Hepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4]. With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO. In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan.
{"title":"Hepatitus C Guidelines","authors":"T. S. Akhter","doi":"10.37939/jrmc.v1i1.2533","DOIUrl":"https://doi.org/10.37939/jrmc.v1i1.2533","url":null,"abstract":"Hepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4]. \u0000With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO. \u0000In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"1469 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830950","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}
Hepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4]. With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO. In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan.
{"title":"Hepatitus C Guidelines","authors":"T. S. Akhter","doi":"10.37939/jrmc.v1i1.2533","DOIUrl":"https://doi.org/10.37939/jrmc.v1i1.2533","url":null,"abstract":"Hepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4]. \u0000With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO. \u0000In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"24 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890808","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2041
Anam Fatima, Faridullah Shah, Hareema Saeed Khan, Kashif Rauf, Asif Jalil, Muhammad Saleem Akhter
Objective: To find out the association between electroencephalogram (EEG) and hepatic encephalopathy. Methodology: This cross-sectional study included 100 patients (with the age of52.5±6.09years for males and 51.7 ± 6.10 years for females) of reported hepatic encephalopathy, visiting the medical department (indoor and OPD) at Federal Government Polyclinic Hospital, Islamabad. The study was conducted from January 2020 to May 2021. Patients who had known epileptic and structural brain lesions or strokes were excluded from the study. Statistical analysis was done using GraphPad Prism software. The significance of data (p-value or R2 value) was calculated through a two-tailed test or correlation coefficient. Results: All the patients in hepatic encephalopathy grade IV reported abnormal EEG representing triphasic waves and flattening of EEG pattern. There was no correlation observed between age, gender and hepatic encephalopathy grades. However, a significant correlation (R2= 0.9032) was observed between serum ammonia levels and hepatic encephalopathy grades. Elevated serum ammonia levels depicted the severity of hepatic encephalopathy. Overall, the percentage of patients with abnormal EEG increased with increasing grade of hepatic encephalopathy. It was quite intriguing to note that EEG, being the common method to diagnose hepatic encephalopathy grades, is not dependent on patients’ socio-economic status. Conclusion: Data concluded that serum ammonia levels are well associated with the progression of hepatic encephalopathy. Moreover, the EEG patter provides the appropriate information about the neurological abnormalities associated with the severity of hepatic encephalopathy. Hence, serum ammonia levels and EEG both should accurately be used as indicators for diagnosis and monitoring the response to the treatment of various grades of hepatic encephalopathy. Data warrant further investigations to get a better insight into hepatic encephalopathy's relationship with EEG patterns through the inclusion of molecular parameters.
{"title":"Association Of Electroencephalogram Patterns With Ammonia Levels In Hepatic Encephalopathy Patients","authors":"Anam Fatima, Faridullah Shah, Hareema Saeed Khan, Kashif Rauf, Asif Jalil, Muhammad Saleem Akhter","doi":"10.37939/jrmc.v27i3.2041","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2041","url":null,"abstract":"Objective: To find out the association between electroencephalogram (EEG) and hepatic encephalopathy. Methodology: This cross-sectional study included 100 patients (with the age of52.5±6.09years for males and 51.7 ± 6.10 years for females) of reported hepatic encephalopathy, visiting the medical department (indoor and OPD) at Federal Government Polyclinic Hospital, Islamabad. The study was conducted from January 2020 to May 2021. Patients who had known epileptic and structural brain lesions or strokes were excluded from the study. Statistical analysis was done using GraphPad Prism software. The significance of data (p-value or R2 value) was calculated through a two-tailed test or correlation coefficient. Results: All the patients in hepatic encephalopathy grade IV reported abnormal EEG representing triphasic waves and flattening of EEG pattern. There was no correlation