Journal of Islamabad Medical & Dental College

Establishment of Surgical Oncology Services at ANTH: Challenges & Outcomes

Rizwan Aziz — 2023-10-17

The Paradigm Shift in Dentistry: Embracing Digital Innovations for Enhanced Patient Care

Angabeen Anjum — 2023-10-16

Advanced technology in the form of computer aided design and computer aided manufacturing (CAD/CAM) was introduced to the dental profession in 1987.

Dental providers can utilize digital technology in various practice settings, including private offices and public health centers. Learning how to use new technologies broadens dental and dental hygiene practitioners’ skill sets, strengthens job marketability, expands roles in comprehensive care delivery, and provides opportunities to improve patient comfort and enhance preventive patient education. Implementing advanced technology into clinical practice is essential in order to continually raise the level of care and fuel the evolution of future workforce models.

Association of PVL Gene with SCCmec Typing in MRSA (both community associated and hospital-acquired) from a Tertiary Care Hospital, Lahore

Iqra Jamil — 2023-10-16

ABSTRACT

Introduction: Antibiotic resistance is a major problem in staphylococcal infections. Resistance against Methicillin in S. aureus is due to the transfer of mobile cassettes of specific genes in S. aureus called Staphylococcal Cassette Chromosome mec (SCCmec). 13 types of SCCmec have been identified till now. Various clinical syndromes are associated with the presence of the PVL gene. Therefore, the present study was designed to check the prevalence of PVL gene and SCCmec types in CA-MRSA and HA-MRSA.
Materials and methods: This cross-sectional descriptive study was done in LGH/PGMI, Lahore. MRSA isolates were phenotypically confirmed by Cefoxitin (30) disc on Mueller-Hinton agar. DNA extraction was done by using a Genomic DNA purification kit. Detection of PVL gene and SCCmec types was done with PCR using specific primers.
Results: Out of 89 isolates, the maximum isolates were from pus swabs (45%), followed by wound swabs (15.5%). It was found that 55 (61.8%) were HA-MRSA isolates, while 34 (38.2%) were CA-MRSA isolates. PVL gene was found in 37% of isolates. Among PVL-positive samples, 36.4% were HA-MRSA, while 63.6% were CA-MRSA. The most common SCCmec in HA-MRSA was type III (69%), while in CA-MRSA, SCCmec type IVa was predominant (35.4%).
Conclusion:The present study provides insight into the prevalence of the PVL gene and different SCCmec types in CA-MRSA and HA-MRSA. The most common SCCmec type is linked with HA-MRSA.

Comparison of Fetal and Maternal Outcome in Active vs Conservative Management of Prelabor Premature Rupture Of Membranes (PPROM) at 34 to 37 Weeks of Gestation

Sidra Tul Muntaha — 2023-10-16

ABSTRACT:

Background: The precise management of obstetrical crisis like preterm premature rupture of membrane is necessary to be designed for an optimum outcome. Both maternal and fetal morbidity and mortality rate can be decreased by accurate approach of clinical management as it is not still established yet. This study was designed to compare the maternal or fetal outcome in conservative management with active management of prelabor premature rupture of membranes at 34 – 37 weeks of gestation. STUDY DESIGN: Randomized control trial SUBJECTS & METHODS: The patient’s data was collected from the department of Gynecology and Obstetrics, F G Polyclinic Hospital and PIMS Islamabad from July 2019 to March 2020. Two groups were made and 90 cases were included in each group on the basis of active or conservative management accordingly. Fetal and maternal morbidity and mortality was judged on the basis of number of fetal distresses, chorioamnionitis and mode of delivery. RESULTS: 180 fetuses, a total of 140 survived. In group A, with conservative management, of the 17 (18.89%) mortalities, 9 (10%) developed fetal infections, 2 (2.22%) delivered prematurely, 3 (3.33%) had RDS. In group B, the active management was observed, 23 (25.55%) babies were expired, 5 (5.55%) contacted infections and died, 9 (10%) were diagnosed to have RDS, 6 (6.66%) deaths were due to prematurity with low birth weight. In conservative management group days of admission was significantly (p-value < 0.05) higher compared to active group. The duration of NICU stay was significantly (p-value < 0.05) higher in active management group (8.88% vs. 15.55%) as compared to conservative group (table 7). The rate of respiratory distress was also significantly (p-value < 0.05) in active management group (5.55% vs. 20%) as compared to conservative group. The mortality rate (25.5%) was bit higher in active management group as compare to (18.89%) in conservative management group but this difference was not statistically significant (p-value >0.05).

