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

Background: Human Adenovirus (HAdV) is one of the most common causes of infection in children. HAdV commonly affects respiratory system, however can also involve other parts of the body like nervous system, eyes and urinary tract. The virus usually causes a mild infection of the lower and upper respiratory tract. Objective of the study was to find the prevalence of HAdV in paediatric patients presenting with Influenza like symptoms and severe acute respiratory illness across Pakistan.

Methods: This cross-sectional study was conducted at the National Institute of Health, Islamabad. Respiratory swabs were collected from 389 children with age less than five years from 14 hospitals in different regions of Pakistan from October 1, 2017 to September 30, 2018. Patients' demographics, signs and symptoms were recorded through a predesigned proforma while Real-time polymerase chain reaction (RT-PCR) was performed for respiratory samples.

Results: Out of all 389 samples, HAdV was found in 25 (6.4%) cases. The proportion of HAdV obtained was greater in females 18 (4.6%) than male 7 (1.8%). The influenza-like illness in children attending outpatient department had a higher prevalence of HAdV 13 (3.3%) compared to admitted children 12 (3.1%). Similarly, patients from one to 6 months of age had higher positive outcome than older children. Majority of positive patients were from Islamabad (2.0%) followed by Gilgit (1.8%), Azad Jammu Kashmir (1.0%), Multan (0.5%), and Karachi (0.5%). The most frequent signs and symptoms were cough, fever, sore throat, nasal congestion and shortness of breath.

Conclusions: The present study concludes that HAdV infection is common in Pakistan especially in female patients aged 1-6 months. It's crucial to improve the diagnosis of HAdV infections in our country to prevent complications associated with the virus. Furthermore, genetic analysis may help find different genotypes of HAdV circulating in Pakistan.

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year. That's why early correct diagnosis is very essential.

Background: Renal cell carcinoma being the commonest primary renal malignancy of adulthood accounts for approximately 80-90% renal malignant lesions. The purpose of radiological imaging modalities when devising the treatment options for renal masses is crucial as it significantly influence the clinical outcome and prognosis of the disease. Subjective impression by a radiologist for diagnosing a mass lesion is known to be critical and its precision is improved by contrast enhanced CT as demonstrated by certain retrospective analyses. We aimed to ascertain the diagnostic accuracy of contrast enhanced computed tomography to diagnose renal cell cancers by verifying through histopathology reported diagnoses.

Methods: This Cross-sectional (validation) study was carried out in Radiology and Urology departments of Ayub Teaching Hospital; Abbottabad, from 1st November 2020 to 30th April 2022. The study population included all admitted symptomatic patients with age range 18-70 years of either gender. The patients were subjected to detailed clinical examination and history and an ultrasound and contrast enhanced CT abdomen and pelvis. CT scans were reported under supervision of single consultant radiologist. Data was analysed in SPSS version 20.0.

Results: Mean age of the patients was 38.88±11.62 years ranging from 18-70 years and mean duration of symptoms was 54.64±49.171 ranging from 3-180 days. All of the total 113 patients underwent contrast enhanced CT scan and later operated to confirm the diagnoses by histopathology. The comparison yielded true positive (TP) cases to be 67, True Negative (TN) 16, False Positive (FP) 26, and 4 False Negative (FN) as per CT scan diagnoses. CT scan had a diagnostic Accuracy of 73.45% with 94.37% sensitivity and 38.10% specificity.

Conclusions: Contrast-enhanced CT has a high sensitivity for making the diagnosis of renal cell carcinoma; however, its specificity is low. A multidisciplinary approach is necessary to overcome the low specificity. Therefore, collaboration between radiologists and urologic oncologists should be considered while devising treatment plan for patients.

