Journal of Islamabad Medical & Dental College

Dry Needling: An Evidence Based Approach to Treat Myofascial Trigger Point

Abdul Ghafoor Sajjad — 2024-03-19

Re-Emergence of SARS-CoV-2: Frequent Mutations, Amplified Transmissibility and Immune Elusion

Anam Zia — 2024-03-19

New Onset Pancytopenia in Adults: Clinico-etiological Profile at a Tertiary Care Hospital

Ama tul Naval — 2024-03-31

Objective: To evaluate and compare common disorders leading to new onset pancytopenia among both genders.

Methods: It was a cross-sectional study conducted at the Department of Pathology at Watim Medical College and Watim General Hospital, Rawat, from November 2020 to November 2021.A total of 98 adult patients with persistent pancytopenia for one week who gave consent for bone marrow aspiration and a trephine biopsy were selected. A blood-complete picture with peripheral smears along with bone marrow aspiration biopsy were done. Trephine needle biopsy and cytochemical staining were performed when required.

Results: There were 44 males and 54 female patients. The mean age was 43.49 ±19 years. Common presenting complaints were pallor (82.6%), weakness (63.2%), petechial haemorrhages (45.9%) and fever (23.5%). The hemoglobin value, white blood cell count and platelet count were 6.5± 1.65 g/dl, 3.20 ±1.43 x 10⁹/L and 55.21 ±28.01 x 10⁹/L respectively. Major causes were megaloblastic anemia with female predominance (S.D: 0.003) in 43.8% patients, aplastic anemia with male predominance (S.D:0.001) in 17.3%, portal hypertension induced splenomegaly in 13.2%, infectious diseases in 7%, leukemias in 5.1% and Myelodysplastic syndromes in 3.1%.

Conclusion: Megaloblastic anaemia is the major cause of pancytopenia in females and aplastic anemia in male pancytopenic patients.

Optimizing Dental Waste Practices: A Comprehensive Review of Waste Management in Hospital and Private Dental Practice across Pakistan

Noor ul Huda — 2024-04-02

Objective: To analyze and document the management of biomedical waste, assessing potential health and environmental risks, over a period of six months throughout the dental hospitals of Pakistan.

Materials and methods: In this cross-sectional questionnaire-based study, the questionnaire was distributed to final-year students, house officers, postgraduate trainees, practicing dentists, and dental assistants in both private and public healthcare settings across Pakistan through electronic media. A convenient sampling technique was used, and the study was completed in six months, from April to September 2023, with a sample size of 356, actively practicing dental professionals, students, trainees, and dental assistants with a minimum of 6 months of experience included in this study. Non-practicing dentists and assistants within the last 6 months were excluded from the study. The study assessed criteria and dental practitioners' knowledge regarding waste disposal in dental setups and hospitals.

Result: In biomedical waste disposal practices across hospitals and clinics, incorrect methods were observed in amalgam disposal (77.2% vs. 75.8%), fixer disposal (92.2% vs. 87.1%), bloody gauze disposal (52.1% vs. 68.5%), tooth disposal (73.2% vs. 60.4%), sharps disposal (75.1% vs. 29.4%), and solid waste disposal (24.8% vs. 24.4%) in hospitals and clinics, respectively. Proper methods, such as separators, silver recovery, yellow bags, and incineration, were variably used/adopted.

Conclusion: According to the current study, most private dental facilities and hospitals are unaware of the various types of biomedical waste and do not use proper disposal methods. There is an immediate need for practitioners to receive ongoing dental education on waste management in dental care.

Frequency and Clinical Implications of Atrial Fibrillation in Patients with Accessory Pathways

Hameed Ullah — 2024-03-31

Abstract:

Atrial fibrillation (AF) is a common arrhythmia associated with various cardiac conditions. This study investigates the frequency of AF in patients with accessory pathways, anomalous electrical connections that can lead to supraventricular tachycardia.

Objective:

The primary objectives are to determine the prevalence of AF in patients with accessory pathways, identify associated factors, and assess the impact on clinical outcomes. A comprehensive dataset of 400 patients undergoing supraventricular tachycardia ablation at Hayatabad Medical Complex from 2020 to 2022 was analyzed.

Method:

A retrospective study design was employed, utilizing patient records with documented accessory pathway(s) and complete clinical-electrophysiological data. Demographic information, clinical presentation, electrocardiographic and electrophysiological data, ablation procedures, and clinical outcomes were systematically collected. Analytical approaches included frequency calculation, comparative analysis, regression analysis, and outcome assessment.

