org/10.51273/esc20.251633
Abstract
Objective: To find out gross anatomical variations of embalmed cadaveric livers.
Methods: Present study was conducted in dissection halls of Anatomy departments of Allama Iqbal Medical College, Lahore, Sahiwal Medical College, Sahiwal and Fatima Jinnah Medical University, Lahore during 2016-2019. In this study, 74 livers were dissected out from embalmed cadavers and preserved in 10% formalin. Different morphological variations were observed in livers which included presence of accessory lobes, accessory sulci, notches, changes in size and shape of lobes. Liver specimens were photographed and classified according to Netter’s classification of morphological variations of liver.
Results: The hepatic morphological variations observed included accessory fissures in the right, left, caudate and quadrate lobes of the liver, accessory lobes, elongated left lobe, hypoplastic left lobe, multiple deep diaphragmatic sulci, pons hepatis, Reidel’s lobe, notched borders and bilobed caudate lobe.
Conclusion: The knowledge of various variations in morphology of cadaveric livers may help the radiologists to make accurate interpretation of the radiological images, thus minimizing the chances of incorrect reporting. It may also be helpful to the hepatobiliary surgeons to be aware of the morphological variations on the liver surface to avoid surgical complications.
Key Words: Embalmed cadaveric livers, accessory lobes, accessory fissures
Frequency of various Dermatoses requiring Histopathological Evaluation for definite Diagnosis; A Retrospective Analysis
Authors: Hira Tariq, Rabia Mukhtar, Abeer Fahad, Taqiq Rashid, Ambreen Anwar & Ameena Ashraf
DOI: https://doi.org/10.51273/esc20.251634
Abstract
Objective: To assess the frequency of various dermatological disorders those require histopathological analysis for definite diagnosis.
Methods: We included 669 patients of either gender and all ages in this retrospective study, carried out in the Department of Dermatology, Jinnah Hospital, Lahore for a duration of 2 years. Their clinical data and histopathological reports were analyzed. The dermatoses were categorized into (a) papulosquamous disorders, (b) bullous disorders, (c) eczemas, (d) neoplasia, (e) granulomatous disorders, (f) connective tissue diseases, (g) drug reactions, (h) vasculitides, (i) chronic ulcers and (j) miscellaneous disorders.
Results: The frequency of various dermatoses noted were as follows: papulosquamous disorders 28.25%, bullous disorders 11.5%, granulomatous disorders 11.5%, connective tissue diseases 10.61%, miscellaneous disorders 10%, eczemas 9.4%, chronic ulcers 7.17 neoplasia 6.8%, vasculitides 2.84% and drug reactions were 1.79% of total biopsies.
Conclusion: The frequency of different diagnostic groups was unique in some respects and confirmed to other studies in others. The significantly high frequency of papulosquamous disorders highlighted the importance of these disorders.
Key words: Skin biopsy, papulosquamous disorders, bullous disorders, eczemas, neoplasia, granulomatous disorders, connective tissue diseases, drug reactions, vasculitides, chronic ulcers.
Frequency of Electrolyte imbalance in children of pediatricacute diarrhea
Authors: MUHAMMAD Zain ul Abadin, Maria Iftikhar, Navaira Arshad, Zeeshan Mahmood, Beenish Tahira, MUHAMMAD Shafiq, Tayaba Khawar Butt
DOI: https://doi.org/10.51273/esc20.251635
Abstract
Objective: To find out the electrolyte abnomalities among children affected by pediatric acute diarrhea.
Methods: Two hundred and eighty children fulfilling the inclusion/exclusion criteria admitted in Department of Pediatrics, Services Hospital, Lahore was taken. Informed consent of the parents of children was obtained to include their data in the study. Demographic profile age, gender, was recorded. Every children with acute diarrhea was followed through 5cc venous blood test sent to the hospital laboratory with the help of pramedical staff of the hospital for evaluation of electrolyte imbalance.
Results: In our study, out of 280 cases of Pediatric acute diarrhea, 50 %( n=140) had up to 1 year of age. 64%(n=174) were male while 38 %( n=106) were females. Hyponatremia was the most common electrolyte abnormality effecting 22.5% males and 6.5% females followed by hypokalemia.Electrolyte imbalance was more common in children of age group 2-5years.
Conclusion: Electrolyte and acid base abnormalities are common in children with acute watery diarrhea affecting children of 3-12 months of age. Hyponatremia and hypokalemia are the most common abnormalities. Both abnormalities increase with an increase in duration of diarrhea, occur more frequently in patients who are severely dehydrated.
Keywords: Electrolyte imbalance, paediatric acute diarrhea, hyponatremia
Efficacy of inhaled salbutamol in the management of Transient tachypnoea of Newborn
Authors: Shaukat Hussain, MUHAMMAD Arslan Farooq, MUHAMMAD Tayyab & Isfand Yar Khan
DOI: https://doi.org/10.51273/esc20.251636
Abstract
Objective: To compare the outcome of salbutamol nebulization with controls (normal saline) in transient tachypnea of newborn.