Extended trochanteric osteotomy is an invaluable technique for enhancing femoral exposure during revision total hip arthroplasty. Complications are rarely reported but may include non-union. Even rarer is the incidence of extended trochanteric osteotomy resorption. We present our experience using a modular tapered stem in managing a resorbed extended trochanteric osteotomy following revision total hip arthroplasty in a patient with extensive hip surgical history. Good surgical technique is important in the prevention and management of resorption. It is also important to identify high risk patients such as smokers or those with peripheral vascular disease. Long femoral stem prosthesis with diaphyseal fixation may help in dealing with proximal bone loss due to resorption of an extended trochanteric osteotomy, and avoids the need for allogenic bone graft.

Background: Salmonella typhi cause typhoid fever which is life threatening disease. It affects approximately 600,000 people per annum around the world. Food and water are the integral components through which this disease is transmitted and becomes base of typhoid. It spreads widely where cleanliness is very poor. Objective was to analyse three-dimensional structure of transcriptional regulator of Salmonella typhi CT18 by homology modelling to inhibit virulent effect of Salmonella typhi.

Methods: Bioinformatics tools and programs like comprehensive Microbial resource (CMR). Interproscan, Basic Local Alignment Search tool (BLAST), Modeller 9.10, Procheck and Prosa were used as bioinformatic tools for effective study of protein.

Results: Homology modelling is an appropriate and precise method to find three-dimensional transcriptional regulator to stop its virulency.

Conclusions: Homology modelling is computational and accurate method to find 3D structure of transcriptional regulator to inhibit its virulence effect of causing disease.

Intra-vitreal Vancomycin (IV-V) and ceftazidime (IV-C) are commonly in the treatment of acute post operative endophthalmitis. But there are suboptimal responses in some cases due to the emergence of antibiotic resistant micro-organisms. Moxifloxacin is a wide range antibacterial drug that is available as an eye drops for topical use for different types of ocular infections including post-operative endophthalmitis. But it has not been explored extensively as an intra-vitreal drug for post-operative endophthalmitis. We unveiled its broad spectrum anti-bacterial properties by giving it as an intra-vitreal route of delivery so to see its efficacy in post-operative endophthalmitis case. A 65 years old diabetic male presented with acute painful loss of vision in his right eye 2 days following his cataract extraction with posterior chamber intraocular lens implantation (PC IOL). His visual acuity (VA) on presentation was just counting finger close to eye. Slim lamp examination (SLE) revealed swollen lids, discharge in the inferior conjunctival fornix, conjunctival redness and chemosis, hazy cornea, fibrinous exudate in AC along with hypopyon, there was marked vitritis with yellowish fundal glow apparent. The patient was injected with intra-vitreal moxifloxacin 0.5mg/0.2 ml, along with topical and oral antibiotics in combination with steroids. VA reached to 6/24 and follow-up at 4th week didn't show any of intra ocular inflammatory changes on SLE. Intra-vitreal moxifloxacin mono-therapy is a better substitute to combination of vancomycin and ceftazidime due to its broad-spectrum coverage in acute post-operative endophthalmitis.

Fractures are an ordinary consequence of trauma. Paediatric fractures are rather uncommon because the bony framework is still in its growth phase and therefore compliant to such traumas. The incidence of vascular injuries is also low lying (<1%) in this age group. Nevertheless, management and recovery continue to be a challenge. In this case report, we discuss a 2-year-old child with a traumatic bilateral femoral fracture, a tibial fracture with added vascular injury. Delayed management may give rise to a variety of complications in such a peculiar case. Fortunately, this child is healthy, leading a normal life with no complications.

Background: Identification of gene targets and biological pathways involved in colorectal carcinoma (CRC) is essential for better management of patients. Our study aims to highlight common somatic mutations in colorectal carcinoma and to identify dysregulated pathways and gene enrichment based on KRAS and BRAF interaction network analysis.

Methods: By using cancer browser tool in COSMIC database, mutation frequencies of the top 20 mutated genes listed for colorectal adenocarcinoma were identified. The most frequent variants of selected genes were explored with ClinVar database which led to identification of protein change along with its cytogenic location, variant type, variant length and the associated single nucleotide polymorphism (SNP). These identified SNPs were searched in Pakistani database using 1000genome in an attempt to identify common polymorphisms. Using the database ClinicalTrial.gov the number of clinical trials based upon these selected mutations was explored. Enrichment and protein interaction (PI) analysis of KRAS and BRAF was carried out to reveal significant biological pathways associated with these genes.