Result:

Out of 400 patients, 3.5% presented with AF at the time of accessory pathway ablation. Age was identified as a significant predictor of AF occurrence, with a mean age of 63.2 years in AF cases compared to 55.8 years in non-AF cases. Recurrence of arrhythmias was observed in 57.1% of patients with AF, emphasizing the need for ongoing monitoring and management.

Conclusion:

This study contributes valuable insights into the relatively low prevalence of AF in patients with accessory pathways. While certain factors, including age, may be associated with AF, they do not serve as definitive predictors. Tailored management and adherence to guidelines are crucial for optimizing outcomes in this unique patient population. Future research may explore genetic factors and refine risk stratification models for a deeper understanding of AF in patients with accessory pathways.

Incidence of Pocket Infection after Implantation of Permanent Pacemaker

Hameed Ullah — 2024-04-11

Objective: The research aimed to enhance clinical awareness and optimise preventive strategies in permanent pacemaker (PPM) implantation

Methodology: We followed the patient on 2nd and 4th weeks after implantation of PPM. A total of 500 patients were followed over a 1-year period of time. We defined pocket PPM infection as the presence of local oedema and redness or swelling with and without systemic signs of infection that required antibiotic therapy and/or device removal.

Results: The mean age of the patients was 55.4 ± 14.2 years, and 58% were male. The most common indications for PPM implantation were atrioventricular block (42%), sick sinus syndrome (32%), and atrial fibrillation with slow ventricular response (18%). The median follow-up time was 12 months. The overall incidence of PPM infection was 2.4% (12 cases).

Conclusion: PPM pocket infection is a rare but serious complication that occurs mainly within the 2 weeks after implantation. Diabetes mellitus, renal failure, and the use of temporary pacing wires are significant risk factors for PPM infection. Prevention strategies and close follow-up are essential to reduce the morbidity and mortality associated with this complication.

Radiographic Assessment Regarding the Pattern of Third Molar Impaction and its Association with Gender in the Population of Islamabad

Hina Nasim — 2024-03-31

Abstract

Objective: To analyze and document the gender-specific incidence of impacted third molars and elucidate the specific patterns associated with impacted third molars.

Methodology: This retrospective cross-sectional study analyzed orthopantomograms (OPG) data from 278 patients, covering a total of 445 impacted third molars. A convenient sampling technique was used and the study was completed in three months from September 2023 and December 2023, Inclusion criteria: OPGs of individuals aged 25 years or older with fully formed third molar roots, Exclusion criteria: OPGs of individuals younger than 25, with craniofacial anomalies, prior orthodontic treatment, erupted third molars, or incomplete root formation in third molars.

Results: Both males and females were almost equal in number. The majority 73.2% of OPG showed mandibular third molar impaction while 26.8% showed maxillary third molar impaction. In the maxillary arch, the distoangular type of impaction was observed in the majority, accounting for 48.7%. In the mandibular arch, mesioangular impaction prevailed, comprising 41.7%. In the maxillary arch, a statistically significant correlation (p=0.006) was found between gender and impaction type, with females exhibiting a distinct and more prevalent impaction pattern than males. In the mandibular arch, there was no statistically significant association between gender and impaction type (p=0.23).

Conclusion: In conclusion, our study reveals noteworthy gender variations in the prevalence and types of third molar impactions. Mandibular third molars exhibit a higher prevalence than maxillary counterparts, with mesioangular impaction prevailing in the mandibular arch and distoangular impaction in the maxillary arch.

Effect of Probiotics on Plasma Glucose Level in Obese Patients on Risk of Gestational Diabetes Mellitus

Naseem Fatima — 2024-03-31

Background: A range of physiologic, metabolic, and gut microbial changes occur during pregnancy. Pregnancy is linked to insulin resistance and hyperinsulinemia, which increase the risk of gestational diabetes. Probiotics are being extensively examined for their potential benefits in the treatment of a variety of disorders. Moreover, there is no local study connected before on the supplementation of probiotics in such cases to find the improvement in glycemic control level and prevention of gestational diabetes (GDM), so this study was planned.

Methods: This one-year randomised control trial was conducted at PIMS Islamabad, Department of Obstetrics and Gynaecology. After receiving informed permission, 126 patients were enrolled in the trial. In group A, patients were given a standard diet plan along with a probiotic sachet daily from 20 weeks of pregnancy until 26 weeks. In group B, patients were given a standard diet plan along with routine vitamins daily for the same period. Patients were followed-up in OPD up to 26 to 28 weeks, and OGTT was done, then GDM was labelled if OGTT deranged.