Methods: In this randomized controlled trial 284 (142 in each group) neonates were included with gestational age above 35 weeks of any gender. Study was conducted in Department of Pediatrics Holy Family Hospital Rawalpindi. Sampling technique was consecutive non probability sampling. Duration of study was 6 months. Sample size had been calculated using WHO calculator; Significance level 5%, Power of test 80%, Population mean 5.4, Test value of population mean 4.8, Standard Deviation 1.8. At admission complete blood picture, C-reactive protein and chest x-ray were done. Group-1 received salbutamol nebulization at a dose of 0.15mg / kg / dose for 10 minutes in 2ml normal saline QID while Group-2 received only normal saline nebulization 2ml QID in 24 hours. Double blinding was ensured and in case of any side effects of salbutamol (tachycardia, arrhythmias and hypoglycemia) treatment was stopped immediately and managed accordingly.
Results: In this study, comparison of outcome of inhaled salbutamol with controls in transient tachypnea of newborn shows that respiratory rate per minute was 50.15+2.34 in Group-1 and 64.92+2.70 in Group-2, p value was 0.0001, heart rate per minute in Group-1 was recorded as 120.08+2.36 and 134.79+3.27 in Group- 2, p value was 0.0001, oxygen saturation(%) was 97.27+0.92 in Group-1 and 83.28+1.81 in Group-2, p value was 0.0001, duration of oxygen therapy(hours) was recorded as 15.49+1.84 in Group-1 and 27.78+5.57 in Group-2, value of p was 0.0001, duration of hospitalization(days) was recorded as 2.03+0.45 in Group-1 and 5.07+0.72 in Group-2 while value of P was 0.0001
Conclusion: Salbutamol Nebulization is more effective than normal saline in TTN.
Key Words: Transient Tachypnea of newborn, management, inhaled salbutamol, outcome.
Demographic profile of Endocrine disorders in patients admitted in Endocrinology ward, Services hospital, Lahore
Authors: MUHAMMAD Maaz Arif, Najam ud Din, Amjad Ali Raza, Nauman Mazhar, Taskeen Zahra, Nayyer Riffat
DOI: https://doi.org/10.51273/esc20.251637
Abstract
Objective: To find out frequency and demographic profile of endocrine disorders in patients admitted in endocrinology ward at Services Hospital Lahore.
Methods: The cross-sectional study was conducted at Services Hospital Lahore in Punjab, Pakistan. The study included 105 patients admitted in Endocrinology Ward. Data used was secondary and it was collected via medical record from June, 2018 to January, 2019. All information pertaining to patients was kept confidential. Ethical Review Committee permission was undertaken with final approval from Head of Department.
Results: Demographic characteristics of patients included age, gender, and showed majority to be middle- aged females. The number of female cases were 65.71% (n = 69), while male cases were 34.29% (n = 36). The average age of all the patients was 40.62 ± 16.52. Majority of the patients with 76.19% (n = 80) cases were reported with having glucose homeostasis disorders with 65.71% (n = 69) cases having diabetes mellitus and 10.48% (n = 11) with hypoglycemia. Pituitary gland disorders comprised 8.57% (n = 9) of the cases with 5.71% (n = 6) diagnosed as pituitary tumors and 2.86% (n = 3) as hypopituitarism. Pituitary tumors further included Cushing syndrome with 4.76% (n = 5) cases and acromegaly with 0.95% (n = 1). Hypopituitarism comprised of hypocortisolism with 1.90% (n = 2) cases and Sheehan’s syndrome with 0.95% (n = 1). 7.62% (n = 8) cases were reported with having thyroid disorders, with 4.76% (n = 5) having hyperthyroidism and 2.86% (n = 3) with hypothyroidism. 4.76% (n = 5) cases were diagnosed as sex hormone disorders comprising puberty disorders with 1.90% (n = 2) cases, fertility disorders with 1.90% (n = 2) and turner syndrome (inherited disorder) with 0.95% (n = 1). Calcium homeostasis disorders with 1.90% (n = 2) included one case each of parathyroid adenoma (parathyroid gland disorder) and osteoporosis (metabolic bone disease).
Conclusion: The research indicated that glucose homeostasis disorders constituted highest in frequency, followed by pituitary gland disorders, thyroid disorders, sex hormone disorders and calcium homeostasis disorders. The current study urges us to act collectively in order to prevent endocrine disorders which can be done by promoting public education programs, proper counseling about its preventive measures and undergoing periodic medical examination.
Key Words: Demography, Endocrine disorders.
Short term Effectiveness of Intraatricular injection of Methylprednisolone Acetate in Subacromial Impingement syndrome in a Tertiary care hospital
Authors: M. Amir Sohail, Nijat Ali, Zulfiqar Zahoor Ahmad, Sohail Razzaq, Arif Mahmood & Shafqat Wasim
DOI: https://doi.org/10.51273/esc20.251638
Abstract
Objective: To determine mean decrease in VAS pain score of intraarticular injection of methyl prednisolone acetate in patients of subacromial impingement syndrome.
