Journal of Islamabad Medical & Dental College

Next Generation Sequencing and it’s Clinical Applications

Naghmi Asif — 2024-09-21

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Ali Raza Jafri — 2024-09-16

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population.

Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children.

Study Design: Prospective comparative study.

Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024.

Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations.

Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287).

Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Laparoscopic Appendectomy: A Safe and Feasible Procedure in Emergency Department of a Public Sector Hospital

Huma Sabir Khan — 2024-09-16

OBJECTIVES:

To evaluate LA (laparoscopic appendectomy) in terms of operative time, post-operative recovery and rate of post-operative complications in Department of Surgery, Benazir Bhutto Hospital, Rawalpindi

METHODOLOGY:

A prospective Descriptive study. This study was carried out at Benazir Bhutto Hospital, Rawalpindi. The data was collected prospectively for a duration of five years, from March 2019 to March 2024. Data was collected prospectively for patients operated for acute appendicitis by laparoscopic appendectomy with the help of questionnaires. Data of patients undergoing laparoscopic appendectomies over five years was collected by consective non-probabilty sampling technique.

RESULTS:

108 patients underwent laparoscopic appendectomy from March 2019 to March 2024 with follow-up of up to 01 month. 50(46.2%) men and 58(53.7%) women were included in the study. The mean age was 28±7.8 years. The mean operative time was 45±24.3 mins. 3.3% of operations required conversion to laparotomy. The mean length of stay was 1.5±3 days. Post-operative pain on the visual analog scale averaged around 6 on day one and reduced thereafter. The mean resumption of physical activity was 6 hrs. post-operatively. There was no death in the 30-day postoperative period. No complication occurred except for port site skin infection in 3 patients, intrabdominal abscess in 1, and fever in 9 patients.

CONCLUSION:

Our study advocates that laparoscopic appendectomy is a safe minimal invasive procedure with minimal complications.

Early Postoperative Pain in Mesh Fixation Versus without Fixation in Open Lichtenstein Mesh Hernioplasty

Asad Sami — 2024-09-16

Background & Objective: Inguinal hernia is a frequently encountered issue in surgical practice. Surgical techniques for hernia repair have significantly advanced and improved. The study objective was to compare early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty regarding early postoperative pain.

Methods: A randomized control trial was done at the Department of Surgery of the Federal Government Services Hospital, Islamabad from April to December 2023. Total 60 patients meeting the inclusion criteria and were presented with inguinal hernia. Randomly patients were divided into two groups, each consisting of 30 patients and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of mesh. Patients from both groups were observed for 24-hours and early postoperative pain was recorded using visual analog scale (VAS). The data underwent analysis utilizing SPSS v 25.

Results: The mean age of the patients was 46.0±9.2 years. Among 60 patients, 36 (60%) men and 24 (40%) women. The average BMI was 26.34±4.27 kg/m². No significant difference was observed in postoperative pain between two groups (p ≥ 0.05). A t-test was utilized to compare the VAS score between two groups and it was observed the results insignificant except in patients with BMI less than 25 (p ≤ 0.05).

Conclusion: There is no difference in occurrence of postoperative pain in fixed versus non-fixed mesh.

Role of MDCT in Patients with Abdominal Trauma

Abdul Qadeer Khan — 2024-09-16

Objectives: To assess the role of abdominal imaging for precise identification of the injuries for early surgical exploration by using Multidetector Computed Tomography (MDCT) and to assess those patients that can be managed conservatively.

Study Design: Prospective cross-sectional observational study.

Place and Duration of the Study: Pakistan Air Force Hospital Islamabad, November, 2022-November, 2023.

Methodology: The study was carried out on 120 cases of abdominal trauma. MDCT scan with contrast was performed after the initial resuscitation and stability of the patients in the emergency room being done by the respective medical and paramedical staff.

Results: In clinically stable patients, the use of multi-detector CT as initial triage of abdominal trauma resulted in a reduction in the number of laparotomies by 91% and an increase in number of conservatively managed with a better outcome of around 95% and 92% respectively.

