Bladder cancer is a common genitourinary malignancy with variable metastatic potential. Cutaneous metastasis is uncommon and often presents with a poor prognosis. We presented a 47-year-old man with a history of muscle-invasive urothelial carcinoma of the bladder and suffered from headache and right arm swelling that had persisted for months. The excisional biopsy of the skin lesions and scalp tumor showed high-grade metastatic carcinoma of urothelial origin. Even though is rare, cutaneous metastasis is still the possibility of urothelial carcinoma metastasis and mimics several types of skin lesions. There is no guideline for cutaneous metastases of urothelial carcinoma because of the small number of patients and poor prognoses. Chemotherapy remains the treatment of choice, and further studies are needed to assess the efficacy of immunotherapy for skin metastases of urothelial carcinoma.
{"title":"Case Report: A Rare Case with Cutaneous Metastasis of Bladder Urothelial Carcinoma","authors":"Min-Jui Wu, Hui-Kung Ting, Ting-Ying Lee, Yu-Cing Jhuo","doi":"10.4103/jmedsci.jmedsci_138_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_138_23","url":null,"abstract":"Bladder cancer is a common genitourinary malignancy with variable metastatic potential. Cutaneous metastasis is uncommon and often presents with a poor prognosis. We presented a 47-year-old man with a history of muscle-invasive urothelial carcinoma of the bladder and suffered from headache and right arm swelling that had persisted for months. The excisional biopsy of the skin lesions and scalp tumor showed high-grade metastatic carcinoma of urothelial origin. Even though is rare, cutaneous metastasis is still the possibility of urothelial carcinoma metastasis and mimics several types of skin lesions. There is no guideline for cutaneous metastases of urothelial carcinoma because of the small number of patients and poor prognoses. Chemotherapy remains the treatment of choice, and further studies are needed to assess the efficacy of immunotherapy for skin metastases of urothelial carcinoma.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-25DOI: 10.4103/jmedsci.jmedsci_8_23
Chung-Yi Wu, Zhi-Fu Wu, Yi-Hsuan Huang, W. Tseng, Bo-Feng Lin, H. Lai
The same-day bidirectional endoscopy (BDE) under anesthesia is commonly performed for its efficacy. Until now, the optimal regimen of sedation for same-day BDE is still inconclusive. The aim of this study is to investigate the relationship between the effect-site concentration at loss of consciousness (CeLOC) and maximal maintained Ce (CeM) in patients undergoing sole propofol sedation with the targeted-controlled infusion (TCI) pump and to explore the potential factors for extra fentanyl administration for same-day BDE to improve the quality of anesthesia. After excluding the patients with different anesthesiologists/endoscopists and esophagogastroduodenoscopy before colonoscopy, a total of 183 patients receiving BDE with the American Society of Anesthesiologists I to III were enrolled. Anesthesia with TCI of propofol ranged from 2.5 to 5.0 μg/mL was administrated and propofol was increased in steps of 0.5 μg/mL when inadequate or too deep sedation during the procedure. If the sedation level failed to meet satisfaction after two times of Ce increments or CeM achieve 5.0 μg/mL, bolus of fentanyl (25 μg) would be administered. The age, height, weight, gender, CeLOC, CeM, awake Ce, anesthesia time, examination time, frequency of TCI adjustments, total consumption of propofol or fentanyl, incidence of patient movements affecting the procedure, and use of ephedrine or atropine were retrieved from anesthetic charts and electronic medical record was recorded and the factors affecting the extra bolus of fentanyl or CeM were calculated. One hundred and fifty-seven patients underwent procedures with only propofol sedation and 26 patients with additional fentanyl bolus 25 μg. There were three patients with hypotension, bradycardia, and transient hypoxemia in only propofol sedation, respectively. The incidence of patient movements affecting the procedure was 36.6% (67/183), 41 patients completed the procedure after increasing propofol Ce, and 26 patients required an extra bolus of fentanyl. After linear regression, the optimal formula was CeM = 1.9–(0.006 × age) + 0.658 × CeLOC. After controlling for confounding covariates, only CeLOC was the most informative covariate for the demand for fentanyl. Finally, we simplified the formula as propofol CeM = CeLOC + 0.7 μg/mL to avoid patient movements affecting the procedure and adverse effects. We showed that the age and CeLOC were associated with CeM and only higher CeLOC (>4.5 μg/mL) was the only contributing factor for the extra bolus of fentanyl in BDE. We also provided the simplified formula as propofol CeM = CeLOC + 0.7 μg/mL to avoid patient movements affecting the procedure and adverse effects.
