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

Background: Acute Appendicitis, a surgical emergency, is one of the most common causes of acute abdomen. Its' immediate diagnosis and surgery are of immense significance for the disease itself and its surgery carries a potential risk of morbidity and mortality. The goal of this study was to find out the role of Neutrophils to Lymphocyte Ratio (NLR) in making a confident diagnosis of acute appendicitis in a facility limited setup.

Methods: It is a cross-sectional validation study on 100 patients admitted to the surgical wards of Ayub Teaching Hospital Abbottabad, with suspicion of Acute Appendicitis (AA), who subsequently underwent open appendectomy. Data were collected regarding the demography (name, age, gender) of the patient, physical examination, clinical presentations, and investigations including the complete blood count, from which the NLR value was calculated. Data was also collected regarding the histopathology examination of the appendix.

Results: The sensitivity was 70.65% while the specificity was 87.5% and accuracy was 72%. Positive Predictive Value (PPV) was 98.4% and NPV was 20.6%.

Conclusions: There is a strong correlation between NLR value and Acute Appendicitis. According to the results of our study, NLR ≥ 2.5 seems to be a reliable parameter to obtain a more certain diagnosis of Acute Appendicitis.

Background: Dental caries in the mixed dentition stage is a common problem leading to tooth decay and extractions. This study aimed to evaluate the pattern of caries among children of 6-15 years age presenting to Ayub College of Dentistry and its association with different factors such as age, dietary habits, snacking habits, and previous dental visits.

Methods: It was cross-sectional research on 250 participants of 6-15 years presenting to Ayub College of Dentistry from November 2023 to April 2024. Dental caries was examined and DMFT index calculated with the help of questionnaires. DMFT was correlated with age, tooth brushing habits, gender, snacking habits, and previous dental visits. Data was analyzed using SPSS software version 22. Statistical correlation tests were applied to find the association between different variables such as age group, brushing habits, snacking habits and prevalence and severity of caries.

Results: Dental caries was prevalent among 79.7 percent whereas the mean DMFT of sample was 5.82±4.48. There was a trend of higher DMFT scores among male population than females. A greater DMFT score of 4.2±1.8 was seen among children of 13-15 years followed by 10-12 years (3.8±1.7) and 6-9 years (2.7±1.5).

Conclusions: This study highlights the high prevalence of dental caries among children and adolescents and its association with brushing habits, snacking habits, age, gender, and previous dental visits. Regular dental check-ups, proper oral hygiene practices, and a healthy diet low in sugar are key factors in preventing dental caries in elementary school students.

Background: This clinical audit aimed to assess the accuracy of allergy documentation within the Hospital Management Information System (HMIS) of the Gastroenterology and Pulmonology Wards at Lady Reading Hospital, MTI Peshawar. Proper documentation of allergies, including food, drugs, and other types, is crucial for patient safety to prevent adverse reactions.

Methods: The clinical audit was conducted using the "HOPE" Hospital Management Information System (HMIS), donated by the Shaukat Khanum Memorial Trust. It involved a retrospective review of medical records for 20 patients from each ward across two audit cycles. In the first cycle, 10 patients were randomly selected from each ward, making a total of 20 patients. After identifying gaps in allergy documentation, interventions were implemented. A second cycle was then conducted to reassess documentation, selecting another set of 10 patients from each ward. Data collection involved checking if allergies were documented, and the results were recorded in an Excel sheet, marked as 'Yes' or 'No' for allergies. Data analysis was done using Microsoft Excel 2023 and the graphical representations were created in Microsoft Office Word 2023 and Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA). The audit aimed for a 100% documentation standard as per the HMIS reading manual.

Results: In the first cycle, 70% (n=7) of patients in the Gastroenterology Ward and 60% (n=6) in the Pulmonology Ward had no documented allergies. After implementing the recommended interventions, the second cycle showed a remarkable improvement, with a 100% documentation rate achieved in both wards.

Conclusions: After implementing the recommendations, allergy documentation in the HMIS of Lady Reading Hospital MTI Peshawar significantly improved, which helped in preventing allergic reactions in patients admitted to the Gastroenterology and Pulmonology Wards.

Background: Firearm injuries are critically important in criminal proceedings and jurisprudence discussions. The aim of the current study was to reinforce the growing concern of firearm violence in society and authenticate findings through autopsy examinations in the casualty department of Ayub Teaching Hospital Abbottabad.

