Journal of Islamabad Medical & Dental College

Challenges for Infection Prevention and Control Practices in Hospital

Naghmi Asif — 2023-01-03

Vascular Complications and their Risk Factors in Patients of Diabetes Mellitus, Type 2

Dr. Tariq Farhad — 2023-01-03

Introduction: To evaluate the vascular complications and their correlation with different risk factors among type-2 diabetic patients in Hyderabad, Sindh, Pakistan.

Methodology: Cross-sectional study was conducted at the department of medicine Isra University Hospital, Hyderabad from March to September 2021. Type 2 diabetics of either sex, between ages 20 and 70 years, on diabetic medication, were included in the study. While patients with type I diabetes, unconscious or with any mental health issues were excluded. A Non-random consecutive sampling technique was applied for the selection of participants. Socio-demographic, disease and medication information was collected using a written questionnaire while serum glucose level, albumin and lipid profile was analyzed.

Results: Over half of the participants (51.72%) were females, while most (70.87%) of the participants were aged < 40 years. A total of 124(28.5%) patients showed symptoms of macro-vascular complications with most (16.78%) of them having coronary artery disease. A significant relation (p<0.05) was found between coronary artery disease and age, duration of diabetes, blood pressure, body mass index and serum triglycerides. Peripheral vascular disease was significantly related (p<0.05) to the duration of diabetes, systolic blood pressure and serum triglyceride. While significant relation (p<0.05) between cerebrovascular disease with age, systolic and diastolic BP was there.

Conclusion: Coronary artery disease seems to be the most common macro-vascular complication among type 2 diabetic patients, with a high prevalence of risk factors such as advanced age, duration of DM, male sex, hypertension, Body Mass Index, and serum triglycerides.

Keywords: Coronary artery disease, diabetes mellitus type 2, Macro-vascular complications, peripheral vascular disease.

Functional Outcome of Ilizarov Technique in Managing Proximal Tibial Fracture in Combined Military Hospital, Rawalpindi

Hassan Udin Hassan — 2023-01-03

Background: Tibial plateau fractures involve injuries affecting the major weight-bearing joint and result in functional impairment which can be prevented by implying competent treatment techniques including dual column plating, assisted reduction, internal fixation with plating and Ilizarov circular fixator. The objective of this study was to evaluate the functional outcome of Ilizarov technique in treating closed tibial plateau fractures.

Methodology: A Quasi experimental study was conducted in the Orthopedic department of Combined Military Hospital, Rawalpindi from 30^th July 2019 to 29^th January 2020. A total of 100 patients with tibial plateau fractures of Schatzker type III to VI, 20 to 60 years of age of either gender were included. In all patients, Ilizarov technique was performed. Data were entered in SPSS 22. Descriptive analysis was done for quantitative variables and percentages were calculated for qualitative variables. Chi square test was applied to determine association of variables with functional outcome.

Results: Mean age of patients was 37.42 ± 8.94 years. Out of 100 patients, 70% were males and 30% were females, 76% patients managed with Ilizarov technique in treating closed tibial plateau fracture had excellent functional outcome, 15% good outcome, 5% fair and 4% poor outcome. Functional outcome with respect to age, gender, BMI and DM showed statistically significant difference with p value 0.017, 0.016, 0.004 and 0.001 respectively.

Conclusion: Functional outcome of Ilizarov technique in treating closed tibial plateau fracture is significantly better.

Keywords: Ilizarov Technique, Orthopedic Fixation Devices, Tibial Fractures

Effect of Pretreatment of Lignocaine Versus Midazolam in the Prevention of Etomidate Induced Myoclonus

Fizza Batool — 2023-01-03

Background: The myoclonus after induction of anesthesia with etomidate can lead to increased risk of regurgitation and aspiration. We conducted this study to compare the effectiveness of midazolam and lidocaine for the prevention of etomidate induced myoclonus.