麻醉下的当日双向内窥镜检查（BDE）因其疗效显著而被广泛采用。迄今为止，当日双向内窥镜检查的最佳镇静方案仍无定论。 本研究旨在探讨使用靶向控制输注（TCI）泵接受单纯异丙酚镇静的患者在意识丧失时的效应部位浓度（CeLOC）与最大维持Ce（CeM）之间的关系，并探索在当日BDE中额外使用芬太尼以提高麻醉质量的潜在因素。 在排除不同麻醉师/内镜医师和结肠镜检查前进行食管胃十二指肠镜检查的患者后，共有 183 名接受美国麻醉医师协会 I 至 III 级 BDE 的患者入选。使用 2.5 至 5.0 μg/mL 的异丙酚 TCI 进行麻醉，如果手术过程中镇静不足或过深，则以 0.5 μg/mL 为单位增加异丙酚。如果镇静水平在两次Ce递增或CeM达到5.0 μg/mL后仍不能令人满意，则会注射芬太尼（25 μg）。从麻醉病历和电子病历中提取年龄、身高、体重、性别、CeLOC、CeM、清醒Ce、麻醉时间、检查时间、TCI调整频率、丙泊酚或芬太尼总消耗量、影响手术过程的患者移动发生率、麻黄碱或阿托品的使用情况等数据，并计算影响额外栓注芬太尼或CeM的因素。 157例患者仅使用异丙酚镇静，26例患者额外使用了25微克芬太尼。在仅使用异丙酚镇静的情况下，分别有 3 名患者出现低血压、心动过缓和一过性低氧血症。影响手术过程的患者移动发生率为 36.6%（67/183），41 名患者在增加异丙酚 Ce 后完成了手术，26 名患者需要额外注射芬太尼。经过线性回归，最佳公式为 CeM = 1.9-(0.006 × 年龄) + 0.658 × CeLOC。在控制了混杂协变量后，只有 CeLOC 是对芬太尼需求量最有参考价值的协变量。最后，我们将公式简化为丙泊酚 CeM = CeLOC + 0.7 μg/mL，以避免患者移动影响手术过程和不良反应。 我们的研究表明，年龄和 CeLOC 与 CeM 相关，只有较高的 CeLOC（>4.5 μg/mL）才是 BDE 中额外栓注芬太尼的唯一因素。我们还提供了简化公式，即丙泊酚 CeM = CeLOC + 0.7 μg/mL，以避免患者移动影响手术过程和不良反应。
{"title":"The Optimal Maintained Effective-site Concentration of Propofol under Target-controlled Infusion in Same-day Bidirectional Endoscopy","authors":"Chung-Yi Wu, Zhi-Fu Wu, Yi-Hsuan Huang, W. Tseng, Bo-Feng Lin, H. Lai","doi":"10.4103/jmedsci.jmedsci_8_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_8_23","url":null,"abstract":"\u0000 \u0000 The same-day bidirectional endoscopy (BDE) under anesthesia is commonly performed for its efficacy. Until now, the optimal regimen of sedation for same-day BDE is still inconclusive.\u0000 \u0000 \u0000 \u0000 The aim of this study is to investigate the relationship between the effect-site concentration at loss of consciousness (CeLOC) and maximal maintained Ce (CeM) in patients undergoing sole propofol sedation with the targeted-controlled infusion (TCI) pump and to explore the potential factors for extra fentanyl administration for same-day BDE to improve the quality of anesthesia.\u0000 \u0000 \u0000 \u0000 After excluding the patients with different anesthesiologists/endoscopists and esophagogastroduodenoscopy before colonoscopy, a total of 183 patients receiving BDE with the American Society of Anesthesiologists I to III were enrolled. Anesthesia with TCI of propofol ranged from 2.5 to 5.0 μg/mL was administrated and propofol was increased in steps of 0.5 μg/mL when inadequate or too deep sedation during the procedure. If the sedation level failed to meet satisfaction after two times of Ce increments or CeM achieve 5.0 μg/mL, bolus of fentanyl (25 μg) would be administered. The age, height, weight, gender, CeLOC, CeM, awake Ce, anesthesia time, examination time, frequency of TCI adjustments, total consumption of propofol or fentanyl, incidence of patient movements affecting the procedure, and use of ephedrine or atropine were retrieved from anesthetic charts and electronic medical record was recorded and the factors affecting the extra bolus of fentanyl or CeM were calculated.\u0000 \u0000 \u0000 \u0000 One hundred and fifty-seven patients underwent procedures with only propofol sedation and 26 patients with additional fentanyl bolus 25 μg. There were three patients with hypotension, bradycardia, and transient hypoxemia in only propofol sedation, respectively. The incidence of patient movements affecting the procedure was 36.6% (67/183), 41 patients completed the procedure after increasing propofol Ce, and 26 patients required an extra bolus of fentanyl. After linear regression, the optimal formula was CeM = 1.9–(0.006 × age) + 0.658 × CeLOC. After controlling for confounding covariates, only CeLOC was the most informative covariate for the demand for fentanyl. Finally, we simplified the formula as propofol CeM = CeLOC + 0.7 μg/mL to avoid patient movements affecting the procedure and adverse effects.\u0000 \u0000 \u0000 \u0000 We showed that the age and CeLOC were associated with CeM and only higher CeLOC (>4.5 μg/mL) was the only contributing factor for the extra bolus of fentanyl in BDE. We also provided the simplified formula as propofol CeM = CeLOC + 0.7 μg/mL to avoid patient movements affecting the procedure and adverse effects.\u0000","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-18DOI: 10.4103/jmedsci.jmedsci_174_23
Fu-Chieh Hsu, Wei-Ting Kuo, Yi-Chang Lin
An arteriovenous fistula (AVF) refers to an anomalous connection between an artery and a vein. It can arise from traumatic or iatrogenic injuries. The occurrence of multiple spontaneous AVFs is rare. We present a case that used endovascular therapy to treat multiple spontaneous AVFs involving the internal iliac, common femoral, superficial femoral, and profunda femoris arteries and veins.