Methods: Its Descriptive Case Series/ Quasi experimental study. Study was conducted in department of Orthopedics Unit- I, Jinnah hospital Lahore. Study completed in Six months i.e. from June 2014 to December 2014.After taking an informed consent, 70 newly diagnosed cases of Subacromial impingement syndrome by history and examination (described by the patient as pain in subacromial space when the humerus was elevated or internally rotated and tested by having the patient place his hand on the unaffected shoulder and gradually forward flexing the shoulder (positive impingement sign)which have not received any kind of treatment were included.
Results: Effectiveness of intraarticular injection of methyl prednisolone acetate was measured on visual analogue scale (VAS) from 0 to 10 by VAS score after 6 weeks. 70 patients with mean age of 36.2 ± 10.6 years were included. 61 patients (75.7%) were male, 10 patients (14.3%) had gout and 20% were diabetic. Mean pretreatment VAS score was 5.03 ± 1.58 while mean post-treatment VAS score was 3.86 ± 0.839. Mean reduction was 1.17 ± 1.57 ranged from 2 to 6. There was non-significant association of age and diabetes with mean reduction in VAS score while female gender and gout were significantly and negatively associated with treatment outcome. It is concluded that mean reduction in VAS score after 6 weeks of treatment of subacromial impingement syndrome after intra articular methylprednisolone injection is 1.17 ± 1.57 and acceptable.
Conclusion: It is concluded that intraatricular injection of methyl prednisolone injection is efficacious and effective for treatment of Subacromial impingement syndrome in Pakistani population.
Keyword: subacromial impingement syndrome, intra articular methylprednisolone injection, visual analogue scale, effectiveness.
Myoinositol in restoring Spontaneous Ovarian Activity in patients with polycystic Ovarian Syndrome (PCOS)
Atuhors: Ikramuallah, Nadia Sabeen, Qaiser Javed Iqbal, Shazia Zulfiqar & Tayyiba Wasim
DOI: https://doi.org/10.51273/esc20.251639
Abstract
Objective: To assess the efficacy of myoinositol in the management of patients with Polycystic ovarian syndrome (PCOS)
Methods: It was quasi experimental study conducted inDepartment of Obstetrics and Gynecology Services institute of Medical Sciences, Services Hospital, Lahore from 30-6-2018 to 31-12-2018. 140 sub fertile patients with PCOS were selected through random sampling. Patients were given 2gram of myoinositol/day. The effect was assessed after 3 and 6 months of treatment by monthly menstrual cycle regularity and ovulation. All this information was recorded in proforma.
Results: The mean age of patients was 26.90±5.52years. The mean BMI of patients was 37.38±4.08kg/m2. After 3 months of treatment, menstrual cycle become regular in 34 (24.3%) patients and ovulation occurred in 54 (38.6%) cases. After 6 months of treatment, menstrual cycle become regular in 75 (53.6%) patients and ovulation occurred in 101 (72.1%) cases.
Conclusion: The myoinositol is an effective treatment in terms of regularity of menstrual cycle and ovulation induction in subfertile women with PCOS.
Keywords: Myoinositol, Polycystic ovarian syndrome, Menstrual irregularity, Ovulation
Frequency of patients passing an impacted Esophageal meat Bolus by Conservative method Alone
Authors: Ghulam Murtaza, Sarwat Hassan Syed, Damish Arsalan, MOHAMMAD Qamar Nasir, MUHAMMAD Awais Amin & Amir Ayub
DOI: https://doi.org/10.51273/esc20.2516310
Abstract
Objectives: To determine the frequency of patients passing the impacted esophageal meat bolus by conservative management
Methods: After obtaining permission from ethical committee of Hospital,a total of 62 patients meeting the study criteria were recruited in the study which was conducted in Department of Otorhinolaryn-gology, Services Hospital, Lahore. Demographic information (name, age, gender, contact) was also obtained. Patients with clinical suspicion of impacted esophageal food bolus of age 20-50 years of either gender were included. Patients with known esophageal abnormalities like stricture, web or growth on either barium swallow or esophagogastroduodenoscopy, peptic ulcer and GERD were excluded. After taking informed written consent from each patient, single intravenous dose of buscopan 20mg was given to each patient. Each patient was followed by the researcher himself for 24 hours to assess the passage of food bolus.
Results: 20-50 years was the age range in our study, with mean age being 34.10± .63 years. Majority of the patients 32 (51.61%) were between 20 to 35 years of age. Out of 62 subjects, 37 (59.68%) were male, 25 (40.32%) were females with male to female ratio 1.5:1. In our study, Frequency of patients passing the impacted esophageal meat bolus by conservative management was found in 51 (82.26%) patients.
Conclusion: This study concluded that there is a high frequency of patients passing the impacted esophageal meat bolus by conservative management.
Keywords: Esophagus, foreign body, conservative management.