Conclusion: The current study assessed and showed the better role of MDCT in evaluation of the blunt trauma patients in early detection and timely surgical exploration. MDCT imaging test helps the clinicians in making an early and right choice of intervention. The high-resolution MPR, MIP, and 3-D volume reconstruction images assisted in displaying complex injuries, increasing diagnostic capacity, accuracy, associated vascular and bony pathologies, and reduced reporting time.

Pattern of Abdominal Injuries, Organ Involved and Rate of Negative Laprotomy in Tertiary Care Hospital

Viqar Aslam — 2024-09-16

Objective:

This study was designed to evaluate the pattern of abdominal injuries the value of the surgery in assisting diagnosis, laparotomy and mortality rate.

Methods:

Out of 1923 total trauma patients 886 individuals were included in the study from a tertiary care hospital. Demographic , trauma-related traits, laparotomies with their indications, etiology and the organs affected were all collected. With SPSS 23 were used to evaluate data

Results:

The mean age patients were 27.05 years mostly male. Mortality and negative laparotomy rate were 5.9 and 15.4 percent respectively. Blunt injures were more than penetrating .Spleen was the frequent organ damage.

Conclusion:

Blunt trauma with spleen mostly involved organ. Mortality and negative laparotmy rate are comparable to other studies

Comparison of Open Haemoridectomy (Milligan-Morgan) and HAL-RAR in the Treatment of Grade III and IV Haemorrhoids

Atia Khatoon — 2024-09-16

Background & Objective: Hemorrhoidectomy (HD), either open (Milligan-Morgan) or closed (Ferguson), is the conventional treatment for stages 3 and 4 of the condition. HAL-RAR therapy, a minimally invasive treatment for high-grade hemorrhoids, involves the integration of HAL (hemorrhoidal artery ligation) with a procedure known as mucopexy, which lifts the hemorrhoidal prolapses. The study objective was to compare the efficacy of open hemorrhoidectomy against haemorrhoid artery ligation with recto-anal repair (HAL-RAR).

Methods: A comparative randomized controlled trial was conducted at general surgery department of Pakistan Aeronautical Complex Hospital Kamra and Pakistan Air Force Hospital Islamabad between June 2021 and December 2022. Total 30 patients diagnosed with hemorrhoids of grades III–IV were assigned randomly to either HAL-RAR (n=15) or hemorrhoidectomy (n=15). Every procedure was a day surgery performed under spinal anesthesia. After 15 days, 30 days, and 6 months patients were re-evaluated. Patients rated their own pain on a visual analog scale. All the data was analyzed by SPSS v 26.

Results: Mean age of the participants was 51.3±6.67 years. HAL-RAR group addressed a greater number of prolapsed hemorrhoidal cushions compared to the hemorrhoidectomy group (2.9 vs 2.02, p = 0.001), and the operation took longer in HAL-RAR group (40 min vs 24 min, p = 0.001). HAL-RAR group had less discomfort in the first 30 days after surgery (p = 0.001). In addition, higher number of patients in HAL-RAR group reported experiencing relief from pain (VAS = 0) after day 7. By day 15, HAL-RAR group had substantially better symptom resolution than the hemorrhoidectomy group. Resolution of bleeding, prolapse, itching, and soiling occurred sooner in HAL-RAR group than in hemorrhoidectomy group during the 30-day follow-up.

Conclusion: The symptoms of haemorrhoids are resolved with less discomfort with HAL-RAR than after hemorrhoidectomy, and recovery time is shorter.

Ovulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome at Fertility Clinic of a Tertiary Care Hospital, Rawalpindi