{"title":"Multiple Spontaneous Iliac and Femoral Arteriovenous Fistulas","authors":"Fu-Chieh Hsu, Wei-Ting Kuo, Yi-Chang Lin","doi":"10.4103/jmedsci.jmedsci_174_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_174_23","url":null,"abstract":"\u0000 An arteriovenous fistula (AVF) refers to an anomalous connection between an artery and a vein. It can arise from traumatic or iatrogenic injuries. The occurrence of multiple spontaneous AVFs is rare. We present a case that used endovascular therapy to treat multiple spontaneous AVFs involving the internal iliac, common femoral, superficial femoral, and profunda femoris arteries and veins.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Karim, Jahanzeb khan Afridi, Salman Afaq, Muhammad Batoor Zaman, Sobia Naeem, Maha Amjad Zaman
OBJECTIVE: To compare Sodium abnormalities associated with Maintenance Infusions, Hypotonic versus isotonic in hospitalized children: A Randomized Controlled Trial MATERIAL AND METHODS: This study was a randomized control trial conducted in the Department of Pediatrics A Hayat Abad Medical Complex Peshawar from 28 October 2020 to 28 April 2021. All the admitted patients aged 1 year to 12 years requiring maintenance infusion and were nothing by mouth (NBM) for at least 48 hours and serum sodium between 135-145 mmol/l were included in the study. Patients with renal disease and on drugs affecting sodium level were excluded from the study. Two hundred and four patients who fulfilled the inclusion criteria, were randomly classified into two groups A and B 102 each. Group A was given Isotonic fluids (0.9% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L) and Group B was given hypotonic fluids (0.45% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L). The baseline tests and targeted tests, such as CBC, Blood sugar, urea, creatinine, electrolytes (sodium, potassium, and chloride), osmolality, and arterial blood gases, were performed. Data was analyzed using SPSS version 21.0. The post-stratification chi-square test was utilized to examine potential effect modifiers, and results were presented in tables. RESULTS: For a total of 204, there were 43 (42.3%) female patients and 59 (57.8%) male patients in Group A. Eighty (78.4%) male patients and twenty-two (21.6%) female patients were documented in Group B. In Group A, 61 (59.8%) patients had ages of 1-6 years while 41 patients (40.2%) were 7-12 years old. Eighteen patients in this group developed hyponatremia after receiving isotonic fluids. Fifty-two (51.0%) patients in Group B were 1-6-year-old and 50 (49.0%) patients were 7-12 years old. while 49 patients in this group developed, hyponatremia receiving hypotonic fluids. Patients given isotonic fluids didn’t develop any complications (Hypernatremia and hyperchloremic metabolic acidosis). CONCLUSION: On the basis of the results of this study, Isotonic intravenous maintenance fluids are a safe option in the pediatric population. KEYWORDS: Children, Intravenous fluids, Hypotonic, Isotonic Maintenance Infusions
{"title":"COMPARISON OF SODIUM ABNORMALITIES ASSOCIATED WITH HYPOTONIC VERSUS ISOTONIC MAINTENANCE INFUSIONS IN HOSPITALIZED CHILDREN","authors":"R. Karim, Jahanzeb khan Afridi, Salman Afaq, Muhammad Batoor Zaman, Sobia Naeem, Maha Amjad Zaman","doi":"10.52764/jms.23.31.4.16","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.16","url":null,"abstract":"OBJECTIVE: To compare Sodium abnormalities associated with Maintenance Infusions, Hypotonic versus isotonic in hospitalized children: A Randomized Controlled Trial MATERIAL AND METHODS: This study was a randomized control trial conducted in the Department of Pediatrics A Hayat Abad Medical Complex Peshawar from 28 October 2020 to 28 April 2021. All the admitted patients aged 1 year to 12 years requiring maintenance infusion and were nothing by mouth (NBM) for