Journal of Islamabad Medical & Dental College

Need Assessment of Renal and Liver Transplant in Pakistan

2025-01-07T07:14:35+05:00

Comparison of Sevoflurane Versus Ketamine for Induction of Anaesthesia in Children

2025-01-07T07:14:57+05:00

Background and Objective: Induction of general anaesthesia in paediatric patients is a challenging task. Sevoflurane and ketamine both can be used for induction. The purpose of this study was to find out ideal induction agent in paediatric cases. We compared induction time, hemodynamic variation and oxygen saturation with ketamine and sevoflurane in paediatric patients undergoing different surgeries.

Methodology: A randomized controlled trial was conducted at Department of Anaesthesia Children Hospital, PIMS, Islamabad from December 2018 to May 2019. We enrolled a total of 130 paediatric patients of either gender with age 4-12 years, who were planned for surgery under general anaesthesia. Patients were randomly allocated into two groups for anaesthesia induction. Group S patients received 8% Sevoflurane given via face mask in 100% oxygen at FGF of 6L/min and group K patients received Ketamine 1 mg/kg body weight via intravenous route. Mean time of induction, heart rate response, mean arterial pressure (MAP) response and oxygen saturation after induction was measured at one and two minutes and compared in both groups. All information was recorded via study Proforma and SPSS version 17 was used for data analysis.

Results: Mean age of group S patients was 6.8 years ± 2.9 and in group K patients was 7.3 years ± 2.5 (Ρ=0.372). There were 73.8% males and 26.2% females in group S and 61.5% males and 38.5% females in group K. Mean induction time in group S patients was 56.2 seconds ± 27.7 and in group K patients was 71.2 seconds ± 37.3 (Ρ=0.011). The induction time was significantly shorter in group S patients as compared to group K patients. At one minute, mean heart rate in group S patients was 112.4 bpm ± 18.8 and in group K patients was 121.9 bpm ± 18.7 (Ρ=0.005). At two minutes, mean heart rate in group S patients was 115.4 bpm ± 17.5 and in group K patients was 123.9 bpm ± 18.8 (Ρ=0.008). At one minute, MAP in group S patients was 60.1 mmHg ± 6.1 and in group K patients was 73.6 mmHg ± 9.2 (Ρ=0.001). At two minutes, MAP in group S patients was 60.4 mmHg ± 6.4 and in group K patients was 76.3 mmHg ± 10.8 (Ρ=0.001). At one minute, mean oxygen saturation in group S patients was 99.8% ± 0.54 and in group K patients was 99.7% ± 0.44 (Ρ=0.477). At two minutes, oxygen saturation in group S patients was 99.8% ± 0.54 and in group K patients was 99.6% ± 1.53 (Ρ=0.253).

Conclusion: Sevoflurane as an inhalational induction agent is a better choice in children due to shorter induction time and stable hemodynamic response as compared to ketamine, an intravenous induction agent.

Key words: Anaesthesia induction; ketamine; sevoflurane

Comparison of Laparoscopic Total Extraperitoneal (TEP) Repair and Transabdominal Peritoneal (TAPP) repair of Inguinal Hernia

2025-01-07T07:14:50+05:00

Introduction: The study compares the outcomes of laparoscopic total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair of inguinal hernia, focusing on operative time, post-operative pain, and hospital stay, following widespread use of laparoscopy.

Methods: The study design employed for this research was a Comparative Observational RCT. A total of 62 patients with inguinal hernia, 25 to 65 years of age of both genders were included. Patients with irreducible hernia, strangulated hernia, obstructed hernia, recurrent hernia, radiation to pelvic tumors and previous history of gut surgery were excluded. Group A included the cases in which TEP repair was done while group B included the cases in which TAPP repair was done. Operative time in both groups was noted. All the patients were followed by the researchers.

Results: In this study, the mean operation time was 64.52 ± 7.58 minutes for TEP repair versus 87.35 ± 3.77 minutes for TAPP repair (p-value = 0.0001). Mean duration of hospital stay for patients in TEP repair group was significantly shorter when compared to TAPP repair group (9.70 ± 2.15 versus 21.90 ± 6.91 hours) which was statistically significant (p = 0.0001). Mean post-operative pain was 1.68 ± 1.08 for TEP repair versus3.32 ± 1.45 for TAPP repair (p-value = 0.0001).