Unsa Malik — 2024-09-16

Background: More than 80% of premenopausal females presenting with Polycystic Ovarian Syndrome (PCOS) have above average BMI. Obesity enhances the magnitude of hormonal and metabolic disturbances leading to anovulation.
Objective: To validate the influence of obesity on response of ovulation induction by Clomiphene citrate in PCOS related subfertility.
Methodology; Study Design & Setting: Comparative Analytical study at Fertility Clinic of Department of Obstet & Gynae, Benazir Bhutto Hospital, Rawalpindi.
Study Duration: Twelve months (Dec 2020-Dec 2021)
Method: Rotterdam criteria was used to diagnose PCOS. WHO criteria of BMI=23 kg/m² cutoffs for Asian population was used to divide women in two groups; non-obese (Group-A < 23 kg/m²) and obese/overweight (Group-B ≥ 23 kg/m²). In both groups ovulation was induced with Clomiphene Citrate and response was assessed via ultrasound follicular tracking, Day 21 serum progesterone and serum B-HCG levels two weeks after the HCG injection.
Results: Total participants were 200 (100 in each group). Mean age (years) in Group-A vs Group-B was 25.38 vs, 27.62 and mean BMI (kg/m²) was 20.82 vs 28.34 respectively. The frequent symptoms in Group-A Vs Group-B were Oligomenorrhoea (87% vs 97%) and amenorrhoea (13% vs 03%). P-value (0.009) was significant. Difference in Ultrasound features of PCOS and LH:FSH ratio in both groups were insignificant (P-value=0.214 and 0.316 respectively). The difference in almost all parameters of OI between the two groups was statistically significant. In Group-A vs Group-B; the presence of dominant follicle after Clomiphene citrate was 52% vs 34% (p value=0.01); Day 21 serum progesterone >30ng/ml was 21% vs 09% (p value=0.01); a positive serum β-HCG level >50 mIU/L 02 weeks after HCG administration was 12% vs 04% (p value=0.09).
Conclusion: Obesity control and lifestyle modification are imperative for significant improvement in fertility outcomes for PCOS related subfertility.

Trends of Antimicrobial Sensitivity Among Common Isolates in a Tertiary Care Hospital, Rawalpindi

Uzma Mussarat — 2024-09-16

Objective: To evaluate the resistance patterns of frequently found pathogens to different antimicrobial agents, aiding physicians in choosing appropriate treatment strategies for patients within our locality.

Materials and Method: This retrospective observational study took place at Pakistan Railway hospital (PRH) Rawalpindi; from January 2021 to December 2021. Data was obtained from the institute's database, the Hospital Information Management System (HIMS). Pathogens were identified in the laboratory through Gram staining and biochemical tests, and their antibiotic sensitivity profiles using disk diffusion method assessed following protocols established by the Clinical & Laboratory Standards Institute. Statistical analysis was conducted using SPSS version 24, and data entry was carried out accordingly.

Results: Overall, 1128 positive cultures were reported in study period including urine, pus, HVS, sputum cultures, stool, blood, catheter tip, and others (tissue fluid, wound, and cannula tip etc.). They comprised 32.8 %, 30.9 %, 16.6%, 5.05 %, 3.81%, 3.72 %, 1.15%, 0.70 % and 0.08% of the other specimens respectively. Among the isolates, Escherichia coli revealed 31.4% resistance against one of the third-generation cephalosporin and 8% to imipenem while Klebsiella pneumoniae exhibited 58.7% resistance. Moreover 82% Staphylococcus aureus were resistant to oxacillin, and 6% to vancomycin.

Conclusion: Moderate to reduced susceptibility to frequently utilized antimicrobials has been noted across diverse gram-positive and gram-negative species, apart from Penicillin. To address the escalating resistance to carbapenems and cephalosporins, it is essential to establish and enforce rigorous infection control measures.

Types and Frequency of Complications in Laparoscopic Cholecystectomy in Acute Cholecystitis in Tertiary Care Setup

Asma Bibi — 2024-09-16

Abstract

Laparoscopic cholecystectomy is the procedure usually performed in our setups for both acute & chronic Cholecystitis and simple gall stone disease.

Objective

Find the outcomes of laparoscopic cholecystectomy in acute cholecystitis in our hospital setup.

Methods

This prospective cross sectional study was conducted in Hazrat Bari Sarkar Hospital Islamabad on 10^th Nov 2022 to 30 June 2023. The patients from above 10 year age with both genders were included by convenient sampling. All Diagnosed cases of gall stone disease with acute cholecystitis, acute on chronic cholecystitis, abscess, and empyema or mucocele gall bladder were included in this study. SPSS 22 was used for data analysis that was recorded on a performa.

Results

This study included 77 laparoscopic cholecystectomies done for Acute Cholecystitis. 53 female & 24 male patients with female to male ratio of 2.2:1 undergoing laparoscopic cholecystectomies were included in the study. The mean age of patients was 47.6 years + 11.6 SD. The mean operative time was around 90min + 13.5 SD and the mean hospital stay was 2.23 days + 0.77 SD with a range of 1-4 days.

