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

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: Blood transfusion is a lifesaving method in clinical emergencies. Despite various preventive measures, the spread of Hepatitis B, C and HIV remains a big issue in Pakistan. This study was done to describe transfusion transmitted diseases using NAT and CLIA techniques, on exposure to these viruses.

Methods: This study was conducted from 1st April to 25th August 2022. A descriptive study was done along with univariate analysis. The data was obtained from the regional blood centre in Abbottabad and it consists of reactive and non-reactive cases of NAT and CLIA in the sample size of 6233 donors. Data was collected from donors, and selected according to predefined criteria.

Results: In 6233 samples, 53 were reactive for either Hepatitis B, C or HIV. Forty-seven were reactive with both CLIA and NAT. 6 were reactive with NAT only and 6107 were non-reactive.

Conclusions: NAT yield detected in this study is 0.096%. (1:1039 donations). It implies that NAT should be the preferred method for screening in blood banks.

Background: This study aimed to evaluate the impact of Insulin Degludec Aspart on daily insulin dose in comparison with premixed insulin aspart.

Methods: It was a Quasi-Experimental study conducted in the Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi and the Department of Medicine, Pak Emirates Military Hospital, Rawalpindi. One hundred and twenty participants with documented type 2 diabetes, taking premixed insulin aspart therapy were enrolled in the study. Sixty participants were substituted with insulin degludec aspart from premixed insulin aspart. Daily units of insulin were recorded for 12 weeks and compared for both groups. SPSS version 26 was used for analysing the study results.

Results: Participants of the insulin degludec aspart group showed a significant reduction in the daily insulin dose compared to the premixed insulin aspart group. Fifty-two units per day were administered in the participants of the premixed insulin aspart patients while insulin degludec aspart participants received 40 units of median daily insulin dose (p-value<0.001).

Conclusions: Insulin degludec aspart proved superior to premixed insulin aspart in a reduction in the daily dose of insulin with insulin degludec aspart.

Background: Incompetence of the great saphenous vein (GSV) is a global issue and the most prevalent cause of chronic venous disease of the leg. Clinical manifestations range from moderate to severe, including tiredness, heaviness, and irritation, as well as hyperpigmentation and leg ulcers. Significant advancements in GSV ablation employing percutaneous methods, such as endovenous laser ablation, have been made in recent years. (EVLA). The objective of the study is to compare the outcome of the compression dressing for two days vs. seven days after varicose vein surgery. This case control study was performed on the Surgical floor, Mayo Hospital, Lahore, from September 15 to March 15, 2020.

Methods: We took a sum of 60 patients admitted from the outpatient department fulfilling the inclusion criteria after the approval of the ethical committee of the hospital. Group-A wore compression dressing for 2 days after surgery and Group-B wore compression dressing for seven days after surgery. Each patient received 1gm paracetamol I/V 8 hourly followed by tab. paracetamol 500mg P/O 8 hourly. Then the outcome of compression dressing was analyzed in the form of mean postoperative pain. The mean pain score was assessed in 1 week. Data were entered in SSPS v23.0 and stratification of pain score was done against age, gender, and grades of varicose veins. A comparison of the two groups was done by applying a t test. A p-value ≤0.05 was considered statistically significant.

Results: We took a sum of 60 patients with Primary varicose veins based on their eligibility for this study. Patients were divided into two groups, i.e., Group-A (Compression dressing for 2 days) and Group-B (Compression dressing for 7 days). The average ages of patients in group A were 33.4±9.6 years and in group, B was 35.4±9.9 years. A mean pain score of 4.5±1.2 was noted in patients in group-A (Compression dressing for 2 days) while 2.9±0.8 in patients in group B (Compression dressing for 7 days) with a p-value of 0.0001 which is statistically significant.

Conclusions: When compression stockings are used for more than two days after the Trendelenburg procedure is done, it can lead to lesser pain and enhanced physical activity in the first-week post operatively.