Conclusion: This study concluded that operative time, post-operative pain and hospital stay is less after laparoscopic total extraperitoneal (TEP) repair of inguinal hernia as compared to transabdominal preperitoneal (TAPP) repair.

Hemostatic Net Sutures: A New Solution to an Old Problem

2025-01-07T07:14:43+05:00

Objective: The use of hemostatic net sutures, known for their efficacy in reducing hematoma formation in rhytidoplasty, is emerging as a promising technique for skin graft fixation. This research focuses on evaluating the effectiveness of hemostatic net sutures in securing full-thickness skin grafts, aiming to improve graft uptake and minimize complications.
Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi, From July 2022 to December 2023.
Methods: We conducted a prospective study at a single institution, involving 30 patients who underwent full-thickness skin grafting in the head and neck region and required hemostatic suturing over a period of 1.5 years.
Results: The study encompassed 30 full-thickness skin graft reconstructions, with a follow-up period extending up to three weeks. A notable graft take rate of 90% was observed, with half of the cases achieving 100% adherence. The average time for the procedure was approximately 26.7 minutes across an average defect area of 58 cm². Major hematoma formation was observed in only 3% of the cases, with no significant influence of age, sex, or defect area on the graft take rate.
Conclusion: Hemostatic net suturing demonstrates its efficacy in ensuring adequate graft adherence while simultaneously minimizing tissue manipulation, reducing surgical time, and lowering complication rates.

From Free Flaps to Pectoralis Major Flaps: A Workhorse in Limited Resources

2025-01-07T07:14:27+05:00

Objective: To assess the functional and aesthetic outcomes of using pectoralis major flaps in patients with head and neck region soft tissue defects after oral squamous cell carcinoma tumors in a resource-limited setting.

Methodology: This prospective study was conducted on patients who received repair of post-ablative defects at the plastic surgery unit of Liaquat University of Medical and Health Sciences and Bilawal Medical College, Jamshoro, between October 2022 and March 2023. All patients admitted to the plastic surgery unit during the study period for reconstruction of post-ablative defects using subsequent PMC flap repair for head and neck region soft tissue defects after oral squamous cell carcinoma that were surgically treated and aged between 20 and 70 years. All major and minor PMC flap-related and flap-unrelated complications were assessed.

Results: Among 78 patients, 63 (80.7%) were male and 15 (19.3%) were female, with a mean age of 34.10 ±12.10 years (range: 24-70 years). The Buccal mucosa was the most common location for oral cavity cancer, whereas the base of the tongue and floor of the mouth were used for reconstruction. Infections and wound dehiscence were the most common consequences, and the reconstruction site was statistically significant (p<0.05).

Conclusion: Despite encountering a few minor complications both associated and isolated to the PMMC flap, the survival rate of the flap remains high, while the occurrence of complete flap necrosis is extremely rare.

Comparison of Dexamethasone with Prednisolone in Treatment of Acute Asthma

2025-01-07T07:14:20+05:00

OBJECTIVE:

The objective of this study was to compare the efficacy of single dose oral dexamethasone with single dose oral prednisolone in the treatment of acute asthma exacerbation

MATERIALS AND METHODS

This study was conducted in the in the Department of Paediatrics,Hameed Latif Teaching Hospital Lahore from March 2023 to November 2023. Through a randomized controlled trial Study Design, a total of 160 children under 12 years of age were randomly allocated in two groups, children in group A were subjected to oral dexamethasone and in group B oral prednisolone was given. All children were followed up till 10^th day after discharge to determine the efficacy of treatment in terms of relapse

RESULTS

The mean age of the infants in group A was 7.53 + 2.23 years while in group B it was 8.1 + 2.3 years (p value 0.107). Off the whole sample, we had 65% (n=52) males in group A and 55% (n=44) in group B, female gender was found in 35% (n=28) in group A while 45% in group B (n=36) with p value of 0.197. Efficacy in terms of relapse for group A was 85% while that of group B was 70%, (p value of 0.023).

CONCLUSION

The dexamethasone is more effective than prednisolone in the treatment of acute asthma exacerbation below 12 years of age, however, more randomized controlled trials especially in various combinations with bronchodilators in the management of acute asthma are required.