Methods: This retrospective observational study was conducted in the casualty department of Ayub Teaching Hospital Abbottabad. Data was collected from registers spanning 1st September 2023 to 31st May 2024, after obtaining permission from the hospital administration.

Results: Data from 56 cases were analyzed using SPSS 22. Among these, 50% suffered from firearm injuries, while the remaining 50% died due to sharp weapons, blunt weapons, poisoning, hanging, strangulation, road traffic accidents, electric shocks, or unknown causes. Of the total cases, 45 (80.4%) were male and 11 (19.6%) were female. The most affected age group was 20-40 years, comprising 36 (64.2%) cases. Furthermore, 42 (75%) cases were homicidal, 2 (3.6%) were suicidal, and 12 (21.4%) were accidental.

Conclusions: The most common weapon used in homicidal deaths is firearms. Firearm violence should be prioritized as a critical issue in global health discussions.

Background: Diabetes mellitus is a disease with many possible complications like macrovascular, i.e., stroke, coronary artery disease, peripheral artery disease, and microvascular, i.e., retinopathy, neuropathy and nephropathy. Many studies have been done in past to find the frequencies of these complications and their association with sociodemographic determinants of diabetic patients, but there was limited data available in our setup. This study was carried out to determine the frequency of micro and macrovascular complications of diabetic patients and their association with socioeconomic determinants at Ayub Teaching Hospital, Abbottabad.

Methods: This cross-sectional study was carried out at Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2022 till December 2023 on 113 diabetic patients. The data was collected on micro and macrovascular complications of diabetes on a pre-designed structured proforma and analyzed by means of SPSS-23.

Results: The most common macrovascular complication was coronary artery disease 10 (8.8%) while neuropathy 35 (31%) was the most common microvascular complication. Among macrovascular complications stroke was associated significantly with age (p=0.01) and duration of diabetes (p=0.032). Among microvascular complications neuropathy was associated with gender (p=0.047), nephropathy with smoking (p=0.02) and retinopathy with both gender (p=0.019) and smoking (p=0.017).

Conclusions: In this study there was significant association between, gender with neuropathy and retinopathy, smoking with nephropathy and retinopathy, stroke with age and duration of diabetes.

Background: Chronic suppurative otitis media (CSOM) tubo-tympanic type is a common ear condition in underdeveloped nations. Cortical mastoidectomy in conjunction with tympanoplasty has long been regarded as the preferred surgical procedure for patients with chronic non-cholesteatomatous otitis media. Studies contrasting tympanoplasty with and without cortical mastoidectomy improved hearing, but the results were comparable. Both of these procedures are still debatable and mandate further research. This comparison has not been conducted in Pakistan before. Our objective is to evaluate whether tympanoplasty is effective in managing tubo-tympanic otitis media in patients with or without cortical mastoidectomy.

Methods: Eighty-two patients (equally divided into two groups) were recruited from the Shaikh Zayed Hospital, Lahore. Group A (n=41) referred to tympanoplasty with mastoidectomy and group B (n=41) referred to tympanoplasty alone. Data was gathered using a pre-designed Proforma, and SPSS version 25.0 was used for analysis. Post-operative hearing improvement was calculated from the audiometric' air-bone gap before the operation minus the ABG of post-operative follow-up at 16 weeks. A hearing gain of at least 15dB was considered clinically relevant.

Results: Hearing improvement was observed in 73.3% of participants in group A while 83.3% in group B, grafting status was 95.1% in group B and 90.2% in group A, and discharge presence was 7.3% and 17% in group A and group B respectively.

Conclusions: In CSOM, mastoidectomy does not add significant benefit in terms of hearing & graft uptake, however, it is advantageous if the middle ear mucosa is unhealthy. Tympanoplasty alone is sufficient if the middle ear mucosa is healthy.