Association of serum Vitamin D levels with Hypertension
Atuhors: Maryam Rao, Tabinda Kazmi, MUHAMMAD Imran, Anmir Mahmood Farooqi, Akif Mahmud & Qanita Mahmud
DOI: https://doi.org/10.51273/esc20.2516311
Abstract
Objectives: The objective of our study was to identify the effect of low serum vitamin D levels on hypertension & to make a comparison of levels of vitamin D in hypertensives and healthy individuals.
Materials and Method: A cross-sectional comparative study carried out in Cardiology Department of Shaikh Zayed Hospital and Punjab Institute of Cardiology, which involved measurement and comparison of serum Vitamin D levels in 64 subjects, categorized in two groups; hypertensives and normotensives, in order to establish a potential association between vitamin D levels and hypertension.
Results: Our study showed that Serum Vitamin D was equally sub-optimal in all participants of study, including both hypertensive group and the healthy controls. As a result of this finding, a clear pattern of association of vitamin D deficiency with hypertension could not be seen. Mean ±SD Vitamin D levels was 19.5±10.0 ng/L in hypertensives and 19.5±13.6 in healthy individuals. This study did not lead to establishment of an association between hypertension and vitamin D levels.
Conclusion: Because of deficiency of Vitamin D in general population in this region, our study failed to show an association between Vitamin D and hypertension. Further exploration is needed in this regard.
Key words: Hypertension, serum Vitamin D levels
Periodontitis: A risk factor for Preterm Labour
Authors: Shamila Ijaz, Falak Naseer, Amna Ahsan, Mahnaz Gondal, Nazia Khalil & Nimra Rao
DOI: https://doi.org/10.51273/esc20.2516312
Abstract
Objective: To determine the relationship between periodontitis and preterm labour in pregnant women presenting to a tertiary care hospital in Lahore.
Methods: This case control study was conducted at Obstetrics & Gynecology Unit 4 of Sir Ganga Ram Hospital, Lahore for six months. The delivering women, who consented to participate, were divided into two case and control groups. For each case one control was enrolled who met the inclusion criteria, so total sample size was 380 women. Women delivered before 37 weeks of gestation were case group and those delivered after 37 weeks were control group. A patient was considered having periodontitis if she had probing pocket depth of ≥3mm in at least 3 sites. Data was collected and analyzed on SPSS version 21.
Results: In this study the mean age of the case group patients was 28.52±6.45 years while of the control group was 28.67±6.35 years. The mean value of probing depth pocket in the case group was 3.872±1.37 while the mean value probing depth pocket of the control group was 3.58±1.52. Out of 380 patients the periodontitis was found in 275 patients. The odds of having periodontitis in case group was 1.85 times higher than control group i.e. OR=1.85[1.17-2.92].
Conclusion: Periodontitis is a preventable risk factor of preterm labour in women presenting at a tertiary care hospital.
Keywords: Preterm Labour, Periodontitis, dental hygiene, preterm delivery
Morphological spectrum of Lesions seen in Thyroidectomy Specimens at a Tertiary care Institute
Atuhors: Iram Nadeem, Samra Sameen, Sahar Iqbal & Tazeen Anis
DOI: https://doi.org/10.51273/esc20.2516313
Abstract
Objective: To determine the morphological spectrum of thyroid lesions encountered in thyroidectomy specimens at a tertiary care institute.
Methods: It was a retrospective study conducted in Pathology Department, Allama Iqbal Medical College, Lahore. A retrospective manual collection of data was done from record registers, for the years 2012 & 2013.
Results: A total of 307 cases were retrieved with age range of 16-70 years. Amongst them, 47 were males and 260 were females. Non neoplastic conditions outnumbered the neoplastic lesions as 229(75%) cases were of colloid goiter. Hashimoto thyroiditis was present in 12(3.9%) specimens and associated hyperplastic changes were seen in 15(4.9%) cases. There were 19(6.2%) cases of papillary carcinoma, 3(0.9%) cases of follicular carcinoma, 3(0.9%) cases of medullary carcinoma, 1(0.3 %) case of insular carcinoma and 2(0.6%) anaplastic carcinoma. Papillary microcarcinoma was seen in 4(1.3 %) cases and medullary microcarcinoma in 1(0.3%) case. Follicular adenoma comprised 29(9.4%) cases and Hurthle cell adenoma 3(0.9%) cases. Study data also showed 1(0.3%) rare case of hyalinizing trabecular tumor.
Conclusion: Non neoplastic thyroid diseases are more common as compared to neoplastic lesions. Papillary carcinoma is most common thyroid malignancy encountered in our setting.
Key Words: Thyroidectomy, Colloid goiter, papillary carcinoma
Agreement between Waist hip ratio and total Cholesterol to HDL ratio in the Diagnosis of raised total Cholesterol in Post Menopausal Women
Authors: MUHAMMAD Asif, Abida pervaiz, Wajiha Fatima, Naseer Umar, MUHAMMAD Iftikhar Yousaf & Ayesha Mahmood
DOI: https://doi.org/10.51273/esc20.2516314
Abstract
Objective: To establish the presence of hypercholesterolemia in post-menopausal women by checking an agreement between waist hip ratio (WHR: at a cut off 0.84) with total cholesterol to HDL ratio (TC/HDL at a cut off 4).