KEY WORDS

Acute Asthma, dexamethasone, steroid, prednisolone, , relapse

Comparison of Iron Bisglycinate to Iron Polymaltose for the Treatment of Iron Deficiency Anemia in Children

2025-01-07T07:14:12+05:00

Abstract:

Introduction: Different iron formulations are prescribed to correct iron deficiency anemia, however, there is a lack of head to head trials locally. Objective: To compare the efficacy of Iron Bisglycinate with Iron Polymaltose in treating iron deficiency anemia in children. Methodology: A parallel group randomized double blind study was carried out at Benazir Bhutto hospital from 1st July 2022 to 31st December 2022. A total of 132 children were enrolled. Participants were allocated 1:1 to either Group A or Group B. Group A was given iron bisglycinate and Group B received iron polymaltose. Patients were assessed at baseline and were followed up at 1 month and 3 months. At all these intervals hemoglobin levels, MCV, MCH, Serum ferritin and adverse effects were noted and outcomes were assessed. Results: The mean age of the patients in Group A versus B was 7±2.31 versus 6±2.33. The mean hemoglobin levels at baseline in Group A versus B was 9±0.48 versus 8.9±0.49 g/dl and at 3 months in Group A versus B was 10±0.43 versus 9.4±0.48 g/dl, respectively with p value of 0.000. The mean serum ferritin levels at baseline in Group A versus B was 9.1±1.31 versus 8.8±1.19 ng/ml and at 3 months was 29±5.65 ng/ml and in Group B was 23±1.87 ng/ml, respectively with p value of 0.000. Conclusion: In children with iron deficiency anemia, iron bisglycinate significantly increased hemoglobin, MCV, MCH and serum ferritin levels compared to iron polymaltose. Keywords: Anemia, Ferritin, Hemoglobin, Iron Bisglycinate, Iron Polymaltose, Iron Deficiency.

Assessing the Vitamin-D (Calciferol) Supplementation Impact on Glycemic Levels among Patients with Type-2 Diabetes (DM-2); A Quasi-Experimental Trial

2025-01-07T07:14:04+05:00

Background: Calciferol has vital role in maintenance of glucose levels by its action on VDR receptors which are located on beta cells of the pancreas after that leading to the surge in insulin secretion as well as improvement of insulin sensitivity offered by an increased expression of insulin receptors

Objective: To determine the effect of Vitamin-D (calciferol) on the control of blood glucose (measured in terms of mean reduction of ≥1 in HbA1c) in calciferol deficient and insufficient diabetics, who have poorly controlled DM-2

Methodology: A Quasi-Experimental trial at the Department of Medicine, Fauji Foundation Hospital, Rawalpindi for 06 months was conducted after, meeting inclusion and exclusion criteria. 115 patients were enrolled and effect of calciferol on levels of blood glucose was assessed by measuring HbA1c levels, and pre-& post calciferol supplementation.

Results: Results showed mean of ages was 57.80 ± 7.64 years, 39(33.91%) patients were male and 76(66.09%) patients were females. On pre-intervention, the mean HbA1C of the patients who participated was 7.99 ± 0.48 while on post-intervention the mean HbA1C of the patients was 7.97 ± 0.48 (p-value=0.7523).

Conclusion: Effect of calciferol on glycemic control (measured in terms of mean reduction of ≥1 in HbA1c) in calciferol-deficient and insufficient diabetics was insignificant. Therefore, vitamin D supplementation appears to have no effect on blood glucose control in diabetes individuals who have low levels of calciferol—both inadequate and deficient—both of which are low.

Keywords: Calciferol (Vitamin-D), Levels of blood sugar, Poorly Controlled Type-2 Diabetes

Sonography and Magnetic Resonance Imaging for the Diagnosis of Adenomyosis: Comparison with Histopathology

2025-01-07T07:13:56+05:00

ABSTRACT

Introduction: Modern magnetic resonance imaging (MRI) and transvaginal ultrasound techniques have significantly improved the ability to diagnose adenomyosis with a high level of accuracy. This enables healthcare professionals to administer customized treatments that target this specific disease condition.

Objectives: To assess the accuracy of sonography and MRI in identifying adenomyosis, with histopathology serving as the reference standard for comparison i.e. the gold standard.

Study Design: a cross-sectional validation design

Setting: The Department of Diagnostic Radiology/ Pathology, POF Hospital / Wah Medical College, Wah Cantt.

Duration of Study: From August, 2018, to August, 2019.

Subjects and Methods: The patients who underwent surgical treatment in the relevant department were included in the study. Tissue samples obtained from these patients were subjected to histopathological analysis, which was interpreted by a consultant pathologist. The sonographic and MRI findings were subsequently compared to the histopathology report for each patient.