Conversion rate to open cholecystectomy was noted in 8 cases. The operative complications were bleeding in 2 cases, minor bile duct injury in 2 cases, surgical site infection 15 cases, retained stone in 2 cases.

Conclusion

Laparoscopic cholecystectomy for acute cholecystitis has better results in patient outcomes as regards post-operative recovery & length of hospital stay & safety.

Effect of Warm Saline Irrigation Versus Negative Gas Suction on Reduction of Postoperative Pain in Patients of Laparoscopic Cholecystectomy

Saad Ali Shah — 2024-09-16

ABSTRACT

OBJECTIVE: To compare warm saline irrigation and negative gas suction in terms of frequency of severe postoperative pain in patients of laparoscopic cholecystectomy.

PATIENTS AND METHODS: A comparative clinical trial was conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of six months. After ethical approval from the hospital ethics committee, all patients who had laparoscopic cholecystectomy for gallstones were enrolled in the study. Patients were randomly divided into two equal groups by lottery methods. One group had warm saline irrigation of the operative field while the other group had negative gas suction at the end of the procedure. The pain score was recorded postoperatively by visual analog score. SPSS version 21 was used for descriptive analysis of the variables.

RESULTS: A total of 102 patients were included according to the study's inclusion criteria. All the patients were observed for 24 hours for severe postoperative pain. The mean age (years) of the patients was 40.40+11.55 years. There were 28 (27.5%) male and 74 (72.5%) female patients in the study. The frequency of severe postoperative pain in patients of laparoscopic cholecystectomy among warm saline irrigation and negative gas suction was 33 (64.7%) and 14 (24.5%) respectively which was statistically significant (p-value ˂0.001).

CONCLUSION: Patients in the negative gas suction group have better modalities in reducing severe postoperative pain after laparoscopic cholecystectomy. This helps in early pain relief that reduces the agony of the patients and shortens the post-operative hospital stay.

KEYWORDS: Cholelithiasis, Laparoscopic Cholecystectomy, Postoperative Pain

Assessment of Clinical Outcomes in Patients with Oral Lichen Planus and Oral Lichenoid Lesions Following Treatment with Topical Corticosteroids

Fareed Ahmad — 2024-09-16

Objective: To assess the clinical outcomes in patients with oral lichen planus and oral lichenoid lesions (OLP & OLL) following treatment with topical corticosteroids.

Methodology: A total of 175 patients diagnosed with OLP and OLL were recruited from the outpatient department. This cross-sectional study was conducted at Institute of Dentistry (IOD) & CMH, Lahore from July 2023 to December 2023. Inclusion criteria included patients aged 18 years and above with clinically and histopathologically confirmed OLP or OLL lesions. All enrolled patients received topical corticosteroid therapy according to a standardized protocol. Patients were instructed on proper application techniques and advised to adhere to the prescribed treatment regimen. Clinical evaluation of the oral mucosal lesions was performed at baseline and at regular follow-up. Outcome measures included changes in lesion size, severity of symptoms (pain, burning sensation), and overall improvement in clinical appearance.

Results: The mean age of the patients was 52.4 years (SD: 10.3). In terms of gender distribution, among the included patients 25 patients (28.57%) were male and 25 patients (71.42%) were female. Among the symptoms observed, Pain was reported by 95 patients (54.28%), Burning Sensation by 110 patients (62.85%), Discomfort by 75 patients (42.85%), and Other symptoms by 20 patients (11.42%). In the clinical outcomes observed with topical corticosteroids, reduction in lesion size was noted in 140 patients, accounting for 80.0%, complete resolution of lesions occurred in 60 patients, representing 34.3%, and reduction in symptoms was reported by 155 patients, constituting 88.6%. Oral candidiasis was noted in 7 patients (4.0%), Mucosal atrophy occurred in 13 patients (7.42%), whereas the majority.

Conclusion: In conclusion, our study underscores the efficacy of topical corticosteroid therapy in managing oral lichen planus (OLP) and oral lichenoid lesions (OLL). With 80.0% of patients experiencing a reduction in lesion size, 34.3% achieving complete resolution of lesions, and 88.6% reporting a reduction in symptoms, our findings highlight the significant therapeutic benefits of topical corticosteroids.

