Journal of Ayub Medical College, Abbottabad : JAMC最新文献

Background: Giant penoscrotal lymphedema is a rare condition and is treated by surgical debulking and reconstruction with remaining skin and skin grafts. The described techniques may result in a staged surgery, multiple blood transfusions, orchidectomy and early debulking of the scrotal skin. We present a case series describing our technique to address all the concerns, discuss management to decrease progression and transmission in secondary cases and present a novel questionnaire to assess of quality of life of these patients.

Methods: This descriptive case series was done from July 2016 to October 2019. Patients with Campisi grade 5 disease were included. Clinical assessment and relevant investigations were done to identify the cause and confirm the extent of the disease. Procedural detail, post-op haemoglobin levels (Hb), need for transfusion and weight of excised specimen were recorded. Wound healing, recurrence and body mass index were noted on follow up. A scrotal lymphedema quality questionnaire was developed and was filled on follow-up visit.

Results: Twelve patients were operated on. The mean history was 3.0±0.5 years. 4 tested positive for microfilariae, while 4 out of 8 who tested negative had taken the anthelmintic drug. The mean weight excised was 15.8±2.3 kg, mean pre-operative score on quality-of-life assessment questionnaire was 83.3±2.6 versus 9.3±0.8 post operatively. The mean follow up time was 1.4±0.6 years. 1 patient had a minor recurrence necessitating re excision. Mean Hb was 13.5±0.5 mg/dl preoperatively compared to 11.8±0.5 mg/dl post operatively, with none requiring transfusion.

Conclusions: Single staged excision with split thickness skin grafting is an effective and safe way to treat patients with giant scrotal lymphedema. It's the single best way to address the quality of life of patients.

Background: Doxorubicin is one of the most commonly used anti-cancer drugs that treat a large number of haematological and solid malignancies. Its usage in dose and duration is nevertheless restricted by dose related organ damage, particularly cardiotoxicity. Lovastatin is a commonly prescribed drug for hypercholesterolemia and possesses remarkable antioxidant potential. Our study was aimed at evaluating and comparing its cardioprotective effect in two pre-treatment schedules against doxorubicin-induced cardiac damage.

Methods: In this lab-based randomized controlled experiment, 40 BALB/c mice were randomly grouped into five groups (n=8). Group 1 served as control whereas Group 2 was given doxorubicin intraperitoneally at a dose of 10mg/kg. Group 3 received 10mg/kg of oral lovastatin for five days. Groups 4 and 5 were administered lovastatin for five and ten consecutive days correspondingly and doxorubicin was given on 3rd and 8th experimental days of these groups.

Results: Doxorubicin caused a significant rise in cardiac enzymes; Creatine kinase MB (CK-MB) and Lactate Dehydrogenase (LDH) (p value ≤0.0001) whereas cardiac histological alterations were ranked as moderate. The damage was significantly attenuated by lovastatin in the ten-day study design with a p-value of ≤0.001 for both LDH and CK-MB whereas a slightly less efficient restoration was observed in the five-day design with a p value of ≤0.001 for LDH and 0.012 for CK-MB. Histological preservation in both pre-treatment schedules was in accordance with the biological markers.

Conclusions: In doxorubicin-based regimens, pretreatment for at least seven days with an easily available and safe statin can effectively prevent its potentially life threatening cardiotoxicity.

Background: The U grading of Ultrasound scan (USS) is used to assess the likelihood of malignancy in a thyroid nodule and help determine those that warrant an FNAC confirmation. All those of a U3-5 warrant an FNAC for confirmation and typing. This study aims to review the follow-up practice and the likelihood of picking up a malignancy on subsequent USS and FNAC, for those determined as an indeterminate U3 nodule.

Methods: We retrospective reviewed the trust database (Portal) for patients who had a U3 nodule reported on USS identified, and clinical, operative and outcomes data were analysed.