Results: At the 28th week, in the probiotic group, the mean fasting blood glucose was 78.84±18.42 mg/dl, and in the control group, it was 81.25±22.49 mg/dl (p-value = 0.515). At the 28th week in the probiotic group, the GDM was noted in 12 (19%) patients, and in the control group, it was in 22 (34.9%) patients (p-value = 0.045).

Conclusion: From this study, we may conclude that there is an effective role of probiotic supplementation in the prevention of GDM among high-risk obese pregnant women.

Pattern of Adenoviral Conjunctivitis Reported to Tertiary Care Hospitals During Epidemic in Pakistan

Afia Matloob Rana — 2024-03-31

Purpose: To determine clinical pattern of “adenoviral conjunctivitis” during its epidemic in Pakistan.

Patients and Methods: 370 patients (550eyes) diagnosed with “adenoviral conjunctivitis” were included in this descriptive study. Diagnosis was made by the combination of characteristic clinical features and a positive conjunctival swab PCR for “adenovirus”. Clinical pattern of “adenoviral conjunctivitis” was determined by documenting various patient characteristics. Data were analyzed using SPSS 22.

Results: Median age of the study participants was 28.50 (1.00 – 67.00) years. 195 (52.70%) were males and 175 (47.30%) were females. 190 (51.35%) patients had unilateral ocular involvement, while 180 (48.65%) patients had bilateral ocular involvement. Median number of family members of patients that were infected simultaneously was 1 (0-5). Frequency of patients with “adenoviral conjunctivitis” who had concomitant corneal involvement was 30 (8.1%)

Conclusion: Epidemic of “adenoviral conjunctivitis” in Pakistan, fortunately, exhibits a milder and benign clinical pattern with higher prevalence in males and mostly involving single eye. In addition, only 8.1% patients have concomitant corneal involvement.

Comparison Between Myoinositol and Metformin on Biochemical Profile in Women with Polycystic Ovarian Syndrome

Zaib Un Nisa — 2024-04-02

Background: The most common endocrine disorder in women during their reproductive years is polycystic ovary syndrome. Metformin is one of the effective oral insulin sensitizing agent it is also considered first line agent in the treatment of this syndrome. Myoinositol is a new emerging agent in the treatment of polycystic, evidences are showing myoinositol is the good addition for the treatment of polycystic syndrome.

Objectives: To compare the outcome of myoinositol and metformin on biochemical profile in women with polycystic ovarian disease.

Methods: This comparative randomized controlled trial was carried out at the Gynecology and Obstetrics Department of Benazir Bhutto Hospital Rawalpindi, from October 2022 to April 2023. The study involved 100 female patients aged 18 to 35 diagnosed with polycystic ovarian syndrome. The participants randomly were assigned to two groups: Group-I received myoinositol (1 gram twice daily) for 24 weeks, and Group-II received metformin (500mg thrice daily) for the same duration. Hormonal parameters, including FSH, LH, LH/FSH ratio, and fasting blood glucose (measured after 8 hours of overnight fasting), were assessed at baseline and after 24 weeks.

Results: The patients mean age was 28.12±4.84 years. The metformin-treated group exhibited mean baseline values of 7.65±2.79, 5.19±1.79, 1.54±0.68, and 90.82±10.72 for LH, FSH, LH/FSH ratio, and fasting blood sugar, respectively. After 24 weeks of treatment, these values decreased to 6.16±2.57, 4.34±1.65, 1.50±0.68, and 85.96±5.72 (p ≤ 0.05). In the myoinositol-treated group, the mean baseline values were 6.37±3.90, 4.66±1.37, 1.51±1.29, and 88.52±11.13 for LH, FSH, LH/FSH ratio, and fasting blood sugar, respectively. After 24 weeks of treatment, these values decreased to 4.54±2.56, 3.71±1.39, 1.37±1.05, and 88.10±4.43 (p ≤ 0.05).

Conclusion: This study concluded that myoinositol demonstrates superior efficacy compared to metformin in enhancing the biochemical profile of individuals with polycystic ovarian syndrome.

Health Determinants of Methylmercury Exposure in Coastal Pakistani Women: Fish Consumption and Environmental Influences

Asad Ali Khan — 2024-04-03

Background: Mercury pollution from industries poses health risks through bioaccumulation in fish. Women in coastal communities with high fish intakes are particularly vulnerable. However, methylmercury (MeHg) exposure has not been quantified in Pakistan.