observed between age, gender and hepatic encephalopathy grades. However, a significant correlation (R2= 0.9032) was observed between serum ammonia levels and hepatic encephalopathy grades. Elevated serum ammonia levels depicted the severity of hepatic encephalopathy. Overall, the percentage of patients with abnormal EEG increased with increasing grade of hepatic encephalopathy. It was quite intriguing to note that EEG, being the common method to diagnose hepatic encephalopathy grades, is not dependent on patients’ socio-economic status. Conclusion: Data concluded that serum ammonia levels are well associated with the progression of hepatic encephalopathy. Moreover, the EEG patter provides the appropriate information about the neurological abnormalities associated with the severity of hepatic encephalopathy. Hence, serum ammonia levels and EEG both should accurately be used as indicators for diagnosis and monitoring the response to the treatment of various grades of hepatic encephalopathy. Data warrant further investigations to get a better insight into hepatic encephalopathy's relationship with EEG patterns through the inclusion of molecular parameters.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335758","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2241
Umair ul Haq, Hassan Maqbool, Zarnab Rizwan, Khadija Sajid, Kiran Nazir, S. Khattak
Background: Root canal treatment is an endodontic procedure that encompasses cleaning & shaping i.e. preparation of root canals followed by obturation of the prepared canals. Pain is a very common sensation that occurs few hours after root canal treatment (RCT). Objective: To evaluate and compare the efficacy of premedication with flurbiprofen and prednisolone on post-endodontic pain in teeth with symptomatic irreversible pulpitis. Materials and Methods: It is a randomized control trial study conducted in the department of Operative Dentistry & Endodontics, Sardar Begum Dental College, & Hospital Peshawar. Patients were randomly allocated into two groups i.e. A and B using coin flip technique. Thirty minutes before starting the endodontic therapy, single pretreatment dose of Flurbiprofen (100mg) was given to patients in Group A and Prednisolone (30mg) to patients in Group B. Patients’ pain intensity experience was measured using the visual analog scale (VAS) after root canal treatment. They were instructed to complete a pain diary at specific intervals (i.e. at 6, 12 and 24 hours after the commencement of treatment) in order to determine efficacy in both groups. Results: As per efficacy in both groups, in Group A, 44 (55%) showed effective results whereas in Group B, only 20 (25%) patients showed effective results. Conclusion: Single pretreatment dose of flurbiprofen has a more sustained effect in reducing post-endodontic pain as compared to prednisolone.
背景：根管治疗是一种牙髓治疗过程，包括根管的清洁和塑形，即准备根管，然后对准备好的根管进行封堵。疼痛是根管治疗（RCT）后几小时内出现的一种非常常见的感觉。目的评估并比较氟比洛芬和泼尼松龙对有症状的不可逆牙髓炎患者根管治疗后疼痛的疗效。材料和方法：这是一项随机对照试验研究，在白沙瓦萨达尔-贝古姆牙科学院和医院的牙科手术和牙髓病学系进行。使用掷硬币技术将患者随机分配到两组，即 A 组和 B 组。在开始根管治疗前 30 分钟，A 组患者服用单剂量氟比洛芬（100 毫克），B 组患者服用泼尼松龙（30 毫克）。指导患者在特定时间间隔（即治疗开始后 6、12 和 24 小时）填写疼痛日记，以确定两组患者的疗效。结果：就两组的疗效而言，A 组有 44 名患者（55%）取得了有效疗效，而 B 组仅有 20 名患者（25%）取得了有效疗效。结论与泼尼松龙相比，单剂量氟比洛芬在减轻牙髓病后疼痛方面具有更持久的效果。
{"title":"Comparative Evaluation Of Premedication With Flurbiprofen And Prednisolone On Post Endodontic Pain In Teeth With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial","authors":"Umair ul Haq, Hassan Maqbool, Zarnab Rizwan, Khadija Sajid, Kiran Nazir, S. Khattak","doi":"10.37939/jrmc.v27i3.2241","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2241","url":null,"abstract":"Background: Root canal treatment is an endodontic procedure that encompasses cleaning & shaping i.e. preparation of root canals followed by obturation of the prepared canals. Pain is a very common sensation that occurs few hours after root canal treatment (RCT). Objective: To evaluate and compare the efficacy of premedication with flurbiprofen and prednisolone on post-endodontic pain in teeth with symptomatic irreversible pulpitis. Materials and Methods: It is a randomized control trial study conducted in the department of Operative Dentistry & Endodontics, Sardar Begum Dental College, & Hospital Peshawar. Patients were randomly allocated into two groups i.e. A and B using coin flip technique. Thirty minutes before starting the endodontic therapy, single pretreatment dose of Flurbiprofen (100mg) was given to patients in Group A and Prednisolone (30mg) to patients in Group B. Patients’ pain intensity experience was measured using the visual analog scale (VAS) after root canal treatment. They were instructed to complete a pain diary at specific intervals (i.e. at 6, 12 and 24 hours after the commencement of treatment) in order to determine efficacy in both groups. Results: As per efficacy in both groups, in Group A, 44 (55%) showed effective results whereas in Group B, only 20 (25%) patients showed effective results. Conclusion: Single pretreatment dose of flurbiprofen has a more sustained effect in reducing post-endodontic pain as compared to prednisolone.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139336006","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2370