Results: The mean age of the enrolled patients in the study was 38.3±5.5 years. Specificity, Sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of sonography and MRI was calculated by taking histopathology as gold standard and found to be 92.1%, 88.0%, 95.8%, 78.5%, and 91.0% respectively for sonography and 96.0%, 84.0%, 94.8%, 87.5%, and 93.0% respectively for MRI.

Conclusion: Sensitivity of sonography remained to be high as compared to MRI in present study while specificity and accuracy of MRI remained to be high from sonography. It is necessary to observe the unusual and usual characteristics of adenomyosis for further improvements in diagnostic outcomes.

Association between Hemoglobin Levels and Severity of Coronary Artery Disease among Patients Presenting with ST- Segment Elevation Myocardial Infarction

2025-01-07T07:13:49+05:00

Objective: This study aimed to elucidate the association between hemoglobin levels (anemia) and the severity of coronary artery disease (CAD) among patients experiencing ST-segment elevation myocardial infarction (STEMI).

Methods: This prospective cohort study included patients aged 20 to 80 years presenting with STEMI to Liaquat National Hospital and Medicare General and Cardiac Hospitals between September 2023 and February 2024. Anemia was categorized as per the criteria defined by the World Health Organization based on hemoglobin levels. The severity of CAD was assessed based on the number of vessels affected and the Syntax Score system derived from coronary angiography.

Results: Results: Of the 228 patients, 122 were anemic based on hemoglobin levels. The Syntax Score was significantly higher in the anemic group compared to the non-anemic group (27.97±7.15 vs. 24.62±7.04, p<0.01). One-way ANOVA showed significant differences in mean Syntax Scores across anemia severity levels, with the severely anemic group having the highest scores (F(3, 224) = 4.310, p = 0.006). Logistic regression indicated that lower hemoglobin levels were significantly associated with higher CAD severity (β = -0.556, t = -2.284, p = 0.023), and male gender also correlated with higher Syntax Scores (β = 2.294, t = 2.165, p = 0.031). The ROC curve analysis revealed an area under the curve (AUC) of 0.537, indicating that hemoglobin alone is not a strong predictor of multivessel disease in this population.

Conclusion: Lower hemoglobin levels are significantly associated with increased severity of CAD in patients with STEMI, emphasizing the need for careful anemia management in CAD patients.

Diabetic Foot: Its Mode of Presentation and its Grades according to WIfI classification at A Tertiary Care Hospital

2025-01-07T07:13:41+05:00

Abstract

Background: Diabetes Mellitus (DM) is a prevalent metabolic disease that has a major impact on public health. One of the major side effects of diabetes is diabetic foot ulcers (DFU). Objective: To ascertain the method of presentation, analyze, and distribute the diabetic foot lesions in accordance with the WIfI classification of diabetic foot ulceration in a tertiary care hospital of Pakistan. Methodology: This cross sectional study was carried out at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad, from January to December 2022. All adult patients with DFUs were enrolled consecutively. Patients with healed foot ulcerations were excluded. Data regarding age, gender, duration of diabetes, co morbidities, severity of wound, ischemia, severity of infection was noted on a proforma according to WIfI classification. Results: A total of 76 patients presented with DFUs with mean age of 51.03±7.041 years, (range 40 - 70 years). There were 52(68.4%) males and 24(31.6%) females. The duration of diabetes was <5 years in 40(52.6%) followed by 5-10 years in 21(27.6%) patients. According to wound severity, 55(72.4%) patients presented with grade 2 (Deep Ulcer with exposed bone, joints or tendons) followed by 16 (21.1%) with grade 1 (Small Superficial Ulcer without gangrene). According to Ischemia, 44 (57.9%) patients presented with grade 1, 13(17.1%) presented with grade 2 and 19(25.0%) presented with grade 3. There is a significant association of severity of DFUs with age and duration of disease. Conclusion: Diabetic patients commonly present with grade 2 of DFUs followed by grade 1, while presentation with ischaemia were of grade 1.

