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

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.

Background: There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique.

Methods: In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021.

Results: Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29).

Conclusions: Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.

Background: Carpal tunnel syndrome (CTS) can be diagnosed easily on ultrasonography (USG); which is a cheap, non-invasive and readily available modality. However, there is wide normal variation in the normal values of cross-sectional area (CSA) of median nerve among different populations; therefore, its necessary to establish a normal range of variability in median nerve dimensions in different populations.

Methods: A total of 500 asymptomatic patients i.e., 1000 median nerves were evaluated at the distal wrist crease and mid-forearm by 3 expert radiologists independently. All patients having a positive nerve conduction study or history of carpal tunnel syndrome and wrist trauma were excluded. Ultrasound was performed with a 7.5-15 MHz high-frequency linear probe. SPSS v 20 was used to analyze data.

Results: The study population had a mean age of 31.40±10.11 years with a female-to-male ratio of 1.36:1. Mean BMI was 22.15±4.34 Kg/m2 . The mean cross section area of the median nerve at the right wrist was calculated to be 6.8±1.96 mm2 and the left wrist was 6.6±1.96 mm2 . The mean median nerve cross-section area at the right mid-forearm was 5.3±1.46 mm2 and the left mid-forearm was 5.2±1.50 mm2 . A decrease in mean median nerve cross-section areas was noted by moving from wrist to forearm. Similarly, males showed higher median nerve CSA than females.

Conclusions: Mean median nerve cross-section area was found to be different from Western countries. This warrants the utilization of the data of the Pakistani population to establish our own normal reference range for median nerve cross-sectional area to avoid misdiagnoses.

A 58-year-old asymptomatic man was referred by his general practitioner for abnormal blood results. Routine blood tests to monitor blood count and kidney functions showed neutropenia and hyponatremia. He was euvolemic on examination. A further detailed investigation did not reveal any cause of neutropenia and hyponatremia. After careful assessment of their drug history, it transpired he recently started Indapamide for uncontrolled hypertension. Hyponatraemia is a common side effect of Indapamide and in addition, it can rarely cause agranulocytosis and leukopenia. Indapamide was stopped and the blood counts started to improve and became normal after two weeks.

Burkholderia pseudomallei affecting the central nervous system has been extensively reported in the literature. However, combined central nervous system and peripheral nervous system involvement in melioidosis has never been reported. We report a 66-year-old man with diabetes mellitus who was diagnosed to have central nervous system melioidosis and developed acute flaccid quadriplegia. Nerve conduction studies and anti-ganglioside antibodies were consistent with Guillain-Barre syndrome. This case report highlights the importance to recognise the possibility of Guillain Barre syndrome complicating central nervous system melioidosis and stresses the urgency of early consideration of this complication, as early immunomodulatory therapy may hasten neurological recovery.

Background: Non-clear cell renal cell carcinomas are uncommon renal tumours with diverse histologically and genetically defined entities. Due to limited clinical outcomes data, no standardized management approach can be offered to these patients. This study aimed to analyse outcomes of non clear cell renal cell carcinoma after surgical resection of localized renal tumours in our population.

Methods: Patients with renal tumours who underwent partial or radical nephrectomy at the Department of Urology, from January 2010 to December 2019 were identified and evaluated, in terms of prevalence, presentation, recurrence, and survival outcome.

Results: Non-clear cell tumours were found in one-fourth of the total number of nephrectomies performed during this period for renal cell carcinoma (RCC). The mean age was 50.48±14.76 years (range 18-89 years) with 57% being of the male gender. The predominant types were chromophobe RCC, papillary RCC, and sarcomatoid RCC, in all non-clear cell renal tumours. Mean Recurrence Free Survival (RFS) for all tumours was 75.26±2.7 months. The projected 5 years RFS of papillary RCC, chromophobe RCC and sarcomatoid RCC were 94.2%, 84.3% and 62.5% respectively.

Conclusions: RCC of non-clear-cell histology depicts excellent survival in patients with localized renal tumours. Furthermore, sarcomatoid RCC has worse recurrence free survival followed by chromophobe RCC and papillary RCC, in our population subset.

Chronic myelogenous leukaemia is a disease in which bone marrow produces too many white blood cells. It is more common in middle age and its incidence is rare in children. Imatinib is the standard first-line treatment in chronic myeloid leukaemia. It improved the prognosis with lesser side effects. Our point of interest is to highlight its role in the paediatric age group. we present case series of a patient with chronic myeloid leukaemia responsive to imatinib. Because of the rare incidence of chronic myeloid leukaemia in this age room limited studies to explore the role of treatment modalities in the paeds group. Our case series highlights imatinib's effectiveness in treatment and improving the prognosis of the disease in this age group.

Background: The accumulation of fluid between the retinal layers is called retinal or macular oedema, while intraretinal oedema, or macular oedema, refers to fluid accumulation directly within the retina. The purpose of the study was to evaluate the effects of intravitreal injections of bevacizumab on intraocular pressure (IOP) in Non-Glaucomatous patients with Macular Oedema.

Methods: A pre-and post-interventional study was conducted. 220 patients were studied utilizing a non-probability, consecutive sampling method. Open Epi software was used to determine the sample size. The Department of Ophthalmology at Islamabad's Tertiary Care Hospital hosted the study, which lasted six months.

Results: The study's participants ranged in age from 30 to 60, with a mean age of 50.38±6.53 years. Male to female ratio of these 220 patients was 1:1.6, with 86 (39.09%) men and 134 (60.91%) women. The mean IOP at baseline was 11.57±1.42 mmHg, and the mean IOP one month after the injection was 12.81±1.18 mmHg, with a mean change in IOP of 1.24±0.87 mmHg.

Conclusions: This study found that non-glaucomatous patients with macular oedema experienced a high mean change in intraocular pressure (IOP) after intravitreal Avastin.

Multicentric Reticulohistiocytosis is a rare disorder of unknown aetiology which affects skin and joints predominantly. There are no specific laboratory investigations for diagnosis. Diagnosis can be made clinically and on a histopathological basis. There is no consensus on treatment. We report a case from Pakistan with classical presentation who did well on methotrexate and low dose steroids. Prompt diagnosis and early treatment may save from significant disability.

Background: Chronic Obstructive Pulmonary Disease (COPD), the third leading cause of death worldwide, is characterized by airflow limitation that can be due to abnormalities in the airway and/or alveoli. Genetic diagnosis at an early stage can be a key factor in the provision of accurate and timely treatment. Single Nucleotide polymorphisms (SNPs) are an important tool to study genetic association/ predisposition of the disease and have great potential to be diagnostic markers for early diagnosis of disease.

Methods: This case-control COPD association study was designed for the five SNPs residing on potential candidate genes (SERPINA1, SERPINA3, RIN3), to check whether these genes are involved in the genetic predisposition for COPD in the Pakistani population or not. The SNAPshot method was used to find out the risk alleles and haplotypes using ABI Genetic analyzer 3130. GeneMapper, Haploview and PLINK 1.9 software were used for analyzing the genotypes and haplotypes taking smoking exposure and gender as covariates.

Results: Two of the SNPs, rs4934 and rs17473 were found to be independently and significantly associated with COPD in our studied population whereas haplotype H1 for two SNPs, rs754388 and rs17473 (that are in high linkage disequilibrium), was found to be a significant risk factor for developing COPD symptoms.

Conclusions: SNP variants of SERPINA1 and SERPINA3 are significantly and independently associated with COPD in the local population of Pakistan.