Lubna Ejaz
Antenatal care (ANC) improves maternal and newborn health by providing a platform for important healthcare services, including health promotion, primary and secondary prevention by vaccination and screening, timely diagnosis & prompt treatment of various obstetrical and medical complications, which may arise or aggravate during pregnancy. Antenatal care substantially contributes to preparedness for labor and postnatal period 1. Healthcare workers should effectively communicate with pregnant women about their physiological, psychological, and sociocultural issues and provide medical, emotional, psychological, financial, and social support during this vulnerable time period 2, 3. Previously, the quality of ANC was assessed by the number of antenatal visits (ANVs) of a pregnant woman with healthcare providers (contact coverage), but now this indicator of the quality of ANC is no longer accepted because it measures contact frequency without looking into the content of the care actually received during ANVs. Discerning the true picture of ANC quality demands the details of each ANV about the four essential parameters including: WHO recommended indicators, effective utilization of health services, doctors’ performance, and patients’ compliance4. WHO has published widely accepted recommendations for ANC, including suggestions for appropriate contact (frequency and timing between clients and the health system) and content (screening and management) based on evidence of effectiveness5. Measuring effective coverage of essential ANC interventions is more comprehensive than just counting the number of ANVs for assessing the ANC quality. Conceptually, effective coverage is “the proportion of the population who needs a service and receives it with sufficient quality for it to be effective” 6. Therefore, it is important to comprehend that effective coverage, in perspective of ANC, has two components: ANC attendance (contact coverage) refers to total number of ANVs, and standard ANC content (effective coverage) refers to a set of interventions, which include WHO recommended indicators of history, examination, screening tests and managements at specified times during pregnancy 7,8. It is pertinent to add that effective ANC should ensure optimum feto-maternal health outcomes according to the available healthcare facilities. In recent years, there has been growing interest in measuring the quality of ANC but there is no standard measurement system to categorize ANC into poor, average or good. Although several studies have incorporated various groups of indicators for evaluation of quality of ANC, only few studies have proposed categorization systems to objectively assess this important area of healthcare9. Even the proposed systems are insufficient for global assessment of ANC quality. Therefore, a more comprehensive categorization system should be devised by using maximum indicators of WHO guidelines to assess the ANC quality and correlate it with fetomaternal o
通过比较最佳产前检查次数、预约孕期、有效筛查贫血、糖尿病、高血压、乙型肝炎和丙型肝炎、预防破伤风、贫血和营养不良、早期诊断和及时治疗各种产科问题的患者比例，以及这些干预措施对胎儿和产妇结局的影响，从不同方面对产前保健质量进行了评估。研究得出的结论是，15.8%的患者接受了良好的产前护理，71.4%的患者接受了一般的产前护理，12.8%的患者接受了较差的产前护理：研究将产妇大致分为两组：A 组（就诊次数少于 3 次）和 B 组（就诊次数多于 3 次），因为产前检查的次数对疾病的早期诊断和及时治疗率有明确的影响。在 A 组和 B 组中，分别有 8%和 16%的高血压患者和 4%和 7%的糖尿病患者被确诊。由于 A 组高风险患者的诊断延迟，LSCS 率（33%）低于 B 组（40%），但导致 A 组死胎率（5% 对 2%）、IUGR（2% 对 1%）、PPH（3% 对 2%）和险些死亡患者率（4% 对 2%）高于 B 组。总之，产前护理质量的提高对妊娠结局有积极影响。每个医疗机构都必须对其产前护理质量进行评估，不仅要评估产前护理的就诊率（接触覆盖率），还要评估产前护理的标准内容（有效覆盖率），以找出服务中的不足之处。这种自我评估将为我们今后提高我国的母婴健康水平提供指导。