Objective: To estimate MeHg levels in the scalp hair of women from a coastal community in Sindh province and examine the relationship with fish consumption and other risk factors.

Methods: A cross-sectional study was conducted among 100 women aged 15–49 years in Rehri Goth, Sindh. Detailed dietary histories were obtained through interviews. Scalp hair samples were analysed for total mercury using cold-vapour Vapor Atomic Absorption Spectrophotometry.

Results: The median hair MeHg level was 7.15 μg/g, exceeding international guidelines. Higher levels were associated with fish from polluted waters (3.5 μg/g), skin whitening product use (6.5 μg/g), and traditional medicine intake (9.0 μg/g). A weak positive correlation was found between MeHg and age. Fish consumption averaged 4 times/week.

Conclusion: Women in coastal Sindh have high MeHg exposure from frequent fish intake, likely exacerbated by industrial pollution. Risk mitigation is needed to protect vulnerable populations, especially during critical windows of neurodevelopment.

Neonatal Hypoglycemia How common is Hypoglycemia in Newborns Weighing Less Than 2500 gms: A Hospital Based Study

Malak Ahmad Khan — 2024-04-08

Objective:To determine the frequency of hypoglycemia in neonates weighing less than 2500 grams in first 48 hours of life presented to CMH Abbottabad.

Study Design: Cross Sectional Study.

Setting: Department of Pediatrics, Combined Military Hospital, Abbottabad.

Duration of Study: This study was conducted from 1^st July 2020 to 1^st January 2021

Subjects and Methods:

A total of 110 neonates of both genders with birth weight less than 2500 grams using consecutive non-probability sampling technique were included in the study. Capillary blood was collected by heel prick after proper aseptic measure for blood glucose estimation by Glucometer at 0, 1, 2, 3, 6 and every 6 hours till 48 hours of birth. All hypoglycemic neonates were managed with intravenous administration of 10%glucose.

Results:

Gestational age range in this study was from 34 to 42 weeks with mean gestational age of 38.663±1.55 weeks, mean birth weight 1622.818±409.23 grams and mean blood glucose level was 54.763±9.55 mg/dl. Total 80% neonates were male. Hypoglycemia was observed in 27.3% neonates. No significant difference was seen comparing frequency of hypoglycemia among pre-term and term neonates (p-value 0.52), male vs female neonates (p-value 1.00) and different modes of delivery. (p-value 0.6). While frequency of hypoglycemia was significantly high in extremely low birth neonates as compared to low and very low birth weight. (p-value <0.01).

Conclusion:

Our study concluded that frequency of hypoglycemia was 27.3% in newborns weighing less than 2500 grams in first 48 hours of life. Extremely low birth weight (less than 1000gms) is a significant determinant for hypoglycemia.

Keywords:

First 48 hours, frequency, low birth weight, hypoglycemia, new borns

Role of Formoterol on Myogenic Regulatory Factor to Ameliorate Statin-induced Myopathy

Abdullah Qamar — 2024-04-08

Objective: To investigate the effects of β2-adrenergic agonist formoterol on expression of myogenic regulatory factor myogenin in statin-induced myopathies in rats

Methods: Adult male Sprague-Dawley rats were randomized into control (A), statin-only (B), and statin + formoterol groups (C) (n=30 per group). The control group A received no treatment. B group received simvastatin at 60 mg/kg/day by oral gavage for 12 weeks to induce myotoxicity. C group received simvastatin at 60 mg/kg/day plus formoterol at 3 μg/kg/day by oral gavage for 12 weeks. After 12 weeks, extensor digitorum longus muscles were dissected and 5 μm transverse sections were immunostained for myogenin expression. One cross section was selected from each of the specimen for study. Myogenin-positive nuclei were quantified in 8 random 40x magnification fields per muscle section by a blinded investigator. Data was analyzed using IBM SPSS.

Results: Myogenin-positive nuclei were minimal in the control (A) group and statin-only (B) groups. In contrast, the statin + formoterol (C) group exhibited a significant increase in myogenin-positive nuclei compared to both control and statin-only groups (p<0.001), indicating enhanced muscle regeneration.

Conclusion: Formoterol treatment augmented skeletal muscle repair pathways in a rat model of statin-induced myopathy, potentially via activation of quiescent muscle satellite cells and upregulation of myogenic regulatory factor myogenin in group C.