Methods: This cross-sectional descriptive study was conducted at the department of medicine over a period of 6 months. 225patients fulfilling the inclusion criteria were recruited after explaining the procedure and taking informed consent. 5 ml. of an eight hours fasting blood drawn in the serum vial and sent to the laboratory for the analysis of total cholesterol and HDL cholesterol according to the hospital laboratory protocol. Waist and hip measurements taken via a reference point at umbilicus and 5 c.m below it via a measuring tape.
Results: 112(49.78%) individuals were from 61-65 years, 69 (30.67%) between 56-60 and only 44(19.55%) were between 51-55 years of age. Frequency of agreement between WHR and TC/HDL ratio was calculated which revealed 72.44%(n=163) as positive and 27.56%(n=62) as negative. Conclusion: It was established that WHR and TC/HDL remains a strong indicator in preventing major cardiovascular events.
Key words: waist hip ratio, total cholesterol to HDL ratio, post-menopausal.
The Frequency of Intranasal synechiae Formation between Nasal Septum and Lateral nasal wall after Endoscopic sinus surgery among patients with sinonasal polyposis
Authors: Damish Arsalan, Sarwat Hassan Syed, Ghulam Murtaza, MOHAMMAD Qamar Nasir, MUHAMMAD Awais Amin & Aamer Ayub
DOI: https://doi.org/10.51273/esc20.2516315
Abstract
Objectives: To determine the frequency of intranasal synechiae formation between lateral nasal wall and nasal septum after (ESS) Endoscopic Sinus Surgery among patients with Sino nasal Polyposis
Methods: After obtaining approval from the ethical committee of our Hospital, a total number of 150 subjects fulfilling the study criteria were recruited in the research which was conducted in the department of Otorhinolaryngology, Services Hospital, Lahore. Demographic information (name, age, gender, contact details) was also obtained were included in this study. All the patients underwent ESS and were followed up post operatively at the end of 1st, 2nd, 3rd and 4th weeks respectively, to observe the formation of synechiae.
Results: Age range in this study was between 21-40 years out of which a small number of patients were < 20 years old. Mean age of the patients was 35.30±10.54 years. Male patients were 80 (53.3%) while female patients were 70 (46.7%). Intranasal Synechiae formation was observed in 28 patients (18.7%).
Conclusion: Intranasal Synechiae formation between lateral nasal wall and nasal septum was found in 18.4% of the patients after endoscopic sinus surgery.
Keywords: Sino nasal polyposis, ESS, Intranasal Synechiae Formation
Comparison of Efficacy of topical Ciprofloxacin Ear drops (0.6%) versus a combination of systemic with topical Ciprofloxacin in treating Chronically discharging Ears
Authors: Sarwat Hassan Syed, Damish Arsalan, Ghulam Murtaza, MOHAMMAD Qamar Nasir, MUHAMMAD Awais Amin, Aamer Ayub
DOI: https://doi.org/10.51273/esc20.2516316
Abstract
Objective: To compare the efficacy of topical ciprofloxacin alone, versus a combination therapy ofsystemic with topical ciprofloxacin(0.6%) in achieving dry ears in active mucosal chronic otitis media after two weeks of treatment.
Methods: After obtaining permission from ethical committee of Hospital, an over-all of 150 patients (with 75 subjects each, divided into two groups) were included in this study.
In Group-A: Topical Ciprofloxacin ear drops (0.6%) 3-4 drops were instilled three times a day, 8 hours apart for 2 weeks.
In Group-B: Tab Ciprofloxacin 500mg was given twice a day, 12 hours apart for 14 days along with topical Ciprofloxacin ear drops (0.6%) 3 drops were used thrice a day, 8 hours apart for 14 days.
Results: Patients ranged between 15-45 years of age. Mean age of the patients was 30.3±7.4 and 29.2±7.7 years. In group-A, there were 41 males (54.7%) and in group-B 49 males (65.3%). Females were 34 (45.3%) in group-A and 27 (36%) in Group-B. Mean duration of ear discharge was 5.3±1.1 months in group-A while 5.5±1.4 months in Group-B. We could not find any substantial variation among the two group in terms of efficacy (p=0.249). Stratification with regard to age, gender and duration of ear discharge was also carried out.
Conclusion: Results of this study showed that topical ciprofloxacin ear drops (0.6%) were equally effective as systemic ciprofloxacin combined with topical ciprofloxacin (0.6%), for treating chronically discharging ears.
Keywords: CSOM, ciprofloxacin, nature of discharge
Assessment of Antibacterial activities of leaves Extract of some Citrus fruits against pathogenic bacteria
Authors: Rukhshan Khursheed, Lubna Amer, Sumera Saghir, Saima Rasheed, Ayesha Siddiqa & Huma Ashraf
DOI: https://doi.org/10.51273/esc20.2516317
Abstract
Objectives: Study was planned to assess the Antibacterial Activities of leave extract of some Citrus Fruits against Pathogenic Bacteria.