GeneXpert Assay in Detection of Pulmonary Tuberculosis and Rifampicin Tuberculosis Resistant in Tehsil Hazro Population; A Cross Sectional Study

Shaukat Mehmood — 2024-09-24

Objective: To determine the prevalence of Tuberculosis and MDR Tuberculosis by GeneXpert assay in Tehsil Hazro District Attock.

Study design: cross sectional study

Place and duration of study: Study was carried out at THQ hospital Hazro of District Attock from January 2019 to December 2020

Patients and Methods: Total 1460 patients of TB suspect were included in the study. First LED microscopy of all TB suspects was done. LED Microscopy positive cases along with suspects having history of HIV, close contacts of MDR TB, all TB cases of retreatment and sputum-negative cases of LED microscopy having positive clinical findings were sent for GeneXpert Assay. Results from the GeneXpert assay were categorized as GeneXpert positive, GeneXpert negative, and MDR Tuberculosis. Determinants of MDR- TB were identified using questionnaires regarding MDR –TB.

Results: Out of total 205 patients on GeneXpert Assay, 43 patients were GeneXpert positive test with no rifampicin resistance, 3 patients were GeneXpert positive with rifampicin resistance and 63 patients were GeneXpert negative but sign and symptoms, X-ray findings and laboratory tests were supporting tuberculosis and according to opinion of TB specialist they were labeled as Sputum negative Tuberculosis. Tuberculosis prevalence in Tehsil Hazro was 0.073. From the results, it was concluded that an overall MDR rate was 2.7% in our study population.

Conclusion: GeneXpert Assay is a rapid technique and reliable for Mycobacterium detection. The main determinants of MDR-TB were the patients who had contact h/o with MDR cases and those who did not follow the treatment regime in their previous Tuberculosis treatment.

Keywords: GeneXpert Assay, LED microscopy, MDR Tuberculosis, Sputum positive TB, Sputum negative TB.

Head Injury Management in Road Traffic Accident Patients: A Case Report

Soobia Saeed — 2024-09-16

Objective: To examine recovery outcomes for patients with head injuries from road traffic accidents (RTAs), focusing on neurosurgical care.

Methodology: We studied patients admitted to our hospital with head injuries from RTAs. This included a case study of a 55-year-old man severely injured in a road accident, highlighting neuropsychological assessments and treatment outcomes.

Results:

The case report presents the successful recovery of a 55-year-old patient who sustained severe head injuries from a road traffic accident. Following neurosurgical intervention to remove blood clots and comprehensive neuropsychological therapy, the patient showed significant improvement in memory and cognitive functions. The outcomes demonstrate a positive response to the integrated treatment approach, with the patient regaining substantial normalcy in life over the course of three months.

Conclusion: The case of a 55-year-old patient highlights the challenges and outcomes of treating severe head injuries resulting from RTAs. Key findings include the importance of immediate and appropriate neurosurgical care and neuropsychological support.

An Extensive Infiltrative Diffuse Tenosynovial Giant Cell Tumor in Both Compartments of the Forearm: A Case Report

Safdar Ali Khan — 2024-09-16

Diffuse tenosynovial giant cell tumors are relatively rare but second most common tumor effecting the synovial containing tissues. The study aim was to present a case involving a 40-year-old male patient with a complaint of a progressively enlarging swelling on the radial side of right wrist. On local examination, there was a bi-lobed swelling 7×9 and 6×5 cm on the dorsolateral and anterolateral aspect of right wrist respectively. Through Hennery’s modified approach tumor was exposed. It was extending from dorsolateral to anteromedial wrist encasing the flexors, extensor and abductor tendons of thumb and radial neurovascular bundle and adjacent wrist and finger flexors. The tumor surrounding the tendons was carefully removed, and carpal tunnel release was performed to address the tingling sensation. The patient managed was having lobulated diffuse type tumor involving the both flexor and extensor compartment. Better outcome, less morbidity and least chance of recurrence can be expected if the tumor had been operated earlier.

Medical Journalism and Role of Accreditation in Enhancing Quality of Medical Journals in Pakistan

Usman Waheed — 2024-09-25