Results: In cumulative data, among all variants about 57% of substitution mutations are observed to be G>A including mutations in KRAS, Tp53, SMAD4, PI3K and NRAS. The mutations of KRAS (c.35G>A), TP53 (c.524G>A) and APC (c.4348C>T) were found to be pathogenic with single nucleotide variation and variant length of 1bp. Searching 1000genome database revealed that 100 % of alleles found in East Asian population studied are 'C'(frequency=1). Significant biological pathways (<0.05) identified by our search include Trk receptor signalling mediated by the MAPK pathway, signalling to p38 via RIT and RIN, signalling to ERKs, Frs2-mediated activation, ARMS-mediated activation and prolonged ERK activation events.

Conclusions: Our study highlights the role of genetic profiling in CRC, with emphasis on mutations which may define treatment outcome. Targeting several collateral pathways simultaneously may be further explored to improve colorectal cancer therapeutics.

Background: Giant bullae (GB) are space occupying lesions associated with chronic respiratory symptoms. The aim of this study is to evaluate outcome of intra-cavitary tube drainage procedures (ITDP) in terms of clinical and radiological benefits.

Methods: A prospective study was conducted in The Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, from February 2021 to April 2022 after ethical approval. Patients above 12 years, with poor reserve and GB underwent clinical, radiological and laboratory assessment before and after ITDPs to document various studied parameters.

Results: A total of 48 patients were included; thirty-two (66.7%) were males. Mean age was 46.7±12.14 years. Most common aetiology was COPD (28; 58.3%). GB were ≥10 cm in size in 36 (75%) with right upper lobe involvement in 20 (41.7%). Preoperative dyspnoea score of IV was seen in 41 (85.4%) and chest pain in 42(87.5%) patients. In 34(70.8%) patients, Monaldi procedure and in 14 (29.2%) Brompton technique was used. Dyspnoea score improved from grade IV to II (24/41; p=0.004) along with reduction in pain and cough (p=0.012; p=0.002), respectively. Improvement post operatively in oxygen saturation, forced vital capacity, forced expiratory volume in 1 sec (6.08±1.36%, 0.73±0.516 L and 0.57±0.07 L, respectively, p<0.001) was seen. Partial pressure of oxygen (PaO2) and carbon dioxide improved by 40.6±4.82 (p=0.009) and 13.22±3.62mmHg (p=0.7). Improvement of PaO2 was associated with reduction in the size of bullae (9.33±5.13cm; p=0.006). Radiographical resolution was seen in 41 (87.5%) majorly within 2 months (21; 51.2%). Duration of hospital stay was 4.20±0.92 days with no mortality. Complications were seen in 25 (52.1%) patients.

Conclusions: Intra-cavitary tube drainage procedures allow both clinical and physiological improvement in patients with GB. They allow resolution of bullae in patients with poor reserves and help in expansion of underlying compressed lung, improving both the clinical symptoms and radiological picture.

Background: Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity, the incidence of which has significantly increased in the last 10 years. In Pakistan, it is reported to be the most common cancer among men and the second most common in women. Cyclin D1 is a protein involved in cell cycle regulation from G1 phase to S phase. Down regulation of this molecule causes inhibition of cell cycle transition and may lead to carcinogenesis. We studied the expression of Cyclin D1 in biopsies of oral squamous cell carcinoma to evaluate the staining patterns in various grades and sites of the oral cavity. Cyclin D1 was expressed in 53.8% cases of OSCC and showed a significant association with tumour differentiation, with higher intensity staining seen in poorly differentiated cases of OSCC. Thus, Cyclin D1 can be regarded as a marker of malignant potential of OSCC and can help identify cases with poorer outcome.