Methods: The fresh leaves of Citrus grandis, Citrus reticulata, and Citrus limon plant were collected. The plants were recognized phenotypically and confirmed for taxonomic character by P.C.S.I.R Laboratory Lahore. Microbial Strains including strains of Staph. aureus and Salmonella typhi,which were taken from clinical Laboratory of Fatima Jinnah Medical University Lahore. The antimicrobial activity of the powdered form of Citrus leaves was tested against the strains of bacteria through disc diffusion method and the zone of inhibition was noted.
Results: Antibacterial activities by ethanol extracts of C. lemon and C.reticulate were observed with inhibition zone 2.75 mm and activity index 0.675 against S.aureus. However, low antibacterial activities of C. paradisi were noted against S.aureus and S.typhi. On the other hand, low antibacterial activity of C. lemon and C.reticulata was observed against S. typhi.
Conclusion: The results obtained in the study show that the leaves of C. lemon and C.reticulate exhibit higher antibacterial activity as compared to C.paradesi, which may be due to the presence of large amounts of flavonoid and phenolic compounds.
Key words: Citrus fruits, antibacterial activity, S. aureus, Salmonella typhi
Frequency of Hepatitis A & E infections in adult patients of acute hepatitis
Authors: Rukhsana Gulzar, Rehma Dar, Qurat ul ain, Humair Ahmad, Syed Saqib Ali & Hira Sajjad
DOI: https://doi.org/10.51273/esc20.2516318
Abstract
Objective: To study the frequency of Hepatitis A Virus and Hepatitis E Virus infections in adult patients of acute hepatitis in a Tertiary Care Hospital in Lahore.
Methods: All samples received from medical units (indoor and outdoor) of Mayo hospital Lahore from 26 Feb.2019 to 26.Sept.2019, for Hepatitis A & E IgM antibody testing by ELISA were included in the study. The results and other relevant information were recorded on proforma.
Results: Out of 690 study subjects, 62% were male and 38% were female. The mean age ± SD was 33.8 + 7.4years. The percentage of HAV or HEV infected cases was 59%,and 41% were not infected with HAV or HEV. The frequency and percentage of Hepatitis AVirus was 62(15%),whereas the frequency and percentage of HEV was 327(80%) and that of co-infection with HAV and HEV was 21(5%). The mean + SD age of Hepatitis AVirus was 35.2 + 5.0,whereas the mean + SD age of Hepatitis E Virus and co-infection with Hepatitis A and Hepatitis E Virus were 31.45 + 2.3 and 22.6 + 6.3 years, respectively.
Conclusion: Hepatitis E Virus is the commonest cause of acute hepatitis in our study,followed by hepatitis A Virus and coinfection of HAV and HEV.
Key words: Frequency, Hepatitis A infection, Hepatitis E infection, Co- infection Hepatitis A & Hepatitis E.
Hyperglycemia and its impact on length of stay in patients hospitalized with Community-acquired pneumonia
Authors: MUHAMMAD Nazeer, MUHAMMAD Naeem Afzal, Tabish Raza, Sidra Rasheed, Tariq Suleman & MUHAMMAD Arif Nadeem
DOI: https://doi.org/10.51273/esc20.2516319
Abstract Objectives:
- To determine the frequency of hyperglycemia in hospitalized patients with community acquired pneumonia
- To compare mean hospital stay in patients with and without hyperglycemia admitted with CAP
- Methods: It was a descriptive, case series done at Department of Medicine, Services Hospital, Lahore, in 2016. With non-probability, consecutive sampling technique a sample size of 150 cases is calculated with 95% confidence level, 8% margin of error and talking expected percentage of hyperglycemia as 38.2% in hospitalized patients with community acquired pneumonia.
Results: Out of total 150 cases of CAP there were 85 (56.67%) males with mean age of 47.61±14.66 years. Hyperglycemia was seen in 46 (30.67%) patients with CAP. There was equal distribution of hyperglycemia with respect to gender and age groups with p= 0.56 and 0.24 respectively. Hyperglycemia was more in those having temperature more than 101oF however this difference was not significant with p= 0.32. There was significant difference seen in terms of length of hospital stay,4.07±1.51 days in hyperglycemic and 2.85±1.31 days in normoglycemics with p= 0.001. The length of hospital stay was near significant high in males,4.31±1.56 days (p= 0.08), while non -significant in females with p= 0.30. There was no significant difference in terms of age groups in cases with or without hyperglycemia with p= 0.56 and 0.78. The length of hospital stay was longer in those that had temperature more than 101oF,4.29±1.26 days with hyperglycemia as compared to 2.88±1.34 days in normoglycemics with p= 0.13.
Conclusion: Community acquired pneumonia is an important infectious health concern. It is associated with high blood glucose and the length of hospital stay is found significantly high in cases of hyperglycemia.