Conclusion: Conservative management of premature preterm rupture of membranes is more appropriate choice of management than active treatment if decided earlier

Patterns of Developmental Delay in Children with Autism Spectrum Disorder: A Perspective from a Developing Country

Rehamana Waris — 2023-10-16

Background: Autism Spectrum Disorder is a developmental disorder characterized by difficulties in social interaction, initiating conversations, delay in language skills, play skills and stereotypic behaviours. Children with severe developmental delay and those with global developmental delays are needed to be identified as they may have long term problems and disabilities.

Materials & Methods: All children below age of 5 years coming first time for assessment of ASD and diagnosed using ADI-R and ADOS-2 were included in the study. Total 334 children met the criterion. All children having performance deficit below 2SD on age appropriate mean were considered as having developmental delay. Those having delay in two or more than two domains were labelled as having global developmental delay. Detailed clinical and developmental assessment was performed. Data was entered and analysed via SPSS v26.

Results: Mean age of children at time of presentation was 3.6±1.10 years with male to female ratio of 3.5:1. According to developmental assessment using Schedule for growing Scales II, most affected area was speech and language (51.5%) followed by cognitive skills (50.7%), social interactive skills (49.9%), visual skills (46.9%), hearing and language skills, (38.3%), self-care social skills (26.2%), manipulative skills (13.5%) and gross motor skills (0.4%). Global Developmental Delay was found to be present in half of the children for which there was no other possible explanation.

Conclusion: Most of the children with Autism Spectrum Disorder from developmental delay of some sort. Therefore, every child with Autism Spectrum Disorder must be evaluated for Developmental Delay and supported.

Etiology and Pattern of Partially Dentate States with respect to Gender and Choice of Treatment

Adil Bin Irfan — 2023-10-16

Objectives: Edentulism is an irreversible chronic condition that seriously affects the stomatognathic system. Consequently, determining its etiology and pattern with respect to the choice of treatment may contribute to prioritizing preventive and rehabilitative oral health interventions. Therefore, the aim of this study was to identify the causes and patterns of partially dentate states with respect to gender and their respective choice of treatment
Methods: A descriptive cross-sectional study was conducted on 555 patients visiting the prosthodontics department of Altamash Institute of Dental Medicine for a duration of five months from 15th Oct’2019 to 15th March’2020. A close-ended well-structured questionnaire was used to collect the data. The descriptive analysis was carried out using SPSS-25 and Chi-square test was used, to find the effect of gender, and number of missing teeth on partially dentate arch classification. The p-value of ≤ 0.05 was considered as statistically significant.
Results: The results of the study showed the two most common causes of missing teeth were caries (66.3%), and periodontal disease (13.8%). It was also found that Kennedy’s and Mauk’s class 3 to be the most prevalent in maxilla 159 (61.3%), 98(37.1%) and 148 (50%), 120 (41.23%) in mandible. Osborne’s class 2 was most prevalent with 127 (48.65%) in the mandible and 171 (58.16%) in the maxilla, respectively. Furthermore, both genders were found to have Kennedy’s and Mauk’s class 3 and Osborne class 2. Ironically, the majority of the patients choose acrylic partial dentures as a treatment option for the replacement of missing teeth.
Conclusion: This study describes that Kennedys, Mauk’s Class 3 and Osborne Class 2 were found in the majority of participants. Dental caries and periodontal disease were the common cause of missing teeth with acrylic partial denture remained the most opted treatment option.