{"title":"Antenatal Care - How to ensure quality!","authors":"Lubna Ejaz","doi":"10.37939/jrmc.v27i3.2370","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2370","url":null,"abstract":"Antenatal care (ANC) improves maternal and newborn health by providing a platform for important healthcare services, including health promotion, primary and secondary prevention by vaccination and screening, timely diagnosis & prompt treatment of various obstetrical and medical complications, which may arise or aggravate during pregnancy. Antenatal care substantially contributes to preparedness for labor and postnatal period 1. Healthcare workers should effectively communicate with pregnant women about their physiological, psychological, and sociocultural issues and provide medical, emotional, psychological, financial, and social support during this vulnerable time period 2, 3. Previously, the quality of ANC was assessed by the number of antenatal visits (ANVs) of a pregnant woman with healthcare providers (contact coverage), but now this indicator of the quality of ANC is no longer accepted because it measures contact frequency without looking into the content of the care actually received during ANVs. Discerning the true picture of ANC quality demands the details of each ANV about the four essential parameters including: WHO recommended indicators, effective utilization of health services, doctors’ performance, and patients’ compliance4. WHO has published widely accepted recommendations for ANC, including suggestions for appropriate contact (frequency and timing between clients and the health system) and content (screening and management) based on evidence of effectiveness5. Measuring effective coverage of essential ANC interventions is more comprehensive than just counting the number of ANVs for assessing the ANC quality. Conceptually, effective coverage is “the proportion of the population who needs a service and receives it with sufficient quality for it to be effective” 6. Therefore, it is important to comprehend that effective coverage, in perspective of ANC, has two components: ANC attendance (contact coverage) refers to total number of ANVs, and standard ANC content (effective coverage) refers to a set of interventions, which include WHO recommended indicators of history, examination, screening tests and managements at specified times during pregnancy 7,8. It is pertinent to add that effective ANC should ensure optimum feto-maternal health outcomes according to the available healthcare facilities. In recent years, there has been growing interest in measuring the quality of ANC but there is no standard measurement system to categorize ANC into poor, average or good. Although several studies have incorporated various groups of indicators for evaluation of quality of ANC, only few studies have proposed categorization systems to objectively assess this important area of healthcare9. Even the proposed systems are insufficient for global assessment of ANC quality. Therefore, a more comprehensive categorization system should be devised by using maximum indicators of WHO guidelines to assess the ANC quality and correlate it with fetomaternal o","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335893","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2269
Muhammad Mohsin Sajjad, Amina Tariq, Muhammad Shabbir, Sidra Yousaf
Background: General anesthesia is still needed for several surgical interventions and requires endotracheal intubation. The difficult airway is a well-known entity, and a long list of predicting scores is present, yet a high degree of diagnostic accuracy still needs to be improved. Acromioaxillosuprasternal notch index (AASI) has shown some excellent results in recent times. Objective: Its objective is to determine the diagnostic accuracy of acromioaxillosuprasternal notch index for predicting difficult airways and to take the Cormack and Lehane grading system as the gold standard. Methodology: In this study, adults of both genders aged 20 to 70 years undergoing any surgery under general anesthesia having ASA class I to IV were included. AASI score of equal or less than 0.49 was taken as difficult airway while on Cormack and Lehane grade; it was labeled as yes where grade III or IV was seen. Results: The total number of cases were 350 cases, out of which 218 (62.29%) were males, and 132 (37.71%) were females. The mean age was 40.20±12.86 years, and the mean BMI was 24.71±3.13 (table 17). There were 294 (84%) cases in ASA Class I and II and 56 (14%) in class III and IV. Difficult intubation on AASI was seen in 54 (15.43%) and 57 (16.29%) cases on Cormack and Lehane grading. The diagnostic accuracy of AASI for prediction of difficult intubating a difficult was 96.29% with sensitivity of 90.74%, specificity of 97.30%, PPV of 85.96%, NPV of 98.29% with p= 0.001. This difference was also statistically significant with all the confounding variables like age, gender, ASA class, and BMI. Conclusion: The acromioaxillosuprasternal notch index is a significant predictor for tubing a difficult airway and taking Cormack and Lehane's grading as the gold standard. This difference is considerably better regarding age, gender, BMI, and ASA class.
