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

Background: Post acne and post burn facial scarring are more common in young generation leading to disfigurement and unpleasing result. These scars have major aesthetic, functional, and social effects on the affected person. Aim of the study was to establish the role of Autologous Nanofat grafting in treating post acne & post burn facial scarring in terms of pleasing aesthetic appearance of face & patient satisfaction.

Methods: A total no. of 24 patients with mean age of 23 years was enrolled in the study. Thirteen patients were of post acne face scarring and 11 patients were suffering from post-burn face scarring. There were 10 male and 14 female patients. All patients were treated with Nanofat grafting with an average of 3 sessions at an interval of 4-6 weeks. The results were assessed after 6 months from the last session by comparison of pre procedure & post procedure pictures and patient satisfaction.

Results: Scars started improving after first session of Nanofat grafting and significant improvement in the scars was noted after 3rd session in terms of pigmentation, scar thickness and softness. Overall appearances of the scar were aesthetically improved a lot with a higher patient satisfaction rate.

Conclusions: Autologous Nanofat grafting is a potential effective treatment modality for post-acne and post burn facial scarring with a good aesthetic outcome and higher patient satisfaction rate.

Background: Prostate cancer ranks the second most frequent cancer encountered worldwide in men. Radiotherapy has been effectively used to treat localized prostate cancer. Over the years more effective radiation techniques like 3D-Conformal Radiation Therapy (3D-CRT), Proton Therapy, Intensity Modulated Radiation Therapy (IMRT), and Brachytherapy has been evolved and effectively used to deliver radiation therapy. Herein, we compare serological outcomes of two radiation treatment techniques intensity modulated radiation therapy (IMRT) and 3- dimensional conformal radiation therapy (3DCRT) in localized prostate adenocarcinoma.

Methods: It is a cohort study conducted at Department of Oncology, Dr Ziauddin Hospital, Karachi. Patients with localized prostate adenocarcinoma meeting the inclusion criteria were recruited from July 2016 to June 2022, underwent treatment with a total dose >74 Gy using two different advanced radiotherapy techniques, i.e., IMRT and 3D-CRT. Serum PSA levels were assessed prior to treatment, and 6 weeks and 12 months after treatment. Paired t-Test was applied to identify the difference in PSA levels before, and after the treatment. p-value less than 0.05 was taken as significant at 95% confidence interval.

Results: A total of 78 patients with 39 in each group. The mean age of patients in 3D-CRT group was 68±10 years while in IMRT group was 68±07 years. Six weeks after initiation of treatment, we observed that both the treatment methods, i.e., 3D-CRT and IMRT reduced the PSA levels significantly p-value = 0.001 respectively. There was no significant difference in the mean of PSA levels on 06th week and 12th months. Furthermore, the analysis of PSA levels at 12th months when compared with the baseline PSA levels came highly significant in both the groups as depicted in paired-t teat analysis of PSA levels with acceptable toxicity.

Conclusions: Radiation therapy modalities 3D-CRT and IMRT both showed a significant serological response with minimal or acceptable gastrointestinal and genitourinary toxicities in the 3D-CRT group in comparison to the IMRT group. Although the sample size is relatively smaller, but the results of this study are encouraging to treat those patients on 3D-CRT, who cannot afford more expansive radiotherapy treatment technique like IMRT.

Background: Noncommunicable Diseases (NCDs) are considered as major public health threats and contributes a high burden of diseases on health system of Thailand. Around 74% of deaths occur due to NCDs, and more than 40,000 people die annually in Thailand due to this problem. Objectives of the study were to know the blood lipid level and its determinants among university students and employees of Thailand.

Methods: This study was cross-sectional to determine the relationship between various factors with blood lipid level among university students and employees. A total 219 participants were invited and included randomly in this study. Only those respondents who had their lipid profile checked recently during one of time were included and those who had other associated diseases were excluded in this study. Chi-square and Binary logistic regression were used to assess the factors associating with blood lipid level among the study participants. Study was ethically approved from the ethical review board of university and written consent was taken prior to start the data collection.

Results: Total 219 respondents were included in this study, majority 84% were females. The mean age of participants was 26.18 (SD±9.81) years. About three-fifth (63%) had normal blood lipids, when we considering those with abnormal blood lipids, it was found that the sample group had the most abnormal cholesterol 37.44% and LDL 28.77%. Study found that only the variable of age was statistically significant in bivariate analysis. By people aged 26 and over had abnormal blood lipid 2.953 times more than those age 20-25 years. The income variable was found to have no relationship with blood lipid status at p>0.05.

Conclusion: This study concludes that the university students and employees are on high risk to develop the cardiac diseases and the factor like age has a greater impact on abnormal blood lipids.