Methodology: This randomized controlled trial was done in the Department of Anesthesiology and Intensive Care, Holy Family Hospital, Rawalpindi from January-June 2015 after approval of hospital ethical committee. Informed consent (written) was taken from 224 patients. Patients were allocated into 2 equal groups randomly with the help of computer-generated numbers. Two minutes after induction with etomidate, Group A got 1 ml of 2% lidocaine, and one ml (1 mg) of midazolam was given to Group B. Myoclonus was evaluated in the following one minute, after which 0.5 mg/kg of succinylcholine was given to the patient to facilitate endotracheal intubation.

Time of onset of induction was marked by loss of eyelash reflex. Myoclonus was recorded at 20, 40, and 60 seconds. Drug was found to be effective if there was no myoclonus within one minute of etomidate induction. Analysis of data was done using SPSS 17.

Results: Lignocaine was effective in preventing myoclonus in 55.40% of patients and Midazolam prevented it in 69.60%. The variation between the results of the groups was found significant statistically. (P< 0.05)

Conclusion: Both midazolam and lignocaine are effective in preventing the occurrence of myoclonus associated with etomidate. However, midazolam is the more effective of the two drugs.

Keywords: Etomidate, Lignocaine, Midazolam, Myoclonus

Effect of Depression on Serum Levels of Follicular Stimulating Hormone and Luteinizing Hormone in Male Population of Military Hospital, Rawalpindi

Dr. Nasar Abbas Shamsi — 2023-01-03

Background: Depression is a psychiatric illness that affects the overall life quality of an individual. In depression along with other symptoms, one of the features affecting the personal life of individuals is loss of libido which is influenced by the hypothalamic-pituitary-testicular axis. This study was aimed to determine the serum levels of Follicular stimulating hormone (FSH) and Luteinizing hormone (LH) in depressed male patients.

Methodology: This comparative cross sectional study was done at Islamic International Medical College and Armed Forces Institute of Mental Health, Military Hospital Rawalpindi after being approved by ethical review committee. After informed consent, 96 male individuals having 18 – 60 years of age participated in the current study. Participants were segregated into groups A and B. Gender and age-matched healthy subjects in a quantity of 24 were taken in group A whereas group B consisted of 72 male depressed patients. Serum gonadotropins levels of both groups were compared by using an independent student t-test in SPSS 21.

Results: Serum FSH (2.66 ± 0.34 mIU/ml) and LH (2.67 ±0.18 mIU/ml) levels of Group A have shown no significant difference as compared to serum FSH (3.32 ± 0.43 mIU/ml) and LH (3.12 ± 0.19 mIU/ml) levels of Group B.

Conclusion: It is concluded from the study that serum FSH and LH levels were not significantly decreased in individuals with depression.

Keywords: Depression, Follicle stimulating hormone, Luteinizing hormone

C -Reactive Protein, Leukocyte Count and Neutrophils: A Diagnostic Aid in Acute Appendicitis

Ashar Ahmad Khan — 2023-01-03

Background: Many clinical methods, scoring systems, radiological and laboratory investigations are used to diagnose and differentiate simple from complicated appendicitis. Proactive approach results in high rate of negative appendectomies and conservative approach results in increased rate of post-operative complications. The objective of this study was to evaluate the role of CRP, TLC and Neutrophil percentage in the diagnosis and differentiation of simple and complicated appendicitis.

Methodology: This cross sectional study was conducted at department of Surgery, Nishtar medical university/hospital, Multan from 1^st November, 2019 to 30^th April, 2021. Blood samples from patients were collected after admission, for CRP, TLC and Neutrophil percentage. Data were collected and analyzed through SPSS version 23.

Results: A total of 320 patients more than 12 years of age, 168 (52.5%) male and 152 (47.5%) female with 1.10:1, were included in the study. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of CRP were 90.6%, 80%, 96% and 61.5% for acute appendicitis and 96.7%, 80%, 98.3%, and 66.7% for perforated appendicitis respectively with p-value of <0.000. Sensitivity, specificity, PPV and NPV of TLC were 87.5%, 80%, 95.9% and 54.5% for acute and 93.3%, 90%, 99.1% and 52.9% for perforated appendicitis with p= <0.000. Sensitivity, specificity, PPV and NPV of Neutrophils, in acute and perforated appendicitis were 83.8%, 76.7%, 95%, and 46.9% versus 87.5%, 70%, 97.2%, 31.8% respectively with P-value < 0.000.