A Cross-Sectional Study on the Use of Computed Tomography Scan for Diagnosing Renal Masses in Pakistani Adults

Naushaba Malik — 2024-04-08

Objective: The aim of this study is to assess the validity of Computed Tomography (CT) in evaluating solid renal masses by comparing CT findings with histopathological results.

Methodology: This cross-sectional study involved 210 patients at the Department of Radiology PESSI Hospital Islamabad, spanning July 2022 to June 2023. Patients were selected based on predefined inclusion criteria, and their detailed medical histories were examined. Each patient underwent both non-contrast and contrast CT scans, and the radiological diagnoses were confirmed. The CT-based diagnoses were then compared with histopathological results, and measures such as positive predictive value (PPV), accuracy, sensitivity, specificity, and negative predictive value (NPV) of CT in diagnosing renal masses were calculated.

Results: The mean age of the study participants was 48.00±810 years. Male to female ratio was 2:1. The majority of the study participants were belonging from the urban area and were under graduate. The results of the study further revealed the frequency of renal masses which was more in male (71.90%, n=151) as compared to female (28.09%, n=59). The study found that the right kidney was affected in 58.09% (n=122) of cases, the left kidney in 36.19% (n=76), and both kidneys in 5.71% (n=12). In our study, we observed variations in density among patients, with 39.06% exhibiting mixed density, followed by 23.80% with hypo-dense, 20.95% with hyper-dense, and 16.19% with iso-dense lesions. When it comes to enhancement, we found that 40.01% had a moderate degree, 24.76% had mild enhancement, 21.90% had intense enhancement, and 13.33% showed no enhancement.

Conclusion: In this study, we found a strong correlation between histopathological diagnosis and computed tomography (CT) in identifying solid renal masses, with notably high validity test results. Given these robust validity parameters, we can confidently conclude that CT scans serve as an effective and reliable diagnostic modality for identifying and diagnosing renal masses.

Risk Factors Analysis of Vascular Invasion in Hepatocellular Carcinoma

Belqees Yawar Faiz — 2024-04-08

Objective: HCC carries a high recurrence rate after resection and transplant. This depends on the extent of vascular invasion. Preoperative detection of vascular invasion affects the management of patient and determines the prognosis. Vascular invasion may have to be looked for in tumors that show certain risk factors. This study analyzes those risk factors.

Methodology: This retrospective observational study was carried out by retrieving data between 2017 to 2020. Tumors with more than 90% necrosis or those treated by chemoembolization were not included in this study. A total of 78 patients were included in the study. Multi-slice CT and 3 Tesla MRI were used as imaging tools. Vascular invasion was cross-tabulated against risk factors including size, location, morphology and encapsulation of tumor.

Results: Minimum age of patients was 22 and maximum 77 years with a mean age of 56.76 ± 10.857. Mean size of tumors was 7.29 ± 4.761 cms. Forty one patients (53%) showed vascular invasion in one or more branches of portal vein. Large tumors (p=0.002), multifocal tumors (p=0.040), unencapsulated tumors (p=0.001), infiltrative tumors (p=0.000) and those with raised serum AFP levels (p=0.016) were more likely to invade multiple vessels.

Conclusion: Larger size and multifocality of HCC are associated with more vascular invasion.

Keywords: Hepatocellular carcinoma; Vascular invasion; Imaging.

Investigating Machine Learning Models in Acute Myocardial Infarction to Predict Mortality

Cheragh Hussain — 2024-04-08

Abstract:

Background

Pakistan and the rest of the world suffer from a high rate of acute myocardial infarctions (AMIs). In this study, we employed a machine learning model to predict mortality in patients with AMI patients. By analyzing various variables, they assessed the impact of these factors on the predictive models, highlighting the potential of machine learning in improving mortality prediction and informing clinical decision-making in AMI cases.

Method

This study conducted three experiments using a Kaggle dataset to predict mortality in Acute Myocardial Infarction (AMI) patients with machine learning. Relevant input features were selected, and three models (SVM, DT, KNN) classified mortality status. Model performance was rigorously evaluated with metrics like Accuracy, AUC, Precision, Recall, and F1-score. Data preprocessing, including handling missing values and normalization, preceded model training.

Results

Among the evaluated models, the Support Vector Machine (SVM) exhibited the highest accuracy of approximately 87.66% and demonstrated robust discrimination capabilities, with an AUC score of 0.796. Precision, recall, and F1-scores indicated a balanced trade-off between correctly identifying negative outcomes and effectively capturing positive cases.