Results: 258 scans were identified over a 5-year period. The average age was 59 (range 15- 95) years old at first USS with a female to the male sex ratio of 4:1. The average number of USS that each patient prior to final diagnosis had averaged at 2.8 (range 1-12). Of those with an initial Thy status, 64 (33%) were benign (Thy2) and a further 49 (25%) were non diagnostics (Thy1). Over time, only 7 nodules were upgraded to a potential malignancy. Of those who underwent surgery, a final histological diagnosis was obtained in 41 cases. Only Thy1, 2 and 3f produced benign final histology results.

Conclusions: For those indeterminate (U3) nodules of Th1-3f, electing for a watch and wait management strategy is reasonable for up to 2.5 years and 4 follow-up scans at an interval of 6-12 months should be implemented. A Thy2 result on a U3 nodule should not be taken as completely reassuring, a high index of suspicion of malignancy must be maintained.

Background: Carcinomas of the salivary gland are known to be aggressive in nature, making them difficult to manage. The therapeutic options offered include excision of the gland (maxillectomy in cases of palatal tumours), with or without lymph node dissection, proceeded with radiotherapy. Chemotherapy has not produced promising outcomes and has a minimal impact as a therapeutic alternative. Targeted therapy against human epidermal growth factor receptor 2 (HER-2), which is a commonly used treatment modality for their mammary analogues, is not being offered to these patients since scant literature is available showing its usefulness and no promising evidence is present regarding their efficacy and efficiency in such cases. The study aimed to evaluate and quantify the immunohistochemical expression of HER-2 in cases of adenoid cystic carcinoma (AdCC), mucoepidermoid carcinoma (MEC) and salivary duct carcinoma (SDC), which are analogues of similar tumours arising in breast tissue.

Methods: A retrospective, cross-sectional study was carried out in the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, duration of which was six months. A total of 45 cases (15 of each tumour) were taken, and sampled using non-probability convenience technique. The immunohistochemical marker, monoclonal HER-2 antibody (Leica microsystem Germany) was applied on appropriate blocks of all included cases. The staining pattern and intensity were recorded after visualizing the slides under a light microscope.

Results: Seven cases of salivary duct carcinoma and a single case of mucoepidermoid carcinoma expressed positivity for HER-2, while no expression could be seen in the case of adenoid cystic carcinoma. A statistically significant difference was seen when HER-2 expression was compared among the aforementioned tumours.

Conclusions: The use of targeted therapy against HER-2 is limited to patients of salivary duct carcinoma and a fraction of patients suffering from mucoepidermoid carcinoma.

Background: Splenic abscess is an uncommon condition, with autopsy studies estimating an incidence rate of 0.14-0.70%. Causative organisms can be extremely diverse. Burkholderia pseudomallei is the most common cause of splenic abscess in melioidosis-endemic areas.

Methods: We reviewed 39 cases of splenic abscesses in a district hospital in Kapit, Sarawak, from January 2017 to December 2018. The demographics, clinical characteristics, underlying diseases, causative organisms, therapeutic methods, and mortality rates were investigated.

Results: There were 21 males and 18 females (mean age, 33.7±2.7 years). Almost all patients (97.4%) had a history of pyrexia. Diabetes mellitus was present in 8 patients (20.5%). Splenic abscesses were diagnosed using ultrasonography and were multiple in all 39 cases. Positive blood cultures were obtained in 20 patients (51.3%), and all yielded B. pseudomallei. Melioidosis serology was positive in 9 of 19 patients (47.4%) with negative blood cultures. All patients were treated for melioidosis with antibiotics without the need for surgical intervention. All splenic abscesses resolved after anti-melioidosis treatment was completed. One patient died (2.6%) as a result of B. pseudomallei septicaemia with multiorgan failure.

Conclusions: Ultrasonography is a valuable tool for diagnosing splenic abscesses in resource-limited settings. B. pseudomallei was the most common etiological agent of splenic abscesses in our study.