Keywords: Diabetic Foot Ulcer, Diabetic Mellitus, WIfI classification

Correlation of Various Anatomical Facial Landmarks with Inter-Canine Distance in Population of Northern Punjab

2025-01-07T07:13:34+05:00

Background & Objective: The optimal alignment of teeth and face proportion significantly
contributes to a balanced face appearance. Significant ethnic variations in anatomy have been
observed, and incorporating these standard measurements in prosthodontic intervention can
greatly enhance outcomes. The study objective was to correlate various anatomical facial
landmarks, including intercanthal distance (ICD), interpupillary distance (IPD), and inter-alar
width, with inter-canine distance (ICaD) in young adults from the northern Punjab population in
Pakistan, to assess the mesiodistal width of anterior maxillary teeth in edentulous patients.
Methods: This prospective observational cross-section study was conducted at the Department
of Anatomy and Prosthodontics of General Hospital, HBS Medical and Dental College,
Islamabad, and Farooq Teaching Hospital, Akhtar Saeed Medical College, Rawalpindi, from
December 2022 to December 2023. A total of 600 healthy individuals aged between 18 and 26
years were included. ICD, IPD, and inter-alar width were measured with a digital caliper having
a precision of 0.01 mm. A flat metal plate shaped like a "T," known as the "canine tip marker,"
was used to identify the tips of maxillary canines, which were then measured using a digital
caliper. Data was analyzed using SPSS v 25, employing independent t-tests and ANOVA for
statistical evaluation.
Results: The age of individuals was 24.98±4.5 years, with an equal male-to-female ratio of 1:1.
The correlation was significant (p < 0.001) between these anatomical landmarks and ICaD, with
inter-alar width showing the strongest correlation (r = 0.640). The ANOVA test revealed that
most individuals had less than 5% variability between actual and calculated ICaD values for all
extraoral anatomical facial landmarks measurements, except for ICD.
Conclusion: When selecting artificial teeth, it is important to consider a combination of various
facial and oral factors. The regression equation can be effectively applied in selecting teeth to
attain significant results.
Keywords: Anatomy; Alar; Face; Intercanthal; Interpupillary; Inter-canine distance.

Evaluation of Frequency of Beta Thalassemia Trait Among Pregnant Females

2025-01-07T07:13:26+05:00

ABSTRACT:

Objective: To determine the frequency of Beta thalassemia trait in pregnant females

Results: A total of 200 pregnant females, who presented for the first time in antenatal clinics of Shifa International Hospital were included in the study. 11% women were diagnosed as beta thalassemia trait, 29% had normal hemoglobin studies with concomitant iron deficiency anemia. 1.5% were diagnosed as cases of Hemoglobin-D trait, 1% as Hemoglobin-S trait and 0.5% as Hemoglobin-E trait. Among females, who were diagnosed with beta thalassemia trait,17.6% had cousin marriage and 12.5% had positive family history of thalassemia.

Conclusion: This study establishes, that the frequency of β-thalassemia trait amongst pregnant females was alarming (11%), highlighting the importance of routine screening in antenatal clinics.

A robust protocol for early identification of thalassemia carriers and to implement appropriate genetic counselling and management strategies is the need of the hour in a country like Pakistan showing highest birth rate.

Fabrication and Evaluation of Anti-Microbial Efficacy of Root Canal Sealer Using Moringa Oleifera Extract

2025-01-08T07:14:02+05:00

of different root canal sealers, new alternative agents are required. These new root canal sealers should ideally be easy to formulate as well as cost-efficient as well. In developing countries, healthcare products derived from natural/herbal sources are of common use. Moringa oleifera is a plant with reported antimicrobial properties. The extract of this plant can be easily formulated, within an economical range. Our study investigated the use of Moringa oleifera extract as a root canal sealer material by fabricating it and assessing its antimicrobial activity.

Objective: To fabricate a root canal sealer by using extract of Moringa Oleifera, evaluate and compare the antimicrobial activity with Endomethasone N.

Methodology: A new Moringa Oleifera extract (ME) mixture was made and characterization was done using SEM, FT-IR and UV-vis spectrophotometry. In order to evaluate antimicrobial activity, agar well diffusion method was used. The antimicrobial activity was measured by their zone of inhibition against Staphylococcus aureus (ATCC 6538) and Escherichia coli.

Results: The ME mixture exhibited a non-homogenous mixture with a range of particle size distribution. Further, it showed highest zone of inhibition (36.36 + 3.74 mm) against S.aureus in comparison to Endomethasone N.

Conclusion: The results of ME mixture were better than Endomethasone N in terms antimicrobial efficacy. It can be concluded that ME mixture would serve as a better replacement in place of other root canal sealers.