{"title":"Diagnostic Accuracy Of Acromioaxillosuprasternal Notch Index For Prediction Of Difficult Airway Taking Cormack And Lehane Grading System As Gold Standard","authors":"Muhammad Mohsin Sajjad, Amina Tariq, Muhammad Shabbir, Sidra Yousaf","doi":"10.37939/jrmc.v27i3.2269","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2269","url":null,"abstract":"Background: General anesthesia is still needed for several surgical interventions and requires endotracheal intubation. The difficult airway is a well-known entity, and a long list of predicting scores is present, yet a high degree of diagnostic accuracy still needs to be improved. Acromioaxillosuprasternal notch index (AASI) has shown some excellent results in recent times. Objective: Its objective is to determine the diagnostic accuracy of acromioaxillosuprasternal notch index for predicting difficult airways and to take the Cormack and Lehane grading system as the gold standard. Methodology: In this study, adults of both genders aged 20 to 70 years undergoing any surgery under general anesthesia having ASA class I to IV were included. AASI score of equal or less than 0.49 was taken as difficult airway while on Cormack and Lehane grade; it was labeled as yes where grade III or IV was seen. Results: The total number of cases were 350 cases, out of which 218 (62.29%) were males, and 132 (37.71%) were females. The mean age was 40.20±12.86 years, and the mean BMI was 24.71±3.13 (table 17). There were 294 (84%) cases in ASA Class I and II and 56 (14%) in class III and IV. Difficult intubation on AASI was seen in 54 (15.43%) and 57 (16.29%) cases on Cormack and Lehane grading. The diagnostic accuracy of AASI for prediction of difficult intubating a difficult was 96.29% with sensitivity of 90.74%, specificity of 97.30%, PPV of 85.96%, NPV of 98.29% with p= 0.001. This difference was also statistically significant with all the confounding variables like age, gender, ASA class, and BMI. Conclusion: The acromioaxillosuprasternal notch index is a significant predictor for tubing a difficult airway and taking Cormack and Lehane's grading as the gold standard. This difference is considerably better regarding age, gender, BMI, and ASA class.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335964","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2272
Nabeela Riaz, S. Younas
Malignant peripheral nerve sheath tumors (MPNST) are malignant soft tissue neoplasms which account for 2% of all soft tissue sarcomas. These tumors are associated with poor prognosis, propensity to metastasize and high recurrence rates. About half of the MPNST arise from pre-existing neurofibroma and are associated with Neurofibromatosis type I (NF1), 10% are radiotherapy induced others are sporadic. Pathogenesis of MPNST is not fully understood yet. MPNST are common in extremities followed by trunk but are less common in head and neck area. MPNST show limited sensitivity to radiotherapy and chemotherapy and wide surgical resection is mainstay of treatment. We present a series of 3 cases of MPNST of head and neck region originating in patients having NF1.
{"title":"Huge Malignant Peripheral Nerve Sheath Tumors Originating In Neurofibromatosis Type 1","authors":"Nabeela Riaz, S. Younas","doi":"10.37939/jrmc.v27i3.2272","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2272","url":null,"abstract":"Malignant peripheral nerve sheath tumors (MPNST) are malignant soft tissue neoplasms which account for 2% of all soft tissue sarcomas. These tumors are associated with poor prognosis, propensity to metastasize and high recurrence rates. About half of the MPNST arise from pre-existing neurofibroma and are associated with Neurofibromatosis type I (NF1), 10% are radiotherapy induced others are sporadic. Pathogenesis of MPNST is not fully understood yet. MPNST are common in extremities followed by trunk but are less common in head and neck area. MPNST show limited sensitivity to radiotherapy and chemotherapy and wide surgical resection is mainstay of treatment. We present a series of 3 cases of MPNST of head and neck region originating in patients having NF1.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139336031","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}
Background: Pre-eclampsia, a serious multi-systemic pregnancy complication is estimated to occur in 5-10% of pregnancies worldwide. Objective: To determine the frequency of pre-eclampsia in pregnant females with hyper-triglyceridemia and to study its associations. Methodology: This Cross-sectional study was conducted at Gynecology Dept. Poly Clinic Hospital, Islamabad (March - Sept. 2022). Pregnant females of age 15-40 years, gestational age 13-20th weeks and singleton pregnancy were included. Known hypertensives, receiving lipid-lowering or anti-hypertensives, chronic kidney or liver disease, teenage pregnancies, primigravida, history of CVA, IHD, epilepsy or endocrine disorders were excluded. After the detailed clinical evaluation, fasting serum triglyceride levels were checked. A total of 225 cases with elevated serum triglycerides were finally selected and evaluated for the presence of pre-eclampsia by monitoring the blood pressure, cardiovascular, gynaecological examination and urine for the presence of proteinuria. Patients were followed till the development of pre-eclampsia or completion of pregnancy. Results: Among 225 pregnant females with raised serum triglycerides, the mean age was 24.28+5.5 years. Pre-eclampsia was observed in 47(20.89%) of patients. The Chi-square tests of association between pre-eclampsia and each of parity, residential status, and socio-economic status were insignificant while BMI and Gestational age were significant. Conclusion: There is a high prevalence of pre-eclampsia in pregnant women with hypertriglyceridemia. Serum triglyceride levels may predict the women at risk for pre-eclampsia. The risk of preeclampsia in women with hyper-triglyceridemia is independent of parity, and socioeconomic or residential status. Hypertriglyceridemia may predispose to pre-eclampsia even at lower BMI levels. The development of hypertriglyceridemia in early gestation may be an additional risk factor. Early screening of women at risk may lead to better outcomes.