Background: Bruck syndrome or BRKS1 is an extremely rare condition characterized by the onset of fractures in infancy, joint contractures, short stature, severe limb deformity, and progressive scoliosis. Less than fifty cases of BRKS1 have been reported so far. Here, we report Bruck syndrome 1 in two siblings who belong to a consanguineous Pashtun family living in Karachi. Our first case is a seven years old boy who presented with recurrent fractures, lower limb deformity, and unable to walk. He had markedly reduced bone mineral density (BMD) and a normal bone profile. The other sibling presented at one week of age with arthrogryposis multiplex congenita, post-axial polydactyly of both feet and spontaneous fracture of the right proximal femur. Genetic testing of our cases was performed in which genomic DNA was enriched for targeted regions using the hybridization-based protocol, and DNA sequencing was done using Illumina technology; both cases were found homozygous for pathogenic variant c.344G>A (p.Arg115Gln) in FKBP10 gene leading to the diagnosis of BRKS1. FKBP10 gene mutation has been reported earlier in association with BRKS1, but in our case report, we have reported the first case of BRKS1, particularly in the Pakistani population of Pashtun ethnicity. We have reported post-axial polydactyly of both feet and spina bifida for the first time in association with FKBP10 mutation. In addition, the skeletal survey of patients with BRKS 1 is elaborated in detail in this report.

Background: Overactive bladder is mostly treated with a combination of behavioural interventions and commonly prescribed anti-muscarinic medication therapy, including solifenacin, which has considerable side effects and lowers the quality of life. Mirabegron relaxes the detrusor muscle and is a recently approved drug for the treatment of OAB. This study examined the effectiveness and safety of two medications, solifenacin and mirabegron.

Methods: This study was a comparative cross-sectional study conducted at Sami Medical Center, Abbottabad for a period of 6 months from August 2022 to January 2023. Female patients of aged ≥18 years with symptoms of OAB were enrolled.

Results: Current study showed that the average age of patients was 37.47±12.48 years in Group S and 39.93±7.93 in Group M. The population consists of 60 (100%) females. After 4 weeks of follow up dizziness, dry mouth, constipation hypertension and blurred vision were found insignificant between both groups with p-values of 0.312, 0.161, 0.076, 0.076, and 0.313 respectively. OABSS score improved significantly and after therapy 4.20±1.32 in Group S and 3.43±1.13 in Group M. There was no significant difference in frequency of treatment withdrawal p-value 0.150.

Conclusions: When it comes to relieving symptoms of OAB, both solifenacin and mirabegron are effective. The OABSS improved with both drugs; however, mirabegron was associated with fewer treatment-related adverse events. We advocate using mirabegron as the first-line treatment. Solifenacin can be utilized if patients are no longer getting the desired effects from Mirabegron.

Background: Cryotherapy is a common destructive treatment modality for treating plantar warts that results in blistering and scarring. Mitomycin an antitumor drug with antiviral property is a safe, better and a promising option for treating plantar warts. Objective was to compare efficacy of cryotherapy and mitomycin microneedling in the management of plantar warts. It was a randomized controlled trial conducted at the Skin Department CMH Abbottabad from 1st May to 31st December 2021.

Methods: The study included 60 patients with plantar warts. Each group with 30 patients. Random tables were used to determine the distribution of patients within each group. Group A received mitomycin microneedling (1u/ml) repeated every 3 weeks. Group B was prescribed liquid nitrogen cryotherapy. The freeze-thaw cycle was 20 secs and repeated every 2 weeks. Both groups were treated for 4 months duration. For analysis of data, SPSS version 21.0 was used. Efficacy was compared by the application of Chi-square test between the two groups. p<0.05 was considered statistically significant.

Results: Mitomycin microneedling completely cured 76.7% of patients, while cryotherapy was effective for only 56.7%. Complete remission was observed after two to three sessions of mitomycin microneedling while average of 4 sessions of cryotherapy were required for complete remission. In general, microneedling with mitomycin had better tolerance, pain being the commonest adverse effect.

Conclusions: Plantar warts can be effectively treated with mitomycin microneedling. Treatment of plantar warts with this method is more effective, requires fewer sessions, and may take less time to complete.

Heamophagocytic Lymphohistiocytosis (HLH) is problematic to diagnose. The conditions that predispose to HLH present in a similar fashion, such as sepsis and haematological cancers. We look at the case of a 66-year-old man with a diagnosis of CLL, who presented with pyrexia and non-specific symptoms which included abdominal discomfort and weight loss. Sepsis, the principal suspicion was thoroughly investigated and excluded. Routine autoimmune pathologies were exhausted with comprehensive panels. The patient was trialled on steroids, presumptively, with a limited response. What was most peculiar in his blood tests was an unusually high Ferritin of > 50000. The parent clinical team was at a loss to explain the unusually high ferritin when a locum consultant suggested the diagnosis of Haemophagocytic Lymphohistiocytosis based on a similar presentation she had observed many years ago. The patient was started on pulsed Etoposide and Dexamethasone, however, unfortunately, he could not make a recovery.