at least 48 hours and serum sodium between 135-145 mmol/l were included in the study. Patients with renal disease and on drugs affecting sodium level were excluded from the study. Two hundred and four patients who fulfilled the inclusion criteria, were randomly classified into two groups A and B 102 each. Group A was given Isotonic fluids (0.9% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L) and Group B was given hypotonic fluids (0.45% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L). The baseline tests and targeted tests, such as CBC, Blood sugar, urea, creatinine, electrolytes (sodium, potassium, and chloride), osmolality, and arterial blood gases, were performed. Data was analyzed using SPSS version 21.0. The post-stratification chi-square test was utilized to examine potential effect modifiers, and results were presented in tables. RESULTS: For a total of 204, there were 43 (42.3%) female patients and 59 (57.8%) male patients in Group A. Eighty (78.4%) male patients and twenty-two (21.6%) female patients were documented in Group B. In Group A, 61 (59.8%) patients had ages of 1-6 years while 41 patients (40.2%) were 7-12 years old. Eighteen patients in this group developed hyponatremia after receiving isotonic fluids. Fifty-two (51.0%) patients in Group B were 1-6-year-old and 50 (49.0%) patients were 7-12 years old. while 49 patients in this group developed, hyponatremia receiving hypotonic fluids. Patients given isotonic fluids didn’t develop any complications (Hypernatremia and hyperchloremic metabolic acidosis). CONCLUSION: On the basis of the results of this study, Isotonic intravenous maintenance fluids are a safe option in the pediatric population. KEYWORDS: Children, Intravenous fluids, Hypotonic, Isotonic Maintenance Infusions","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139276155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qadir Naseer, Rafi Ullah, Mushtaq Ahmad, Bakht Sardar, Muhammad Shoaib Khan, Yasir Hakim
Objective: To determine the frequency of sagittal imbalance in patients with idiopathic adolescent scoliosis Materials and Methods: This Cross-sectional study was conducted in the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar from 20 May 2019 to 19 Nov 2019 on 88 patients by Consecutive probability sampling technique. A standard technique was used for the study radiograph. Data was stored and analyzed using the statistical software SPSS version 21. All the quantitative variables like age were analyzed by Mean, +/- standard deviation. Post-stratification chi-square test was applied keeping P value equal or less than 0.05. All the results were presented in tables and graphs. RESULTS: A total of 88 patients with adolescent idiopathic scoliosis were enrolled in this study. There were 22 male (25%) and 66 (75%) female patients. The mean age of patients received was 43 years +/- 13.4 years with a standard deviation of +/-0.23. Regarding deformity severity, there was mild deformity (Cobb angle 10-25) in 33, patients (37.5%), moderate deformity (Cobb angle 26-40) in 26 patients (29.5%) moderately severe deformity (Cobb angle41-60) in 18 (20.5%) severe deformity (>60) in 11 (12.5%). Fifty-six (63.6%) patients had structural curves i.e. flexible and corrected with the forward Adam bending test. Thirty-two (36.4%) had a nonstructural or rigid deformity. CONCLUSION: Most of the patients having adolescent idiopathic scoliosis have a sagittal imbalanced spine. Spinopelvic parameters like lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt need to be included in routine workups of scoliotic patients in specific groups like one with a rigid deformity, severe deformity, and advancing age. Spinopelvic imbalance is very important in adult deformity. KEY WORDS: Adolescent Idiopathic scoliosis AIS, Sagittal Imbalance, Spinopelvic imbalance.