{"title":"Association Of Raised Serum Triglycerides With Incidence Of Pre-Eclampsia","authors":"Saima Shafiq, Sara Muzaffar, Qurrat-Ul-Ain, Naushin Farooq, Nadia Shams, Lubna Meraj","doi":"10.37939/jrmc.v27i3.2315","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2315","url":null,"abstract":"Background: Pre-eclampsia, a serious multi-systemic pregnancy complication is estimated to occur in 5-10% of pregnancies worldwide. Objective: To determine the frequency of pre-eclampsia in pregnant females with hyper-triglyceridemia and to study its associations. Methodology: This Cross-sectional study was conducted at Gynecology Dept. Poly Clinic Hospital, Islamabad (March - Sept. 2022). Pregnant females of age 15-40 years, gestational age 13-20th weeks and singleton pregnancy were included. Known hypertensives, receiving lipid-lowering or anti-hypertensives, chronic kidney or liver disease, teenage pregnancies, primigravida, history of CVA, IHD, epilepsy or endocrine disorders were excluded. After the detailed clinical evaluation, fasting serum triglyceride levels were checked. A total of 225 cases with elevated serum triglycerides were finally selected and evaluated for the presence of pre-eclampsia by monitoring the blood pressure, cardiovascular, gynaecological examination and urine for the presence of proteinuria. Patients were followed till the development of pre-eclampsia or completion of pregnancy. Results: Among 225 pregnant females with raised serum triglycerides, the mean age was 24.28+5.5 years. Pre-eclampsia was observed in 47(20.89%) of patients. The Chi-square tests of association between pre-eclampsia and each of parity, residential status, and socio-economic status were insignificant while BMI and Gestational age were significant. Conclusion: There is a high prevalence of pre-eclampsia in pregnant women with hypertriglyceridemia. Serum triglyceride levels may predict the women at risk for pre-eclampsia. The risk of preeclampsia in women with hyper-triglyceridemia is independent of parity, and socioeconomic or residential status. Hypertriglyceridemia may predispose to pre-eclampsia even at lower BMI levels. The development of hypertriglyceridemia in early gestation may be an additional risk factor. Early screening of women at risk may lead to better outcomes.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335733","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2034
Mehtab Munir, Ayesha Khan, Tauseef Sayyar, Mariam Mufti, Iqra Siddiqui, Sara Tariq Abbasi
Background: Knee osteoarthritis is a common disease in older age. Pain and limitation of movement are the main symptoms of knee osteoarthritis. Many pharmacological options are available for symptomatic relief but NSAIDs are mostly prescribed. Diacerein is also prescribed for osteoarthritis but data regarding its efficacy is still controversial. Moreover, studies regarding the comparison of diacerein with NSAIDs are deficient in Pakistan. Objective: The objective of the study was to compare the clinical efficacy of naproxen (NSAID) with diacerein in treating knee osteoarthritis. Methodology: Patients fulfilling inclusion criteria were included in the study. After written informed consent 60 patients of knee osteoarthritis were included in the study. They were divided randomly into two groups. Group A (n=30) was prescribed with tablet naproxen 500mg twice daily and group B (n=30) was given capsule diacerein 50mg twice daily for 12 weeks. Baseline VAS and WOMAC scores of the patients were noted. These scores were compared with scores achieved 12 weeks after intervention. Intra-group comparison of the scores was also carried out. SPSS version 23.0 was used for statistical analysis. Results: WOMAC and VAS scores comparison of the two groups (A & B) before intervention showed an insignificant p-value that is 0.815 for the WOMAC score and 0.509 for the VAS score. After intervention means WOMAC score i.e.10.50 ± 2.46 of group A (treated with naproxen) was better than the mean 29.62 ± 7.03 of group B (treated with diacerein) showing significant p-value (< 0.001). Similarly mean VAS of group A 1.92 ± 0.58 improved more than the mean VAS of group B i.e 3.38 ± 0.75 with significant p-value (< 0.001). Intra-group comparison of the groups also showed a significant p-value. Conclusion: Clinical efficacy of naproxen is better than diacerein in treating knee osteoarthritis.