Conclusion: Sensitivity, specificity and PPV of CRP, TLC and Neutrophils increased with the severity of appendicitis. Combining the results of the above three markers increased the diagnostic accuracy.

Keywords: Acute appendicitis, CRP (C-reactive protein), TLC (Leukocyte count) and Neutrophils.

Role of Steroids in Reducing Recurrence of Urethral Stricture after Direct Vision Internal Urethrotomy

Umer Farooq — 2023-01-03

Background: Recurrence of urethral strictures is the most frequent and bothersome complication, with majority of stricturesrecurring after optical internal urethrotomy. The objective of this study was to establish the role of oral steroid therapy after direct vision internal urethrotomy (DVIU) in minimizing recurrence of urethral stricture.

Methodology: It was a randomized controlled trial carried out at Armed Forces Institute of Urology, Rawalpindi from January 2018 to March 2021. A total of 180 male patients with urethral stricture of ≤2 cm were included. Patients with traumatic stricture, post-anastomotic urethroplasty strictures, neurogenic bladder and history of steroid intake were excluded. Patients were randomly categorized into two groups i.e. Group A patients were given oral prednisolone (6 mg tablet twice daily for 4 weeks) while group B was control group. Patients were followed up to 12 months for recurrence of stricture.

Results: The mean age of patients in group A was 44.38 ± 8.03 years while in group B was 46.64 ± 6.66 years. The mean length of stricture in group A was 0.93 ± 0.26 cm and in group B was 0.95 ± 0.27 cm. Recurrence of stricture was seen in 18 (20.0%) patients in group A (oral steroids group) and 42 (46.67%) patients in group B (no oral steroids) with p-value of 0.0001.

Conclusion: Oral prednisolone therapy after internal urethrotomy waseffective in decreasing the rate of recurrence of urethral stricture.

Keywords: Oral, Recurrence, Steroid, Urethral Stricture.

Nutritional Status of Pediatric Cancer Patients and its Association with Repeated Hospitalizations

Hijab Shaheen — 2023-01-03

Background: Malnutrition is known to be a poor prognostic factor affecting the outcome of pediatric cancers. The objective of this study was to assess the pre-existing malnutrition in newly diagnosed pediatric cancer patients presenting at the Pediatric Oncology Department, Children Hospital, PIMS and their number of hospital admissions due to causes other than chemotherapy.

Methodology: Data of 44 newly diagnosed children with cancer was analyzed to find out the association of nutritional status according to z-score for weight and height for age, body mass index (BMI) and mid-upper arm circumference (MUAC) with their number of hospital admissions for 6 months since their date of diagnosis.

Results: The mean age of the study subjects was 4.25 ± 2.85 years, out of which 33(75%) were males and 11(25%) females. Most of the patients were diagnosed with leukemia or lymphoma. Nutritional status evaluation of thirty patients who got admitted was mild to moderate wasting in 24(80%) assessed by weight for age, mild to moderate stunting in 21 (70%) according to height for age and mild to severe malnutrition in 10 (33%) based on body mass index and mid upper arm circumference (MUAC). There was significant association between nutritional status of patients at the time of diagnosis with additional hospitalization with p value less than 0.05

Conclusion: Malnutrition at the time of diagnosis is significantly associated with an increase in the number of hospital admissions in pediatric cancer patients.

Key words: Hospitalization, Malnutrition, Oncology, Pediatric

Sexually Transmitted Diseases and Associated Risk Factors Among Transgenders in Peshawar

Muhammad asif Zeb — 2023-01-03

Background: Transgenders, male to female, are exceptionally predominant in India-Pakistan, dreaded to be alarming for sexually transmitted diseases. The objective of this study was to determine the frequency of sexually transmitted diseases and their associated risk factors among transgenders.