{"title":"FREQUENCY OF SAGITTAL IMBALANCE IN PATIENTS WITH IDIOPATHIC ADOLESCENT SCOLIOSIS","authors":"Qadir Naseer, Rafi Ullah, Mushtaq Ahmad, Bakht Sardar, Muhammad Shoaib Khan, Yasir Hakim","doi":"10.52764/jms.23.31.4.15","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.15","url":null,"abstract":"Objective: To determine the frequency of sagittal imbalance in patients with idiopathic adolescent scoliosis Materials and Methods: This Cross-sectional study was conducted in the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar from 20 May 2019 to 19 Nov 2019 on 88 patients by Consecutive probability sampling technique. A standard technique was used for the study radiograph. Data was stored and analyzed using the statistical software SPSS version 21. All the quantitative variables like age were analyzed by Mean, +/- standard deviation. Post-stratification chi-square test was applied keeping P value equal or less than 0.05. All the results were presented in tables and graphs. RESULTS: A total of 88 patients with adolescent idiopathic scoliosis were enrolled in this study. There were 22 male (25%) and 66 (75%) female patients. The mean age of patients received was 43 years +/- 13.4 years with a standard deviation of +/-0.23. Regarding deformity severity, there was mild deformity (Cobb angle 10-25) in 33, patients (37.5%), moderate deformity (Cobb angle 26-40) in 26 patients (29.5%) moderately severe deformity (Cobb angle41-60) in 18 (20.5%) severe deformity (>60) in 11 (12.5%). Fifty-six (63.6%) patients had structural curves i.e. flexible and corrected with the forward Adam bending test. Thirty-two (36.4%) had a nonstructural or rigid deformity. CONCLUSION: Most of the patients having adolescent idiopathic scoliosis have a sagittal imbalanced spine. Spinopelvic parameters like lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt need to be included in routine workups of scoliotic patients in specific groups like one with a rigid deformity, severe deformity, and advancing age. Spinopelvic imbalance is very important in adult deformity. KEY WORDS: Adolescent Idiopathic scoliosis AIS, Sagittal Imbalance, Spinopelvic imbalance.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139277400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Asim, A. Badshah, Durkho Atif, W. Mohammad
Objectives: To determine the frequency of risk factors associated with diabetic ketoacidosis in patients presenting at Khyber Teaching Hospital Peshawar. Materials and methods: Patients of either gender, aged between 18 and 60 years, with either type I or type II diabetes mellitus presenting with diabetic ketoacidosis with the duration of diabetes > 1 year were included in the study. DKA was diagnosed based on the clinical presentation of respective patients, serum Random Blood Sugar (RBS), and urinary ketones. Careful scrutinization was done for the detection of common risk factors for DKA like infections, stroke, myocardial infarction, and pancreatitis. Based on the clinical examination for Stroke and acute pancreatitis, CT imaging of the brain and CT of the abdomen with pancreatic protocol were performed. Results: Among 111 DKA patients, the mean age was 43 years with standard deviation ± 12.05. 63(57%) patients were male while 48(43%) were female. Infection was found in 54(49%) patients, stroke in 4(4%) myocardial infarctions in 3(3%), and pancreatitis was found in 7(6%) patients. Conclusion: The most common risk factor for diabetic ketoacidosis is infections in half of the participants while stroke was 4%, myocardial infarction was 3% and pancreatitis was 6%. KEYWORDS: diabetic ketoacidosis; type I diabetes; type II diabetes
{"title":"FREQUENCY OF RISK FACTORS ASSOCIATED WITH DIABETIC KETOACIDOSIS IN PATIENTS PRESENTING AT KHYBER TEACHING HOSPITAL PESHAWAR","authors":"Muhammad Asim, A. Badshah, Durkho Atif, W. Mohammad","doi":"10.52764/jms.23.31.4.6","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.6","url":null,"abstract":"Objectives: To determine the frequency of risk factors associated with diabetic ketoacidosis in patients presenting at Khyber Teaching Hospital Peshawar. Materials and methods: Patients of either gender, aged between 18 and 60 years, with either type I or type II diabetes mellitus presenting with diabetic ketoacidosis with the duration of diabetes > 1 year were included in the study. DKA was diagnosed based on the clinical presentation of respective patients, serum Random Blood Sugar (RBS), and urinary ketones. Careful scrutinization was done for the detection of common risk factors for DKA like infections, stroke, myocardial infarction, and pancreatitis. Based on the clinical examination for Stroke and acute pancreatitis, CT imaging of the brain and CT of the abdomen with pancreatic protocol were performed. Results: Among 111 DKA patients, the mean age was 43 years with standard deviation ± 12.05. 63(57%) patients were male while 48(43%) were female. Infection was found in 54(49%) patients, stroke in 4(4%) myocardial infarctions in 3(3%), and pancreatitis was found in 7(6%) patients. Conclusion: The most common risk factor for diabetic ketoacidosis is infections in half of the participants while stroke was 4%, myocardial infarction was 3% and pancreatitis was 6%. KEYWORDS: diabetic ketoacidosis; type I diabetes; type II diabetes","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139276226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Husnain Qadir, S. Suleman, Shiekh Fahad Falah, Muhammad Saleh Faisal, H. Sadia, Kamran Ullah