Conclusion

The SVM model emerged as the most promising classifier, showcasing strong potential for predicting patient mortality in the context of AMI. However, further refinements and optimizations may be necessary to enhance model performance, ensuring its clinical relevance and utility in real-world medical scenarios.

Clinical Application of Reticulocyte Maturity Indices in Early Diagnosis of Iron Deficiency Anemia in the First Trimester of Pregnancy

Amna Imtiaz — 2024-04-08

Background: Iron deficiency anemia (IDA) is a prevalent global health issue, particularly affecting pregnant females due to increased iron demands during pregnancy. In Pakistan, IDA remains a significant concern, posing challenges to maternal and child health. Early detection and management of iron deficiency are crucial for improving pregnancy outcomes.

Objective: This study aims to investigate the iron status and associated hematological parameters among pregnant females during the first trimester in Islamabad, Pakistan.

Methodology : This cross-sectional study, conducted in collaboration with the Pakistan Atomic Energy Commission (PAEC) and the Pakistan Institute of Medical Sciences (PIMS), aimed to investigate the iron status among first-trimester pregnant females in Islamabad, Pakistan.Laboratory investigations encompassed hemoglobin and serum ferritin assays, reticulocyte counts, and other red blood cell parameters. Participants were categorized into distinct iron status groups based on these evaluations. Utilizing SPSS version 25, statistical analysis followed ethical protocols, striving to uncover discrepancies in hematological parameters across the various iron status groups.

Results : Among 340 first-trimester pregnant women, three iron status groups were identified. Group 1 (n = 102) had low ferritin despite normal Hb, with elevated immature reticulocytes. Group 2 (n = 150) showed normal iron parameters, while Group 3 (n = 88) had high reticulocyte counts. Group 2 exhibited superior erythrocyte indices and higher ferritin levels than Groups 1 and 3. Group 3 displayed the poorest indices and elevated immature reticulocytes. These findings highlight variations in iron status and reticulocyte maturation among pregnant women.

Conclusion: This study underscores the high prevalence of iron deficiency anemia among first-trimester pregnant females in Islamabad, Pakistan. Variations in red blood cell parameters and serum ferritin levels highlight the importance of early iron status assessment for optimizing maternal and foetal health outcomes.

Evaluation of the Effects of Magnesium Sulphate versus Normal Saline on Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy

Rashid Ullah Khan — 2024-04-08

Introduction: Numerous studies have shown that giving magnesium sulphate intravenously before carbon dioxide pneumoperitoneum is produced reduces the adverse hemodynamic response in patients undergoing elective laparoscopic cholecystectomy.

Objective: To examine the effects on hemodynamics in patients undergoing laparoscopic cholecystectomy between magnesium sulphate and normal saline.

Methodology:The Department of Anaesthesia at the Pakistan Institute of Medical Sciences, SZABMU, Islamabad, conducted a Randomised Clinical Trial. The study involved the enrolment of 108 adult patients, regardless of gender, who were admitted for elective laparoscopic cholecystectomy and ranged in age from 18 to 65. Every patient who was enrolled was in ΑSΑ classes I and II. Patients were randomised equally to Group M, which received an IV slow bolus of magnesium sulphate (28 mg/kg) over a 20-minute period, and Group N, which received a 0.9% normal saline solution. The patient was tilted right and up by 15 degrees.

Results:Both groups' baseline characteristics were comparable. The mean age of groups M and N was 42.2 years ± 7.6SD and 40.5 years ± 8.4SD, respectively (Ρ-value t-test=0.258). 22 (40.7%) men and 32 (59.3%) women made up group M, while 20 (37.0%) men and 34 (63.0%) women made up group N (Ρ-value chi-square = 0.693). Both groups' baseline and pre-pneumoperitoneum hemodyanamic parameters (HR, Systolic, BΡ, Diastolic BΡ, and MAΡ) were similar (Ρ-value t-test > 0.05).

Conclusions:The adverse hemodynamic response caused by pneumoperitoneum was significantly attenuated by pretreatment with intravenous magnesium sulphate. Heart rate, systolic blood pressure, diastolic blood pressure, and MTH were all significantly lower than baseline. Significant hypotension and bradycardia, however, were not seen.