背景：膝关节骨关节炎是一种常见的老年疾病。疼痛和活动受限是膝关节骨关节炎的主要症状。有许多药物可用于缓解症状，但非甾体抗炎药是最常用的处方药。双醋瑞因也是治疗骨关节炎的处方药，但有关其疗效的数据仍存在争议。此外，巴基斯坦还缺乏关于双醋瑞因和非甾体抗炎药的比较研究。 研究目的本研究旨在比较萘普生（非甾体抗炎药）和迪卡瑞在治疗膝骨关节炎方面的临床疗效。 研究方法：研究对象包括符合纳入标准的患者。在获得书面知情同意后，60 名膝关节骨关节炎患者被纳入研究。他们被随机分为两组。A 组（30 人）服用片剂萘普生 500 毫克，每天两次；B 组（30 人）服用胶囊剂迪卡色林 50 毫克，每天两次，连续服用 12 周。记录患者的基线 VAS 和 WOMAC 评分。将这些评分与干预 12 周后的评分进行比较。此外，还进行了组内评分比较。统计分析采用 SPSS 23.0 版。 结果干预前两组（A 组和 B 组）的 WOMAC 和 VAS 评分比较显示，WOMAC 评分的 p 值为 0.815，VAS 评分的 p 值为 0.509，差异不大。干预后，A 组（使用萘普生治疗）的 WOMAC 平均得分（10.50 ± 2.46）优于 B 组（使用迪卡瑞林治疗）的平均得分（29.62 ± 7.03），P 值显著（< 0.001）。同样，A 组的 VAS 平均值（1.92 ± 0.58）比 B 组的 VAS 平均值（3.38 ± 0.75）改善得更多，P 值显著（< 0.001）。各组的组内比较也显示出显著的 p 值。 结论在治疗膝骨关节炎方面，萘普生的临床疗效优于迪卡瑞林。
{"title":"Comparison Of Naproxen And Diacerein In The Treatment Of Knee Joint Osteoarthritis","authors":"Mehtab Munir, Ayesha Khan, Tauseef Sayyar, Mariam Mufti, Iqra Siddiqui, Sara Tariq Abbasi","doi":"10.37939/jrmc.v27i3.2034","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2034","url":null,"abstract":"Background: Knee osteoarthritis is a common disease in older age. Pain and limitation of movement are the main symptoms of knee osteoarthritis. Many pharmacological options are available for symptomatic relief but NSAIDs are mostly prescribed. Diacerein is also prescribed for osteoarthritis but data regarding its efficacy is still controversial. Moreover, studies regarding the comparison of diacerein with NSAIDs are deficient in Pakistan. Objective: The objective of the study was to compare the clinical efficacy of naproxen (NSAID) with diacerein in treating knee osteoarthritis. Methodology: Patients fulfilling inclusion criteria were included in the study. After written informed consent 60 patients of knee osteoarthritis were included in the study. They were divided randomly into two groups. Group A (n=30) was prescribed with tablet naproxen 500mg twice daily and group B (n=30) was given capsule diacerein 50mg twice daily for 12 weeks. Baseline VAS and WOMAC scores of the patients were noted. These scores were compared with scores achieved 12 weeks after intervention. Intra-group comparison of the scores was also carried out. SPSS version 23.0 was used for statistical analysis. Results: WOMAC and VAS scores comparison of the two groups (A & B) before intervention showed an insignificant p-value that is 0.815 for the WOMAC score and 0.509 for the VAS score. After intervention means WOMAC score i.e.10.50 ± 2.46 of group A (treated with naproxen) was better than the mean 29.62 ± 7.03 of group B (treated with diacerein) showing significant p-value (< 0.001). Similarly mean VAS of group A 1.92 ± 0.58 improved more than the mean VAS of group B i.e 3.38 ± 0.75 with significant p-value (< 0.001). Intra-group comparison of the groups also showed a significant p-value. Conclusion: Clinical efficacy of naproxen is better than diacerein in treating knee osteoarthritis.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"146 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335820","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 : 2023-09-26DOI: 10.37939/jrmc.v27i3.2207
Aziz-Un-Nisa, Dur Muhammad, Sultan Zaib, Ibrahim Khan, Imran Zaib, Shehrish Saleem
ABSTRACT: Introduction: Covid-19 emerged as pandemic. In the beginning, due to the rapid spread of virus it was difficult to understand fully its pathogenesis but various inflammatory markers were found to be raised. Along with the detection of virus by polymerase reaction (PCR), studies of these markers not only help in diagnosis but also in assessing the prognosis of covid-19 infection. Material and methods: This cross sectional study was conducted in the Capital Hospital, CDA Islamabad from December to June 2022. After taking consent various inflammatory markers were recorded on a proforma. Patients were followed and outcome was also recorded. The data collected was analyzed by percentage/ frequency distribution. T-test was applied and p-values were calculated (significant p-value=<0.05). Sensitivity, specificity, positive and negative predictive values, area under curve (AUC) and accuracy were calculated by using SPSS, version 23. Results: A total of 185 covid-19 PCR positive patients were included in the study. 