Objective: The current study aims to evaluate the susceptibility pattern of relatively older antibiotic Co-trimoxazole and its comparison with Levofloxacin, Nitrofurantoin, and Fosfomycin. Material and Methods: This cross-sectional study was conducted in Mardan Medical Complex, Mardan, and the Postgraduate Medical Education Department of Khyber Girls Medical College, Peshawar from April 2022 to September 2022. Both male and female patients, above the age of 15 years with recurrent uncomplicated urinary tract infections were included in the study. The samples were inoculated onto CLED (Cystine-Lactose-Electrolyte-Deficient) Agar, a differential culture medium. The grown bacteria were identified, using Gram staining and BIOMÉRIEUX® API® 10S kits. Minimum inhibitory concentrations (MIC) were determined by the Agar dilution method; as per standard protocol. The results were compared among Co-trimoxazole, Levofloxacin, Nitrofurantoin, and Fosfomycin using statistical tests. Results: A total of 680 samples were received, of which 158 samples were culture-positive. The gender distribution of females and males was 63.3% and 36.7%, respectively. A predominant proportion of the patient cohort manifested within the age range of 21-40 years, with the subsequent highest representation observed in the 41-60 year age group. The isolated organisms were E. coli (74.1%), Klebsiella (10.8%), Pseudomonas (5.1%), Enterococci (6.3%), Proteus species (2.5%), and Citrobacter (1.3%). Based on MIC analysis, 77.2% of isolates were found to be sensitive to Co-trimoxazole, 52.5% to Levofloxacin, 86.7% to Nitrofurantoin, and 90.5% to Fosfomycin. When comparing antibiotics, Co-trimoxazole displayed significantly higher effectiveness against the isolates compared to Levofloxacin (p-value 0.004). However, in comparison to Nitrofurantoin and Fosfomycin, Co-trimoxazole exhibited lower effectiveness, with respective p-values of 0.000 and 0.007. Conclusion: The study revealed that the susceptibility of bacterial isolates to Co-trimoxazole is significantly higher than that to Levofloxacin but lower than that to Nitrofurantoin and Fosfomycin. KEYWORDS Urinary Tract Infections, Drug Resistance, Culture And Sensitivity, Minimum Inhibitory Concentration
{"title":"COMPARISON OF SUSCEPTIBILITY BETWEEN CONVENTIONAL FIRST LINE ANTIBIOTIC CO-TRIMOXAZOLE AND NEWER ANTIBIOTICS IN RECURRENT UNCOMPLICATED URINARY TRACT INFECTIONS","authors":"Husnain Qadir, S. Suleman, Shiekh Fahad Falah, Muhammad Saleh Faisal, H. Sadia, Kamran Ullah","doi":"10.52764/jms.23.31.4.11","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.11","url":null,"abstract":"Objective: The current study aims to evaluate the susceptibility pattern of relatively older antibiotic Co-trimoxazole and its comparison with Levofloxacin, Nitrofurantoin, and Fosfomycin. Material and Methods: This cross-sectional study was conducted in Mardan Medical Complex, Mardan, and the Postgraduate Medical Education Department of Khyber Girls Medical College, Peshawar from April 2022 to September 2022. Both male and female patients, above the age of 15 years with recurrent uncomplicated urinary tract infections were included in the study. The samples were inoculated onto CLED (Cystine-Lactose-Electrolyte-Deficient) Agar, a differential culture medium. The grown bacteria were identified, using Gram staining and BIOMÉRIEUX® API® 10S kits. Minimum inhibitory concentrations (MIC) were determined by the Agar dilution method; as per standard protocol. The results were compared among Co-trimoxazole, Levofloxacin, Nitrofurantoin, and Fosfomycin using statistical tests. Results: A total of 680 samples were received, of which 158 samples were culture-positive. The gender distribution of females and males was 63.3% and 36.7%, respectively. A predominant proportion of the patient cohort manifested within the age range of 21-40 years, with the subsequent highest representation observed in the 41-60 year age group. The isolated organisms were E. coli (74.1%), Klebsiella (10.8%), Pseudomonas (5.1%), Enterococci (6.3%), Proteus species (2.5%), and Citrobacter (1.3%). Based on MIC analysis, 77.2% of isolates were found to be sensitive to Co-trimoxazole, 52.5% to Levofloxacin, 86.7% to Nitrofurantoin, and 90.5% to Fosfomycin. When comparing antibiotics, Co-trimoxazole displayed significantly higher effectiveness against the isolates compared to Levofloxacin (p-value 0.004). However, in comparison to Nitrofurantoin and Fosfomycin, Co-trimoxazole exhibited lower effectiveness, with respective p-values of 0.000 and 0.007. Conclusion: The study revealed that the susceptibility of bacterial isolates to Co-trimoxazole is significantly higher than that to Levofloxacin but lower than that to Nitrofurantoin and Fosfomycin. KEYWORDS Urinary Tract Infections, Drug Resistance, Culture And Sensitivity, Minimum Inhibitory Concentration","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139277370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Moiez, Hira Zahid, Rida Ashfaq, Saima Zareen, Beenish Altaf, Zakriya Rasheed