Prognostic Significance of Baseline Neutrophil to Lymphocyte Ratio and Lymphocyte to C-reactive Protein Ratio in COVID-19 Patients

Anum Afsar — 2024-04-15

Objective: Neutrophil-to-lymphocyte and lymphocyte-to-C-reactive protein ratios are important prognostic indicators for disease severity measurement among coronavirus patients. To predict the disease severity, CURB-65 scores, and outcome after 14 days of admission using two proxy biomarkers (neutrophil lymphocyte and lymphocyte C-reactive protein ratios) in COVID-19 patients.

Methodology: A prospective study was done at the Department of Medicine, Pakistan Ordinance Factory (POF) hospital, Wah Cantt, Pakistan, from April to August 2022. A total of 123 coronavirus patients were included. Patients with clinical manifestations, decreased lymphocyte and leukocyte counts, imaging characteristics of pneumonia, etiological evidence of a positive real time PCR test of blood or respiratory samples, and viral gene sequencing similar to known COVID-19 were measured. Patients underwent laboratory measurements and imaging analysis for biomarker indications. The analysis of the data was conducted using SPSS version 23.

Results: The patients mean age was 53.83±16.2 years. Among 123 COVID-19 patients, 80 (65%) were males and 43 (35%) were females. It was found to have high NLR and low LCR in severe disease (p = 0.05, p = 0.01). NLR and LCR showed 11% variance for disease severity (β = 0.143, p = 0.00, and β = -0.293, p = 0.01). NLR and LCR showed 29% variance for CURB 65 scores (β = 0.48, p = 0.634, and β = -0.159, p = 0.08). NLR and LCR showed 22% variance for outcome after 14 days of admission (β=-0.53, p=0.562, & β=-0.132, p=0.149).

Conclusion: Neutrophil to lymphocyte and lymphocyte to C-reactive protein ratios are effective prognostic biomarkers for measuring the severity of disease in COVID-19 patients. High neutrophil-to-lymphocyte and low lymphocyte-to-C-reactive protein ratios significantly predict disease severity.

Outcomes of Purse-string versus Conventional Linear Suture Closure of the Skin Wound following Ileostomy Reversal

Muhammad Adnan Khokhar — 2024-04-15

Background: Intestinal stomas are made in a variety of settings and their reversal is also a routine surgery. Due to their clean, contaminated nature, there is a high risk of surgical site infection post-operatively. The objective of this study is to determine the difference in outcomes in two different techniques of skin closure after stoma reversal

Methods: The study was conducted at department of general surgery, Pakistan Institute of Medical Sciences, Islamabad, over a period of six months. Seventy-one patients who underwent ileostomy reversal surgery in an elective setting were assigned two groups randomly: 34 in Group A and 37 in Group B. The group A patients underwent purse string closure for stoma site skin wound, whereas patients in group B underwent conventional linear closure. Time taken for surgery was noted and the patients were followed over one month period for development of any surgical site infection or dog-ear deformity.

Results: The incidence of surgical site infection was 8.8% in the purse string closure group compared to 43.2 % in the linear closure group. Seven patients in group B developed dog ear deformities, whereas no such case was noted in Group A.

Conclusions: Purse string closure is an effective and applicable technique for the closure of skin wounds after stoma reversal surgery. It is comparatively better in terms of prevention of surgical site infection as well as dog ear deformity in the closure of skin wounds after ileostomy reversal.

Typhoid Fever: Pakistan's Unique Challenges and Pragmatic Solutions

Maqsood Ahmad — 2024-04-02

Typhoid fever is a life-threatening disease caused by gram-negative bacteria Salmonella enteric serotype Typhi. Every year, this disease affects almost 21 million people worldwide, the majority of whom are from South Asia. According to the WHO, almost 11 to 21 million cases of typhoid fever and about 200,000 deaths from typhoid fever occurred all over the world. Pakistan health authorities have confirmed that from 2016 to 2020, almost 22,354 cases of typhoid fever were reported, out of which 15,717 cases were extensive drug-resistant typhoid fever reported from the different regions of Sindh. These calculations are used to measure the disease rate of typhoid fever, ratio is about 15.5/1,000, and the XDR strain of typhoid fever is highly resistant to the antibiotic, also known as extensive drug resistance. The diagnosis of typhoid fever is done by culture tests, serological test, nucleic acid assays, protein markers, and biomarkers. The proper diagnosis is very important to ensure the strain of typhoid fever, so treatment should be started accordingly.