Key words: Community acquired pneumonia, Hyperglycemia, hospital stay
Iron Deficiency anemia & adverse events after ST Elevation acute myocardial infarction
Authors: Nighat Majeed, MUHAMMAD Rizwan & Zartashia Samreen
DOI: https://doi.org/10.51273/esc20.2516320
Abstract
Objectives: Study objective was to look for the frequency of iron deficiency in ischemic heart disease patients presenting with acute ST elevation myocardial infarction and to see the association of adverse coronary events with iron deficiency among these patients
Methods: It was a cross-sectional study conducted on three hundred and seventeen patients at coronary care unit/Medical unit of services hospital Lahore. Serum ferritin, iron, and transferrin were measured by using automated immunoassays in patient admitted with acute myocardial infarction and adverse events developed after myocardial were recorded at 5th day of admission. Frequency of iron deficiency anemia was determined in these patients. Adverse events after acute myocardial infarction such as development of recurrent MI, unstable angina, arrhythmias, pericarditis, (EF <50%), adverse outcomes in the form of mechanical complications (ventricular septal defect or mitral regurgitation, and significant impairment of left ventricular functions, stroke and death rate was studied in these patients. Chi-square test was used to see association of iron deficiency anemia with adverse events developed after myocardial infarction.
Results: Frequency of iron deficiency was 82% among patients suffering from acute myocardial infarction. There was significant association of anemia with Post myocardial infarction heart failure (P=0.006), Low EF<50 %( P=0.00), increased mortality (0.076) and pericarditis (P= 0.069).Iron deficiency was associated with of adverse outcomes after myocardial infarction.
Conclusion: Increased frequency of iron deficiency anemia was recorded in patients suffering from acute myocardial infarction and it was significantly associated with the post myocardial infarction adverse events. Keywords: Iron deficiency anemia, Acute myocardial infarction, Adverse outcomes
Postpartum Psychiatric disorders – a neglected issue
Authors: Ameelia Sadaqat, Rabia Afzal, Nauman Mazhar, Naila Mairaj, Sadaf Malik & Aysha Butt
DOI: https://doi.org/10.51273/esc20.2516321
Abstract
Postpartum period along with pregnancy are considered to be emotionally susceptible periods. The association between emotional or psychiatric disorders and postpartum period has been documented since Hippocratic times. Hormonal changes have been implicated, along with multiple factors in the development of depression associated with postpartum period. Moreover, maternal depression can have devastating effects on neonate as well. This study explores an important area to assess the magnitude of problem in our setup, so that appropriate evaluation ohttps://esculapio.pk/wp-content/uploads/2020/12/v16is3a24.pdff mental health status and up-to-date management can be planned.
Objective: To find out psychiatric morbidity among females presenting during postpartum period at a tertiary care hospital in Lahore.
Methods: A cross-sectional study was done in Department of Obstetrics and Gynaecology of Central Park Teaching Hospital, Lahore. One Hundred women presenting in peripartum period were included in the study, using purposive sampling technique. After an informed consent participant’s bio data was recorded. A structured proforma was used for psychiatric evaluation of the cases, which contained social and demographic details along with questions from Edinburgh postnatal depression scale. Psychiatric diagnosis was made according to DSM-5. Severity of illness was assessed using Hamilton rating scale for depression and Hamilton anxiety rating scale.
Results: Postpartum follow up of 100 females revealed that 18% developed psychiatric morbidity. 13 had major depressive disorder and 5 females had anxiety disorder. There was no case of puerperal psychosis in any of the females postpartum in this study. Psychiatric morbidity and age group between 18-25 years (20.6%) showed significant correlation. Similarly, higher incidence of psychiatric morbidity was observed in women living in nuclear household (24.1%).
Conclusion: Psychiatric morbidities are common among females during postpartum period. Major depression is the commonest one. Therefore assessment for depression should be included in routine obstetric follow-ups.
Key Words: psychiatric morbidity, major depression, anxiety disorder, puerperal psychosis, postpartum females.
Bacteriological profile and antibiotic Sensitivity pattern in Infected Diabetic foot ulcers
Authors: Afshan Zia, Shahla Latif, Khadija Irfan Khawaja, Sameen Bint Ali, Salma Hafeez & Hafiza Ammara Sadiq
DOI: https://doi.org/10.51273/esc20.2516322
Abstract
Objectives: To identify the common bacterial pathogens responsible for infection in diabetic foot ulcer and their sensitivity pattern to different antibiotics.
Methods: This prospective observational study was conducted from 24th June 2019 to 27th December 2019 at Services Institute of Medical Sciences Lahore. Specimens of discharge from diabetic foot ulcers (DFU) were received from Diabetes Management Centre (DMC). Cultures were put up and bacteria isolated were identified by standard methods. Antibiotic sensitivity was determined by Kirby-Bauer disc diffusion method.