Objectives: Current study is designed to determine the frequency and association of blood groups and pre-hypertension among medical students. Methods: This cross-sectional study was conducted at Aziz Fatima Medical and Dental College Faisalabad, Punjab, Pakistan. Hundred medical students of age 18 to 25 were enrolled from first year to final year MBBS by convenience sampling. Descriptive of the studied population was presented as mean and standard deviation (age, height, weight and blood pressure). Categorical variables like prehypertension is analysed as a dichotomous variable and is expressed as frequencies and percentages. Proportions were compared using Chi-square test. p?0.05 was taken statistically significant. Results: Study reveal that blood group B was the most common blood group followed by O blood group. While AB blood group is least common blood group in our study. Conclusion: Blood group B was the most common blood group of our studied population. Prehypertension is commonly found in subjects with blood group A followed by O. Keywords: Blood group antigens, Pre-Hypertension
研究目的本研究旨在确定医科学生中血型与高血压前期的频率和关联。 研究方法这项横断面研究在巴基斯坦旁遮普省费萨拉巴德的阿齐兹-法蒂玛医学和牙科学院进行。通过方便抽样，从医学学士学位一年级到最后一年级的 100 名年龄在 18 至 25 岁之间的医学生参加了研究。研究对象的描述性数据为平均值和标准差（年龄、身高、体重和血压）。高血压前期等分类变量作为二分变量进行分析，以频率和百分比表示。比例比较采用卡方检验（Chi-square test）。 结果研究显示，B 型血是最常见的血型，其次是 O 型血。在我们的研究中，AB 型血是最不常见的血型。 结论：B 型血是最常见的血型：在我们研究的人群中，B 型血是最常见的血型。高血压前期常见于 A 型血的受试者，其次是 O 型血：血型抗原 高血压前期
{"title":"FREQUENCY OF PRE-HYPERTENSION AMONG VARIOUS BLOOD GROUPS","authors":"Muhammad Moiez, Hira Zahid, Rida Ashfaq, Saima Zareen, Beenish Altaf, Zakriya Rasheed","doi":"10.52764/jms.23.31.4.2","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.2","url":null,"abstract":"Objectives: Current study is designed to determine the frequency and association of blood groups and pre-hypertension among medical students. Methods: This cross-sectional study was conducted at Aziz Fatima Medical and Dental College Faisalabad, Punjab, Pakistan. Hundred medical students of age 18 to 25 were enrolled from first year to final year MBBS by convenience sampling. Descriptive of the studied population was presented as mean and standard deviation (age, height, weight and blood pressure). Categorical variables like prehypertension is analysed as a dichotomous variable and is expressed as frequencies and percentages. Proportions were compared using Chi-square test. p?0.05 was taken statistically significant. Results: Study reveal that blood group B was the most common blood group followed by O blood group. While AB blood group is least common blood group in our study. Conclusion: Blood group B was the most common blood group of our studied population. Prehypertension is commonly found in subjects with blood group A followed by O. Keywords: Blood group antigens, Pre-Hypertension","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139277589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE: To determine the diagnostic accuracy of FLAIR MRI in identifying acute Subarachnoid Hemorrhage (SAH) using Lumber puncture (LP) as a gold standard. MATERIALS AND METHODS: This was a validation study conducted from 3rd September 2020 to 3rd February 2021 at the Department of Radiology, Khyber Teaching Hospital, Peshawar. The sample size was 266. A non-probability consecutive sampling technique was used. All alert patients aged 20-70 years with sudden acute headache, other signs of SAH (nausea, vomiting, blurring of vision, sensitivity to light, and neck stiffness), and GCS >13 were included in this study. SAH on FLAIR-MRI was determined based on high signals in the subarachnoid space on FLAIR. Diagnostic accuracy was calculated regarding sensitivity, specificity, and positive and negative predictive values. SPSS version 22 was used to perform statistical analysis of the data. RESULTS: Mean age ranged from 20 to 70 years (46.3 + 14.1 years), with 58.6% male, and 41.4% female subjects. On FLAIR-MRI, SAH was observed in 65.4% of patients while SAH was recorded in 57.5% on follow-up LP. Sensitivity of FLAIR-MRI was found to be 91.5% and specificity 69.9%. FLAIR-MRI has 80.5% positive predictive value and 85.8% negative predictive value. CONCLUSION: FLAIR-MRI is effective in accurately identifying SAH with high sensitivity and fair specificity. As such, it is a useful radiological tool for diagnosis of SAH in adults and further studies are recommended to confirm its usefulness. Keywords: Magnetic resonance imaging, lumber puncture, subarachnoid hemorrhage, headache
{"title":"DIAGNOSTIC ACCURACY OF FLUID-ATTENUATED INVERSION-RECOVERY MAGNETIC RESONANCE IMAGING IN DETECTION OF ACUTE SUBARACHNOID HEMORRHAGE KEEPING LUMBER PUNCTURE AS GOLD STANDARD","authors":"Samia Iftikhar, Humaira Anjum","doi":"10.52764/jms.23.31.4.9","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.9","url":null,"abstract":"OBJECTIVE: To determine the diagnostic accuracy of FLAIR MRI in identifying acute Subarachnoid Hemorrhage (SAH) using Lumber puncture (LP) as a gold standard. MATERIALS AND METHODS: This was a validation study conducted from 3rd September 2020 to 3rd February 2021 at the Department of Radiology, Khyber Teaching Hospital, Peshawar. The sample size was 266. A non-probability consecutive sampling technique was used. All alert patients aged 20-70 years with sudden acute headache, other signs of SAH (nausea, vomiting, blurring of vision, sensitivity