Assessment of Inhaler Use Techniques among the Patients of Chronic Obstructive Lung Diseases at a Government Hospital of Islamabad

Maliha Batool — 2023-10-16

Objective: To study the frequency of incorrect techniques used for Metered Dose Inhalers in patients with chronic obstructive lung diseases.
Study Design: Cross-sectional, Observational Study
Place And Duration Of Study: The study was conducted for six months from Ist March 2019 to 31st August 2019, on all patients with chronic obstructive lung diseases visiting the outpatient department of Medicine in Federal Government Polyclinic (FGPC) Hospital as a part of their regular follow-up.
Methodology: All patients visiting the outdoor clinic were checked for their inhaler technique which was explained to them as a 6-step procedure. The record of using the inhaler correctly or otherwise was noted in a proforma.
Results: A total number of 250 patients were included in the study with their ages between 13-70 years. Mean age of patients was 46.5±15.7 years. A total of 6 steps of the inhalation technique were observed. The mean number of steps followed was 3.8±1.4. Incorrect inhaler technique (≤5 steps) was adopted by 220 patients (88%) and correct technique (6 steps) was adopted by only 30 patients (12%). Stratification for age, gender, duration of disease, education, marital status, occupation, and Body Mass Index (BMI) was also carried out.
Conclusion: This study demonstrated that a significant no of patients could not perform the inhalation technique correctly. This implies the need for their clinicians to make it imperative during their follow-up visits to check their inhaler technique periodically.

KEY WORDS

Metered dose inhalers (MDI), Chronic obstructive lung disease (COLD), Correct technique

Comparison of Seroma Formation in Modified Radical Mastectomy: Conventional Scalpel Versus Ligasure™ Technique

Syed Shams ud Din — 2023-10-16

Objective: This study aims to compare the outcome of scalpel versus LigaSure™ dissection with respect to seroma formation in the skin flaps.
Methods: The study was conducted at the Department of General Surgery, Federal Government Polyclinic Hospital (FGPC), Islamabad. The study spanned over a period of twelve months, i.e. October 2020 to September 2021 which recruited 60 patients with breast cancer which were randomly assigned to two equal groups. Modified radical mastectomy with axillary lymph node dissection was done in all the patients. Group-I underwent traditional scalpel dissection while LigaSure™ dissection was done in the group- II. The primary outcome was to assess the seroma formation. The demographic data along with time required for surgery, duration of drain placement, and hospital stay was recorded. The recorded data was constructed and analyzed using SPSS (version 22.0).
Results: Among 60 enrolled patients, the mean age was 38.3 ± 11.4 and 39.8 ± 9.4 years in group I and II, respectively. A total of 6.7% (n=2) patients in group-I and 10% (n=3) patients in group-II showed seroma formation in skin flaps after surgery (p-value = 0.640). The mean time required for surgery was 109.9 ± 7.9 and 105.1 ± 8.3 minutes in group-I and group-II, respectively (p-value = 0.027). The average duration of hospital stay in group-I and group-II was 4.8 ± 1.7 and 5.3 ± 1.9 days (p-value=0.335).
Conclusion: Compared to traditional scalpel dissection, the use of LigaSure™ assisted dissection shows no significant benefit in terms of reduced post-operative seroma formation, and duration of hospital stay. However, LigaSure™ assisted dissection significantly reduces the time-of-surgery. In resourceful hospital settings, LigaSure™ assisted dissection can be used to reduce the morbidity associated with longer anesthesia time by reducing the time-of-surgery.

Analysis of Therapeutic Phlebotomy in Patients of Polycythemia: A Single Center Study