Small intestinal diverticula are rare compared to colonic diverticula. Jejunal diverticulosis can occur in older men. These diverticula are usually asymptomatic but can present with acute abdomen when symptomatic. Complicated cases can present with perforation, peritonitis, and abscess formation. CT scan is the ideal imaging modality to diagnose perforated jejunal diverticulitis. Complicated cases warrant surgical intervention. A high clinical suspicion is necessary for the timely diagnosis of perforated diverticulitis. We are presenting a case of a 45-year-old who presented with an acute abdomen in a surgical emergency. Perforated jejunal diverticulitis was revealed as the cause of his symptoms during surgery. This case signifies the importance of varied clinical presentations of perforated jejunal diverticulitis and keeping it in the differentials of acute abdomen. Perforated diverticulitis has a high mortality rate, so timely management is of utmost importance.

Background: Cardiorenal syndrome is the prevalent form of the syndrome in Pakistan. Despite the rising importance of CRS, more information is needed to understand comorbidities and hospital outcomes. This research study explores the prevalence, and In-hospital outcomes of patients admitted for Acute Decompensated Heart Failure at the tertiary care hospital of Islamabad at the age of above 18.

Methods: This cohort study was conducted at the tertiary care hospital in Islamabad from January to June 2024. Data were collected from 200 known ADHF patients who visited the CCU (OPD) and ward through a structured questionnaire. The data were analyzed using SPSS version 25.

Results: The majority of the sample was diagnosed with Type 1 Cardiorenal Syndrome, which accounted for 30% of the total. Cardiorenal Syndrome Types 3 and 5 had a prevalence of 20% each among the patients, while Types 2 and 4 had a prevalence of 15% each. This suggests that Type 1 was more prevalent, but the other types were equally distributed. The mortality rate in the Hospital was highest for Type 5 CRS at 15% and Type 3 CRS at 13%. During this period, Type 2 CRS exhibited the lowest mortality rate. Type 3 CRS had the most extended average hospitalization duration.

Conclusions: It was concluded in our study that cardiorenal syndrome is the prevalent form among admitted patients with ADHF, and the government needs to increase awareness about health and health-related risk factors related to the communities.

Antihypertensive medications known as angiotensin receptor blockers (ARBs) have become increasingly popular for treating conditions beyond hypertension. The reason for this widespread use is mainly due to their Reno protective and cardioprotective properties in patients with congestive heart failure and diabetes mellitus. There have been conflicting studies on the relationship between ARBs and haematological abnormalities. Using the supplied search terms, we carried out a thorough search for relevant papers written in English and published before July 2023. All of the studies that met the selection criteria were searched for on PubMed, Cochrane Library, and Google Scholar. Based on the examined data from the searched literatures, it has been demonstrated that angiotensin II is essential for stimulation of erythropoiesis and inhibition of it by drugs such as ARBs can lower haematocrit levels, leading to anaemia. Accordingly, dose reduction or stopping administration of ARBs could be a choice for correction of anaemia. However, such decision is based on the clinical situation and the requirements for other management options.

Background: Migration under hostile circumstances and taking refuge in another country is a process which can have a great toll on mental health of the affected individuals. Religious beliefs and closeness to God could be instrumental in bringing post-traumatic growth and positive changes in one's life after any traumatic event. This study was carried out to evaluate the association of post-traumatic growth with use of religion and spirituality as a coping strategy among refugees residing in Azad Jammu and Kashmir.

Methods: In this cross-sectional study, individuals who migrated from Indian Kashmir and got settled in the Thotha refugee camp at AJK were recruited during February to April 2024 for the study. Post-traumatic growth (PTG) was assessed via post-traumatic growth inventory. Religiosity as coping strategy was measured on brief religious coping scale (Brief RCOPE). Relationship of religious coping and other socio-demographic factors was correlated with PTG among the study participants.

Results: A total of three hundred and thirty participants were included in this study with mean age of 44.89±14.81. Majority of participants were male (n=237 (71.8%), married (n=260 (78.8%) and Unemployed (n=103 (31.2%). Participants who were ≤45 years old, single, employed, did not use illicit drugs and had more income had high PTG mean scores (p-value<0.05). The PTG scores of the study participants and Positive Religious coping score had positive correlation while PTG scores had negative correlation with Nnegative religious coping (r=-0.238, p-value <0.001).

Conclusions: Post-traumatic growth was observed in individuals who were lining as refugees in camps at AJK. Individuals who were young, single, well paid and did not used illicit drugs had more chances of having PTG. Positive religious coping also increased the chances of having post-traumatic growth in individuals after migration and taking refuge in another country.