to light, and neck stiffness), and GCS >13 were included in this study. SAH on FLAIR-MRI was determined based on high signals in the subarachnoid space on FLAIR. Diagnostic accuracy was calculated regarding sensitivity, specificity, and positive and negative predictive values. SPSS version 22 was used to perform statistical analysis of the data. RESULTS: Mean age ranged from 20 to 70 years (46.3 + 14.1 years), with 58.6% male, and 41.4% female subjects. On FLAIR-MRI, SAH was observed in 65.4% of patients while SAH was recorded in 57.5% on follow-up LP. Sensitivity of FLAIR-MRI was found to be 91.5% and specificity 69.9%. FLAIR-MRI has 80.5% positive predictive value and 85.8% negative predictive value. CONCLUSION: FLAIR-MRI is effective in accurately identifying SAH with high sensitivity and fair specificity. As such, it is a useful radiological tool for diagnosis of SAH in adults and further studies are recommended to confirm its usefulness. Keywords: Magnetic resonance imaging, lumber puncture, subarachnoid hemorrhage, headache","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139277667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Razzaq, Sumaiyah Obaid, Iqbal Tariq, Muhammad Afsheen Iqbal, Saina Khawar Kiani, Tahir Ramazan
Objective: To determine the effects of Tai Chi exercises on physical activity, pulmonary function, and rate of perceived exertion in post-coronary artery bypass grafting patients. Material and Methods: A Randomized control trial was conducted in the Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan from January 2018 - July 2018. 50 post-coronary artery bypass grafting patients were calculated by the open epi tool and randomly allocated into two groups in equal halves through non-probability purposive sampling with the toss the coin method. 40-60 years males and females with >40% ejection fraction were included while vitally unstable patients were excluded. The experimental group was given Tai Chi exercises while the control group was given a bicycle. Levels of physical activity and pulmonary functions were assessed at baseline, 4thand 6th week of training. Results: Out of the total sample size only 39 were analyzed 11 were dropped off due to not following proper follow-up, and there was no statistical difference in heart rate P=0.095. Oxygen saturation shows a significant difference with P<0.001, Physical activity was low at baseline but after exercise training, the Tai Chi group showed great improvement P< 0.01. Pulmonary functions showed statistically insignificant results P=0.865. The rate of perceived exertion was high in 2nd week and gradually decreased with the mean of 3.20 and 3.37 while the time of exercise was improved with P<0.01. Conclusion: Tai Chi exercises have better improvement in pulmonary function, rate of perceived exertion, time of exercise, and physical activity in post-coronary artery bypass grafting patients. Keywords: Coronary artery bypass grafting, pulmonary functions, physical activity, rate of perceived exertion, Tai Chi
{"title":"EFFECTS OF TAI CHI EXERCISES ON PHYSICAL ACTIVITY AND PULMONARY FUNCTION IN PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING","authors":"Maria Razzaq, Sumaiyah Obaid, Iqbal Tariq, Muhammad Afsheen Iqbal, Saina Khawar Kiani, Tahir Ramazan","doi":"10.52764/jms.23.31.4.1","DOIUrl":"https://doi.org/10.52764/jms.23.31.4.1","url":null,"abstract":"Objective: To determine the effects of Tai Chi exercises on physical activity, pulmonary function, and rate of perceived exertion in post-coronary artery bypass grafting patients. Material and Methods: A Randomized control trial was conducted in the Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan from January 2018 - July 2018. 50 post-coronary artery bypass grafting patients were calculated by the open epi tool and randomly allocated into two groups in equal halves through non-probability purposive sampling with the toss the coin method. 40-60 years males and females with >40% ejection fraction were included while vitally unstable patients were excluded. The experimental group was given Tai Chi exercises while the control group was given a bicycle. Levels of physical activity and pulmonary functions were assessed at baseline, 4thand 6th week of training. Results: Out of the total sample size only 39 were analyzed 11 were dropped off due to not following proper follow-up, and there was no statistical difference in heart rate P=0.095. Oxygen saturation shows a significant difference with P<0.001, Physical activity was low at baseline but after exercise training, the Tai Chi group showed great improvement P< 0.01. Pulmonary functions showed statistically insignificant results P=0.865. The rate of perceived exertion was high in 2nd week and gradually decreased with the mean of 3.20 and 3.37 while the time of exercise was improved with P<0.01. Conclusion: Tai Chi exercises have better improvement in pulmonary function, rate of perceived exertion, time of exercise, and physical activity in post-coronary artery bypass grafting patients. Keywords: Coronary artery bypass grafting, pulmonary functions, physical activity, rate of perceived exertion, Tai Chi","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139276427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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