Methodology: This cross-sectional study was conducted amongst transgenders at Institute of Paramedical Sciences (IPMS), Khyber Medical University Peshawar from January to July,2021. About two ml of venous blood was collected in a gel tube under aseptic conditions among 100 individuals to check for HBsAg, anti-HCV, HIV and syphilis by ICT rapid strip method. Positive samples of HBsAg and anti-HCV were confirmed by Polymerase Chain Reaction (PCR), while positive cases of syphilis were confirmed by Treponema Pallidum Hemagglutination (TPHA). Chi-square test was applied to determine the association between sexually transmitted disease and associated risk factors.

Results: Out of 100, seven (7%) samples were positive for HBsAg, five (5%) for anti-HCV and nine (9%) were positive for syphilis while there were no positive cases of HIV. HBV infection was significantly associated with blood transfusion, a drug injection history and some surgical procedure (p<0.05). For syphilis, the data were significantly associated with a history of blood transfusion and drug injection (p<0.05).

Conclusion: Frequency of HBV, HCV and syphilis infections are high in transgenders with common associated risk factors to be sexual activities, drug injection, unsafe blood transfusion and surgical procedures.

Keywords: Chromatography, Hepatitis B surface antigen, Hepatitis C Antibodies, HIV, Syphilis, Transgenders

Perception of Ethics and Professionalism Teaching among Dental Professionals at a Teaching Hospital in Karachi

Rubab Jawed — 2023-01-03

Background: Health care professionals come across many ethically difficult situations in their clinical practices and community; the students should be equipped with skills to resolve ethical and professional issues.

Methodology: A cross-sectional study was conducted at Baqai dental college, Karachi. All the faculty members and house officers of the dental teaching hospital were included in the study. The tool used for the data collection was a structured questionnaire, for drawing views of the participants on professionalism and ethics teaching. The survey instrument evaluated two domains; attitudes 25 items, and goals 19 items on ethics and professionalism education. Data were recorded and analyzed in SPSS 24. To compare the responses of both the groups, that is, the house officers and the faculty member’s independent t-test was applied to compare the mean scores. A p-value of ≤ 0.05 was considered significant.

Results: The questionnaire was circulated to a total of 157 participants (75 faculty members and 82 house officers) with a 100% response rate. The faculty members and the house officers showed a positive attitude regarding ethics, professionalism, and teachings. The participants agreed with the goals that can be achieved by incorporating professionalism and medical ethics in education. The participant strongly affirmed the learning and teaching of professionalism (4.06 ± 0.989).

Conclusion: The realization of the need to teach ethics and professionalism by dental professionals is the first step to bringing change in their daily clinical practice and interpersonal qualities.

Keywords: Ethics, Professionalism, “Education, Medical”, “Personality development”, “Social Desirability”.

Ectopic Mediastinal Parathyroid Adenoma Excision via Video Assisted Thoracoscopic Approach: A Case Report

Bilal Umair — 2023-01-03

Ectopic parathyroid adenomas can be a cause of recurrent and refractory hyperparathyroidism. Majority of parathyroid adenomas are located in the neck region, however in very few cases they are located within the mediastinum. In such cases excision via cervical approach is not possible and it becomes a diagnostic as well as surgical challenge. Excision via thoracoscopic approach is a preferred approach in this regard. Here we represent a case of ectopic parathyroid adenoma embedded within thymus gland which underwent surgical excision via thoracoscopic approach.

Key words: Ectopic, Parathyroid adenoma, Thoracoscopy

Primary Diffuse Large B Cell Lymphoma Presenting as Chest Wall Mass: A Case Report

Muhammad Zeeshan — 2023-01-03

Primary chest wall masses or tumors can be of two types, either benign or malignant. Diffuse large B cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL). Though an aggressive malignancy, with timely and appropriate treatment, approximately two-third of all patients can be cured. We present a rare case of DLBCL presenting as chest wall mass. This case suggests the possibility of the presence of primary malignant B cell lymphoma, with the presentation as a chest wall lesion.

Keywords: Chest mass, Diffuse large B cell lymphoma, Mass, Non- Hodgkin’s lymphoma.