Background: Early Onset Neonatal Sepsis (EONS) is a serious blood infection mainly microbial in nature and has worse health complications. Metabolic acidosis is one of such complications that occur due to acid-base imbalance and may result in lectic acidosis, myocardial depression, hypo-perfusion, shock and even death in severe cases. Despite of its significance, limited local literature is available in this regard. Aims were to determine frequency of metabolic acidosis in early onset neonatal sepsis among neonates presenting in a tertiary care hospital. This was cross sectional study.

Methods: Present study was conducted in department of Children's Hospital and Institute of Child Health Lahore. The data was collected through Non probability consecutive sampling from 242 neonates aged ≤72 hours of either gender diagnosed as EONS. Data was entered and analyzed in SPSS 22. For association, Chi-square test was applied and p-value ≤0.05 was considered as significant.

Results: The mean age of patients was 36.49±18.33 hours with 137(56.61%) male and 105(43.39%) female cases in this study. The frequency of metabolic acidosis was 67(27.69%) of the cases with no association with age, birth weight, gestational age and gender (p-values >0.05).

Practical implication: Even recently, no local study has published the frequency of metabolic acidosis or found its association directly with EONS in Pakistan. Therefore, metabolic acidosis if found in EONS neonates, then in future every patient with early onset sepsis should be screened and can be managed timely.

Conclusions: It is concluded that very high statistics of metabolic acidosis, i.e., 27.69% so every patient with early onset sepsis should be screened for metabolic acidosis to reduce worse health outcomes.

Background: Coronary interventions, including percutaneous coronary intervention (PCI), have significantly improved management of coronary artery disease by restoration of coronary blood flow to myocardium. However, despite of so many advancements in PCI procedural techniques, there is still a significant and challenging complication known as the "no-reflow" phenomenon exists which worst effect the PPCI outcome.

Methods: It was Cross sectional study conducted at Department of Cardiology, Lady Reading Hospital Peshawar. Study was conducted from 1/1/2023 to 30/6/2023 for six months. All patients who developed no reflow were subjected to intracoronary Tirofiban. Those who do not responded to Tirofiban were given intracoronary adrenalin and effect was noted. Data were analyzed using SPSS Version 23.0. Mean and standard deviation were calculated for quantitative variables like age. Frequencies and percentages were calculated for categorical variables like gender. The p-value less than 0.05 was considered significant.

Results: Among 151 participants, 18% experienced the no-reflow phenomenon. Intracoronary adrenaline and Tirofiban individually showed a significant positive impact on TIMI flow. It was found that 40% patients with no reflow responded to Tirofiban administration. Remaining patients with no reflow were subjected to intracoronary adrenalin therapy and 74% of these patients had improved TIMI flow. It was also found that combine effect of Tirofiban and adrenalin was found in 84% of patients.

Conclusions: No reflow phenomenon is common finding in Primary PCI and can be effectively managed by Tirofiban and intracoronary adrenalin administration in most cases.

Background: Endometrial cancer ranks as the sixth frequently detected cancer and the 14th highest contributor, to cancer-related fatalities, among women globally. High-grade endometrial carcinomas encompass a diverse array of clinically aggressive tumours, including FIGO grade 3 endometrioid adenocarcinoma, uterine papillary serous carcinoma (UPSC), clear cell carcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and carcinosarcoma. The classification and diagnosis of these tumours pose challenges due to the absence of well-established molecular markers or panels. The main purpose of this study is to assess and compare the clinicopathological characteristics of and survival rates of undifferentiated endometrial carcinoma (UEC), dedifferentiated carcinoma (DEC), and carcinosarcoma (CS) in the Pakistani population at SKMCH&RC.

Methods: All patients diagnosed with DEC, UEC, and CS were analyzed from January 2011 and December 2022. Clinicopathological and survival data was retrospectively reviewed and analyzed using SPSS version 27. Kaplan-Meier analysis was used to calculate overall survival (OS) and disease-free survival (DFS).

Results: Among 71 selected patients, 47.9% had CS, 29.6% had DEC, and 22.5% had UEC. Mean±SD age at diagnosis was 58.18±11.35 years. A statistically significant association of DEC, UEC, and CS was identified (p-value <0.05) with myometrial invasion (p=0.02), lympho-vascular invasion(p=0.006), positive margins(p=0.003), and involvement of adnexa/ parametria/ vaginal /adnexa/ parametria/ vaginal /another organ (p=0.01). The commonest pathological stage was pT1 38(53.5%). 56.3% of patients received chemotherapy, 29.6% received radiotherapy, and 38.0% received a combination of chemotherapy and radiation treatment. Recurrence occurred in 19.7% and death occurred in 37.7% of patients. The highest 5-year OS rate for pathological stage 1 was 59.1% (95% C.I: 42.9-81.3%) and 5-year-DFS was 62.2% (95% C.I: 42.9-81.3%).

Conclusions: Patients diagnosed at an early pathological stage demonstrate better survival outcomes compared to an advanced stage, as documented in previous studies. Nevertheless, survival rates remain lower than Western population, indicating a necessity for gathering additional clinical data and alter the management strategies in our population.