Nosheena Noreen — 2023-10-17

Introduction: Polycythemia is increased red cell mass according to age and sex of the individual. It could be primary (Polycythemia Vera), or secondary, due to chronic hypoxia or increased erythropoietic drive. Polycythemia is managed with therapeutic phlebotomy along with treating the underlying cause if determined. Phlebotomy of one unit whole blood should result in fall of Hb of at least 1g/dl. This study was conducted to see the effect of phlebotomy on fall in Hb level.
Different parameters which can affect Hb levels in polycythemia patients, like age, JAK-2 mutation status and underlying cause were also studied.
Methodology: A cross sectional study was conducted at blood bank of Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad Pakistan January 2020 to December 2020. Data were collected from 121 patients of Polycythemia vera who reported in blood bank for phlebotomy.
Results: The average pre phlebotomy hemoglobin of the patients was 17.45g/dl, which dropped to 15.97g/dl after phlebotomy. In total, 89 (73.5%) patients who underwent phlebotomy had a fall in Hb of greater than or equal to 1g/dl, while in 32 (26.4%) patients, Hb drop was less than 1g/dl. One hundred and five patients underwent multiple therapeutic phlebotomies to maintain their hemoglobin within normal range.
Conclusion: This study has shown that there is fall in Hb as result of recommended phlebotomy leading to relief in symptoms due to Polycythemia. Phlebotomy is the basis of treating polycythemia, although in secondary polycythemia the underlying cause should also be diagnosed and treated.

Comparing the Pretreatment with Lignocaine 40 mg and Fentanyl 100 ug as an Adjuvant for Preclusion of Pain Associated with Intravenous Propofol Injection

Syed Adnan Alam — 2023-10-17

Abstract

Background: Propofol (2,6-di-isopropylphenol) is one of the most favored drugs used for induction of anesthesia. Pain on injection is a common problem. Various methods have been tried to alleviate this pain but with conflicting results.

Objective: To compare effectiveness of lignocaine versus fentanyl in patients receiving propofol for general anesthesia in population of Pakistan who come to PIMS hospital in Islamabad.

Materials and Methods: 120 participants of either sex, between 18 and 40 years of age, belonging to ASA physical status I and II, undergoing elective surgery under general anesthesia, were randomized into two equal groups of 60 participants. They received, intravenously, either lignocaine 2 ml (20 mg/ml )or fentanyl 2 ml (50 mcg/mL) as a pretreatment before propofol injection.

Results: The efficacy of lignocaine as a pretreatment drug injection was higher (96.7%) compared to fentanyl (85.0%). In the lignocaine group, 2.3% of the participants experienced pain as compared with 15% in the fentanyl group (P<0.05).

Conclusion: Compared with fentanyl, lignocaine pretreatment was more effective in preventing pain on propofol injection.

KEY WORDS: Comparison, Fentanyl, LIgnocaine, Propofol, Pain.

Does Laparoscopic Lens Contamination Effect Operative Time? A Study on the Frequency and Duration of Lens Contamination and Commonly Used Measures to Maintain Clear Vision

Usman Ali Rahman — 2023-10-17

Objective: To determine factors affecting lens fogging and different methods used for decreasing lens fogging and operation time.
Methods: This cross-sectional study was conducted in General surgery department of Gulab Devi Hospital, Lahore from January 2022 to July 2022. A total of 70 patient undergoing laparoscopic surgery were recruited in this study. Operative time, duration of time the lens remained cleaned or dirty, time wasted during cleaning, methods used for cleaning of lens and causes of lens contamination were the variables of this study.
Results: Total operative time in all 70 laparoscopic procedures was found to be 53 hours and 13 minutes with a mean of 43.8 ± 8.3 minutes. A total of 288 lens contamination events were observed in all these operations with an average of 4.11 lens contamination events per case. According to study an average, 60.9% of the operational time lens remained clear, 31.2% of the operational time lens remained contaminated and 7.92% of the operative time was spent in cleaning the laparoscope.
Conclusion: Our study demonstrates that a significant period of a laparoscopic surgery is performed with foggy display. A lot of time is wasted in lens cleaning.