Background: Cytogenetics is evolving and different molecular mechanisms we know now have proved to be of diagnostic and prognostic significance in both acute lymphoid (ALL) and myeloid leukaemia (AML). This study aims to find out and compare the occurrence of different cytogenetics in paediatric acute leukaemia.

Methods: This is a cross-sectional study of diagnosed B-ALL and AML patients presenting at The Indus Hospital. We studied FISH and karyotype in BALL and FISH in AML patients. FISH analysis shows a total of 69 (12.8%) of B ALL patients had cytogenetic abnormalities. BCR-ABL1 was positive in 5.1%, ETV6/RUNX1T1 in 8.6% and KMT2A in 2.3% individuals. Karyotype reveals hyper diploidy in 24.3%, Monosomy in 1.94%, and t (1:19) and t (17:19) were observed in 5.8% and 0.24% cases respectively. FISH analysis in AML cases reveal positivity of t (8:21) in 26.4%, INV (16) in 6.1% while PML-RARA t(15:17) was done on morphological suspicion in 17 cases; all of which showed positivity; making 7.9% of the total AMLs. The study demonstrated a wide spectrum of heterogeneity in paediatric acute leukaemia.

Conclusion: Hyperdiploidy was the most common cytogenetic abnormality. We report a lower incidence of t (12:21), compared to the world. We showed a higher prevalence of RUNX1/RUNX1T1 in young children. The prevalence of core binding factor AML was 32.5%.

Background: The reconstruction of proximal defects with tight contacts has always been a challenge for dental clinicians, especially with composite material. Recent literature shows that the most frequently used matrix systems for the restoration of proximal cavities are circumferential or sectional matrix band systems. The objective of this study was to compare the contact tightness that is achieved with these two matrix band systems when using composite material.

Methods: A total of 30 patients, i.e., 60 cavities were selected in this quasi-experimental study. Patients with two cavities in the posterior teeth were selected. Both the cavities were restored with the circumferential system, i.e., Tofflemire and sectional matrix band system, i.e., Palodent plus on the same appointment. Hence both systems were used in every patient and then contact tightness assess was ed based on an evaluation criterion, i.e., Fédération Dentaire Internationale clinical criteria for evaluation of contact in direct and indirect restorations. To make a comparison between the two systems Chi square test was used and p<0.05.

Results: The mean age of the patients in the study was 31 years (SD, 7.59 years) with a range from 18 to 45 years. Most of the contact tightness in the Palodent matrix system was score 1 (n=33, 55%) and score 2 (n=17, 28.3%) while in Tofflemire was score 4 (n=28, 46.7%) and score 5 (n=19, 31.7%). Statistical analysis showed significance (p=.037) between Palodent matrix system contact tightness and Tofflemire.

Conclusion: The sectional matrix band system was statistically superior to the circumferential matrix band system in achieving a tighter contact for class II composite restorations.

Burkholderia pseudomallei is a Gram-negative bacterium that causes melioidosis. Melioidosis is a potentially fatal disease that is endemic in Southeast Asia and Northern Australia and is being increasingly recognized in other regions worldwide. Melioidosis can affect any organ system and present with a wide range of clinical manifestations including pneumonia, bone, skin/soft tissue, or central nervous system infections. In this report, we describe a diabetic farmer who succumbed to persistent B. pseudomallei bacteraemia with multiorgan involvement despite treatment with meropenem and ceftazidime.

We present a case report of a potentially lethal post-COVID complication. A 65-year-old male presented with shortness of breath and fever with chills. He had recently recovered from COVID pneumonia. Contrast enhanced CT scan chest gave the suspicion of pulmonary pseudoaneurysm. CT aortogram revealed a well-defined rounded mass in the right lung mainly occupying the lower lobe of the right lung. Angiography through the right common femoral vein was performed and it confirmed a huge pseudoaneurysm arising from the posteromedial branch of the right descending interlobar artery. As the artery was not found suitable for endovascular embolization, the patient was referred to a thoracic surgeon.