112(60.5%) were men and 73 (39.5%) were women. 165(89.2%) patients were > 40 years of age. 117 (63.2%) patients had mild /moderate disease and 68(36.8%) had severe disease. 162 (87.5%) patients were discharged and 23 (23.4%) expired. AUC in relation to severity of disease was 0.603 for C- reactive protein (CRP), 0.543 for lactate dehydrogenase (LDH), 0.525 for D. dimers and 0.619 for ferritin. Accuracy in relation to disease severity was as following: CRP 57.4%, D. dimers 52.4 %, ferritin 57.9% and LDH 55.7%. AUC in relation to outcome of covid-19 was 0.699 for CRP, 0.668 for LDH, 0.742 for D. dimers and 0.677 for ferritin. Accuracy of inflammatory markers in relation to outcome was as following: CRP 45.9%, D. dimers 61.2%, LDH 48.1% and ferritin 46.9%. Conclusion: Serum ferritin showed the highest accuracy (57.9%) in assessing the covid-19 severity and D. dimer came up with highest accuracy (61.2%) in assessing disease outcome.
{"title":"Accuracy Of Serum Ferritin, C-Reactive Protein, Lactate Dehydrogenase And D. Dimers In Assessing Severity And Outcome Of COVID-19 Infection","authors":"Aziz-Un-Nisa, Dur Muhammad, Sultan Zaib, Ibrahim Khan, Imran Zaib, Shehrish Saleem","doi":"10.37939/jrmc.v27i3.2207","DOIUrl":"https://doi.org/10.37939/jrmc.v27i3.2207","url":null,"abstract":"ABSTRACT: Introduction: Covid-19 emerged as pandemic. In the beginning, due to the rapid spread of virus it was difficult to understand fully its pathogenesis but various inflammatory markers were found to be raised. Along with the detection of virus by polymerase reaction (PCR), studies of these markers not only help in diagnosis but also in assessing the prognosis of covid-19 infection. Material and methods: This cross sectional study was conducted in the Capital Hospital, CDA Islamabad from December to June 2022. After taking consent various inflammatory markers were recorded on a proforma. Patients were followed and outcome was also recorded. The data collected was analyzed by percentage/ frequency distribution. T-test was applied and p-values were calculated (significant p-value=<0.05). Sensitivity, specificity, positive and negative predictive values, area under curve (AUC) and accuracy were calculated by using SPSS, version 23. Results: A total of 185 covid-19 PCR positive patients were included in the study. 112(60.5%) were men and 73 (39.5%) were women. 165(89.2%) patients were > 40 years of age. 117 (63.2%) patients had mild /moderate disease and 68(36.8%) had severe disease. 162 (87.5%) patients were discharged and 23 (23.4%) expired. AUC in relation to severity of disease was 0.603 for C- reactive protein (CRP), 0.543 for lactate dehydrogenase (LDH), 0.525 for D. dimers and 0.619 for ferritin. Accuracy in relation to disease severity was as following: CRP 57.4%, D. dimers 52.4 %, ferritin 57.9% and LDH 55.7%. AUC in relation to outcome of covid-19 was 0.699 for CRP, 0.668 for LDH, 0.742 for D. dimers and 0.677 for ferritin. Accuracy of inflammatory markers in relation to outcome was as following: CRP 45.9%, D. dimers 61.2%, LDH 48.1% and ferritin 46.9%. Conclusion: Serum ferritin showed the highest accuracy (57.9%) in assessing the covid-19 severity and D. dimer came up with highest accuracy (61.2%) in assessing disease outcome.","PeriodicalId":34174,"journal":{"name":"Journal of Rawalpindi Medical College","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139335825","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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