Potential of Gut Microbiome in mosquitoes for Dengue Vector Control

Raiha Fatima — 2023-10-17

Medically important mosquito species belonging to genus Aedes are a major public health concern due to their ability to be efficient vectors of dengue, Chikungunya, Zika, and other arboviruses. With limited vaccines available and no effective therapeutic treatments against arboviruses, the control of Aedes mosquito populations is currently the only strategy to prevent disease transmission. The risk of contracting dengue infection has increased dramatically since 190s. This upward trend is due to increases in long-distance travel, population growth and urbanization, lack of sanitation, ineffective mosquito control, and increases the surveillance and official reporting of dengue cases. Traditional control of mosquito vectors using various insecticides has caused toxic effect on environment and living communities, pro magnification, non- target effect and above all developed resistance in vector mosquitoes. Therefore, new tools and strategies are required to control mosquito vectors to control these diseases. Recent studies on midgut and other organs in mosquito vectors indicated the presence of diverse and dynamic microbial flora, known as microbiota. These microbes are mostly containing symbiotic microbiota play a key role in mosquito physiology, reproductive capacity and immunity. The midgut microbiota have also suggested to alter the competency of mosquitoes to transmit various pathogens (arboviruses, malaria parasites etc.). Many of these symbiotic bacteria have been explored for the potential to combat mosquito borne diseases such as dengue, malaria, Zika, yellow fever etc. The possibility to rear mosquitoes in which a particular bacterial species is dominant among the gut microbiota supports the development of strategies based on symbionts that induce antiviral responses or antiviral molecules in Ades mosquitoes

Prolapsed Fibroid in Pregnancy

Mussarat Batool — 2023-10-17

Uterine fibroids are commonly encountered in clinical practice. Majority of the fibroids are usually asymptomatic during pregnancy, however they may lead to complications in all three trimesters of pregnancy and even in the post natal period, causing a management dilemma. Vaginal prolapse of uterine fibroids is a rare phenomenon during pregnancy, delivery or puerperium. While most of the fibroids are managed conservatively, a few require surgical intervention Despite of multiple publications in the medical literature on the gynecological aspects of fibroids, scanty data is available on management during pregnancy and labor, posing a therapeutic dilemma. We present a case of a G4P3, presenting at 30weeks gestation with large degenerated prolapsed uterine fibroid which was successfully managed by vaginal myomectomy concurrently with cesarean section.

Idiopathic Jejunal Diverticulitis: A Rare Case Report

Fahad Akhtar — 2023-10-17

Acquired jejunal diverticulosis often produces few or no symptoms and is generally picked up incidentally on cross-sectional imaging or intra-operatively. Similar to what is observed in colonic diverticulosis, diverticulitis can lead to more complicated clinical presentations including; perforation, gastrointestinal bleeding or obstruction. Acute diverticulitis is the most common presentation, but other complications can occur, mainly perforation, bowel obstruction and hemorrhage. Diagnosis is often difficult and delayed due to its relative rarity and non-specific clinical symptoms which increase the mortality and morbidity of this pathology. We have discussed a patient who presented to us with features of intestinal obstruction and on investigations and exploratory laparotomy he was diagnosed as a rare case of jejunal diverticulitis. He was managed operatively and patient had uneventful recovery where after CT scan, exploratory laparotomy was done and proximal milking through NG tube was done without resection.

Leiomyoma of the Trachea: A Rare Tracheal Tumor

Prof. Dr Iftekhar Ahmed — 2023-10-17

This is a case of a rare tracheal tumor, in a 45year old male farmer who presented with recurrent dyspnea for four years, initially misdiagnosed as asthma. The patient experienced worsening symptoms, including cough, hemoptysis, weight loss, and respiratory failure. Imaging and bronchoscopy revealed a tracheal mass, later identified as leiomyoma. The patient underwent tumor resection via rigid bronchoscopy, resulting in successful removal and tracheal recanalization. Postoperatively, the patient showed improvement, and follow-up examinations confirmed resolution of symptoms and absence of tumors, such as leiomyoma, are rare, often causing airway obstructions. Treatment approaches vary, including surgical resection and endoscopic techniques. In the case of wide-based tumors, surgical intervention is recommended to reduce recurrence risks. Anesthesia management is crucial due to potential airway compromise during the procedure. Although recurrence rates for leiomyoma are unknown, incomplete bronchoscopic resection has been associated with reoccurrence, necessitating surgery and carinal reconstruction.