Chronic Dengue Syndrome: A Narrative Review

Rizwan Aziz Qazi — 2024-04-08

Dengue fever (DF) is a dynamic disease. As the disease progresses, the course of treatment changes. Symptoms range from mild (e.g., fever, headache, retroorbital pain, nausea, vomiting, rash, myalgia, arthralgia) to severe body pain (e.g., rash fever), severe (e.g., dengue hemorrhagic fever) (DHF) and dengue shock syndrome. It changes. (DSS). DHF and DSS are associated with poor outcomes. Although there is a classification of dengue into DF, DHF, and DSS, overlap has been observed between the different presentations. In dengue, end organ damage such as liver, kidney, heart, brain, and bone marrow involvements are often reported along with blood plasma or hemorrhage. Order support system. The World Health Organization recognized these unusual symptoms and coined the term "Extended Dengue Syndrome" (EDS) to encompass atypical manifestations of neurological, renal, hepatic or other isolated diseases that occur with or simultaneously with serious diseases. Co-infections or other diseases in the host. EDS is now recognized worldwide as a common cause of dengue fever, and information continues to appear in medical journals. This review discusses this aspect of dengue fever, which covers the spectrum of symptoms in the body. This review article will help increase clinicians' knowledge about EDS and facilitate early detection and intervention.

Burkholderia cepacia: Understanding Pathogenicity, Virulence Factors, and Therapeutic Strategies

Muhammad Saeed — 2024-04-08

Burkholderia cepacia, formerly described as Pseudomonas cepacia, belongs to the Burkholderia cepacia complex (Bcc), a collection of closely related gram-negative bacteria that is considered a leading organism in causing pulmonary infections in humans. In healthcare settings, Burkholderia species have the ability to colonise medical equipment and surfaces, posing a threat of nosocomial infections. Moreover, they exhibit inherently resistance to various classes of antibiotics, thus being nominated as multi-drug resistant pathogens (MDR), that is why treatment of infections caused by these organisms is challenging. Enzymes such as metalloproteases, serine proteases, metalloproteases, and other extracellular lipases play a major role in its pathogenesis. In addition to this, different components, such as pili, flagella, and lipopolysaccharide (LPS), have a role in both the motility of the bacterial cell as well as its adherence to host cells. Identification is usually done with different biochemical reactions such as late oxidase activity, oxidation of glucose, variable lysine decarboxylation, maltose, mannitol, and lactose, and hydrogen sulphide gas production. Advanced techniques like semi-nested PCR, real-time PCR, or MALDI-TOF mass spectrometry enable quick and precise identification.

Key words: Multi-drug resistant, Polymerase chain reaction, Burkholderia cepacia complex, matrix assisted laser desorption ionisation, time of flight mass spectrometry

Restoration of Bilateral Premolars Using Custom Made Cast Post and Core: A Case Report

Asma Bibi — 2024-04-15

When grossly carious teeth need to be restored after endodontic treatment, long term success depends on the choice of the post and core systems. A custom-cast post and core is recommended when the remaining tooth structure is compromised and an insufficient ferrule is present. The following case report depicts the restoration of bilateral grossly carious premolar teeth by using custom-cast posts followed by PFM crowns. The patient presented with bilateral severely carious premolars with pulpal necrosis. The treatment plan included endodontic treatment followed by custom-cast posts and cores with PFM crowns. In this way, aesthetics and function for the patient can be achieved by using cast metal posts and metal ceramic crowns for the restoration of premolars.

Primary Cutaneous Mucinous Carcinoma: A Case Report

Qudsia Ishaq — 2024-04-15

Primary mucinous carcinoma of the skin is an uncommon malignancy of sweat gland origin. It is usually misdiagnosed clinically because of its benign appearance. On histological examination, it should be differentiated from metastatic mucinous carcinomas arising elsewhere in the body. We present a case of a 77-year-old male presenting with a swelling on the face, which was diagnosed clinically as a benign lesion, but on histological examination, it was diagnosed as mucinous carcinoma, and after thorough investigations, it was labelled as primary mucinous carcinoma of the skin.

Expanded Dengue Syndrome with Pulmonary Manifestations: A Case Report

Rizwan Aziz Qazi — 2024-04-16

Dengue fever is a vector-borne disease that is spread by mosquito called Aedes-egypti. It belongs to Flavivirus family, of which 4 serotypes have been identified. Its incubation period ranges from 7 to 10 days. Currently, dengue fever causes more illness and death than any other arbovirus disease of humans Dengue viruses are distributed world wide in tropical regions. It is currently endemic in 128 countries, mostly developing countries, putting an estimated 3.97 billion people at risk each year. Changing and increasing incidences are associated with rapid urban population growth, overcrowding, and lax mosquito control measures.