Background: Dentin hypersensitivity is a common clinical problem all over the world and it is called the common cold of dentistry. This study aimed to compare the efficacy of glass ionomer cement and dentin bonding agent in management of dentin hypersensitivity in patients presenting to Peshawar Dental College.

Methods: This Quasi-experimental study was conducted on patients presented to the Department of Operative dentistry and Endodontics from February to August 2022.A total of 60 patients in the age range of 18-70 were selected based on convenience sampling. The patients were divided into 2 groups. Group A received glass ionomer cement and Group B received dentin bonding agent. The sensitivity was assessed before treatment using visual analogue scale and documented as baseline reading with both tactile and evaporative stimuli. It was then evaluated immediately after treatment, as well as at 1 week and 6 weeks post-treatment, using the visual analogue scale with tactile & evaporative stimuli.

Results: Thirty Patients in group A were treated with glass ionomer cement & 30 patients in Group B received treatment with dentin bonding agent. The pain scores in both groups decreased from severe to moderate to mild or no pain immediately after application compared to baseline (p=0.613). During the 1 week follow up, most patients in both groups reported mild or no pain (p=0.64). After 6 weeks, most patients in both groups experienced mild pain (p=0.338).

Conclusions: Comparison of glass ionomer cement and dentin bonding agent revealed a significant difference in pain scores immediately after application. However, at 1- week and 6-weeks follow-ups, there was no significant difference between the two groups, as most patients reported only mild pain.

Background: With rising conditions in immunocompromised states, the world is facing the challenge of fungal infections with mucormycosis which was rare previously. With the rise in diabetic patients, COVID-19-related immunosuppression, and steroid use, along with an increasing number of transplant and chemotherapy patients, there has been a notable surge in mucorales infections. Although patients with rhino-orbit-cerebral mucormycosis are the most common type of pulmonary rare ones.

Methods: Here, we are reporting 1st case of laryngeal mucormycosis in a 55-year-old male presented with respiratory distress in the ENT department of Shaikh Zayed Hospital, Lahore. He had a 4-year history of poorly controlled diabetes, with no other identifiable risk factors. An emergency tracheostomy was performed, pus was aspirated, and necrotic tissue was debrided to relieve the airway obstruction.

Conclusions: Laryngeal mucormycosis was diagnosed in the subglottic region via multiple biopsies through direct laryngoscopy under anesthesia. The emergence of new variants of mucormycosis is calling for vigilant identification and meticulous control of predisposing risks. Concomitant debridement and intravenous amphotericin B are recommended under current guidelines.

Hepatic disorders are generally silent, with slow progress, and are usually detected when the organ's function is severely affected. Several studies have shown that oral lichen planus (OLP) is one of the most Hepatitis C-associated diseases. The emergence of such an extrahepatic manifestation is frequent and can lead to an early diagnosis. Patients with chronic hepatitis C virus (HCV) infection exhibit extensive forms of OLP, with frequent periods of exacerbation of symptoms refractory to treatment, which is commensurate with the severity of the liver disease. When treating OLP in HCV patients, researchers have diverged results. This case report presents an extensive, erosive OLP in an HCV-positive female patient for whom clinical management was tremendous. Full remission was obtained after topical corticosteroid application and several sessions of oral cavity sanitation. This clinical case demonstrates that dentists play a major role in OLP diagnosing, managing, and malignant transformation preventing. They may also contribute to the screening of hepatitis C infection.

Background: The optimal management of breech presentation remains a debate among obstetricians worldwide. The Term Breech Trial (2000) highlighted elective caesarean section as a preferable method over vaginal delivery for breech presentations. This study investigates delivery modes in women who had an elective caesarean section for breech presentation in their first pregnancy. Objective was to evaluate delivery outcomes in the second pregnancy of women who had an elective caesarean section for breech presentation in their first pregnancy.

Methods: A cross-sectional study was conducted at Jinnah International Hospital Abbottabad from October 10, 2018, to April 10, 2019. Data was collected from 321 women who had an elective caesarean section for breech presentation during their first pregnancy. The study used per-abdominal examination and obstetrical ultrasound to assess foetal presentation and recorded the mode of delivery in the second pregnancy.

Results: Participants' ages ranged from 18 to 49 years, with a mean age of 28.87±4.07 years. The average interval between deliveries was 1.92±0.92 years, labour duration averaged 5.56±2.41 hours, and foetal head engagement averaged 2.92±1.35. Of the participants, 18.7% achieved a vaginal delivery, while 81.3% had a repeat caesarean section. Reasons for repeat caesarean included recurrent breech presentation in 44.9% and foetal distress in 32.4%.

Conclusions: Approximately 18.7% of women who had an elective caesarean section for breech presentation in their first pregnancy achieved vaginal delivery in their second pregnancy, whereas the majority underwent another elective caesarean section.