Results: Samples from DFU of 50 patients were processed. Thirty-six (72%) samples were from males and 14(28%) were from females; mean age of patients was 53±9.5 years. Forty-nine (98%) patients had unsatisfactory glycemic control. Forty three (86%) samples were growth positive while 07(14%) were bacteriologically sterile. Monomicrobial infection was observed in 38 (76%) cases while polymicrobial infection was seen in 12 cases (24%). The most common isolates were Staphylococcus aureus 14(28%), Pseudomonas species 11 (22%) and Proteus species 10 (20%). Forty three percent of Staphylococcus aureus, were methicillin resistant (MRSA). All MRSA remained sensitive to vancomycin and linezolid. In Pseudomonas species, resistance to third generation cephalosporins, ceftazidime , was 27%, while resistance to imipenem was seen in 3 (9%) of isolates. In Proteus species, resistance to third generation cephalosporins was 90% while to imipenem resistance was 60%. Resistance to commonly prescribed quinolones was more than 70% among all the bacterial isolates.
Conclusions: Common Gram positive and Gram negative organisms responsible for infection in DFU were Staphylococcus aureus, Pseudomonas species and Proteus species. The isolates were multi-drug resistant (MDR). Resistance to antibiotics used as empiric therapy was high.
Keywords: Diabetic foot ulcer, antibiotic resistance, empiric therapy
Adaptation of oral Hygiene habits in Dental professionals: A Kap study
Authors: Hanan william, Deema Munir, Rabia Arshad & Shazel william
DOI: https://doi.org/10.51273/esc20.2516323
Abstract
Objective: The present survey was carried out to assess the practice and perception of dental professionals towards their own dental care.
Methods: This cross-sectional study was carried from May 2019 to April 2020, in Altamash Institute of Dental Medicine, Karachi. Ethical approval was obtained from institutional review board. A self- administered questionnaire was developed comprising of 20 questions among the dental personnel (Staff and BDS students) of Altamash Institute of Dental Medicine Karachi, Pakistan, to assess their practice and care, regarding their own oral hygiene. Responses were collected through both, the hard copy and an online google form link. Data was evaluated for 176 complete forms. For all the asked questions, a comparison was also made between male and female candidates, and between their academic levels. For all the variable as categorical values, percentages were tabulated using SPSS 21.
Results: The results indicated that not all the dental professionals had their same practice to maintain oral hygiene. Not all of them were following the proper theoretical knowledge. From their choices of toothpastes to their habits of flossing and using additional aids for maintaining oral hygiene, majority factors varied individually in spite of the fact that there is well-awareness of consequences of negligence.
Conclusion: It was found that not all the dental practitioners follow the proper guidelines to maintain oral hygiene, and not all of them follow the instructions they give to their patients.
Key Words: Oral Hygiene, Dental Professionals, Tooth Paste, Mouth Wash, Dentistry, Oral Hygiene Maintenance, Dental practitioners.
Safety Efficacy of Four Anti-Diabetic treatment regimens in patients with Type 2 Diabetes during Ramadan Fasting: A comparative Study
Authors: Afshan Zia, Shahla Latif, Khadija Irfan Khawaja, Sameen Bint Ali, Salma Hafeez & Hafiza Ammara Sadiq
DOI: https://doi.org/10.51273/esc20.2516324
Abstract
Objective: To compare the anti-hyperglycaemic effectiveness and safety of different anti-diabetic treatment regimens in fasting type 2 diabetic subjects during Ramadan.
Methods: This was a prospective four-week study of 161 subjects with type 2 diabetes (HbA1c 6.5-8.5%) during Ramadan, at the Department of Endocrinology & Metabolism, Services Hospital, Lahore, Pakistan. Study participants were randomized into four treatment groups: lifestyle modification only (group 1: lifestyle), metformin monotherapy (group 2: Metformin), metformin and sulfonylurea (group 3: Met/SU) and metformin and DPP4 inhibitor (group 4: Met/Sita). Anthropometric and biochemical evaluation were done one week before onset of Ramadan and in the last week of Ramadan. 134 patients completed the study protocol and repeated measures ANOVA was used to compare the groupsfor change inclinical and laboratory parameters from pre-Ramadan baseline.
Results: There was a significant decrease in mean blood glucose (mg/dL) and fructosamine(µmol/L)levels post-Ramadan in all treatment groups, with the greatest reduction seen in Met/Sita treatment group [(fructosamine -35.9, p <0.01), mean blood glucose (-23.6, p< 0.05)]. In the safety analysis, Met/Sita group also showed improvement in several metabolic parameters including lipid profile (cholesterol -12.4 mg/dL, p< 0.05; LDL -8.6mg/dL, p <0.05; triglycerides -41.9mg/dL, p <0.05) and transaminases. Only one patient among the study population reported a hypoglycaemic event (Met/SU group).
Conclusion: During Ramadan fasting, combination treatment with metformin-sitagliptinin type 2 diabetic subjects resulted in the greatest improvement in glycaemic control without causing hypoglycaemia, and was associated with improvement in lipid profile and hepatic transaminases.
Key words: Metformin, sitagliptin, fasting, Ramadan, type 2 diabetes, glucose control