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

Background: Autoimmune encephalitis (AIE) has been ranked as the third most common cause of encephalitis after viral encephalitis and acute disseminated encephalomyelitis. The estimated incidence is 5-8 cases per 100,000 population. The objective of this study was to develop a cost-effective test for detection of anti NMDA R antibodies by using in house prepared rodent brain tissue sections which could facilitate timely diagnosis and management of anti NMDA R Encephalitis, which if left undiagnosed may prove fatal.

Methods: A total of 500 samples sent for autoimmune encephalitis related antibody testing were included in this cross-sectional study from April 2019 to March 2021 at department of Immunology, Shifa International Hospital (SIH), Islamabad. Rodent brain was dissected to prepare tissue sections on which samples were tested by Indirect Immunofluorescence. Simultaneously samples were tested on cell-based assay (CBA) which is gold standard for testing anti NMDA R antibodies. Sensitivity, specificity, positive and negative predictive values were calculated.

Results: Median age of patients who tested positive for anti NMDA encephalitis was 19 years (range: 1 to 57). Out these 76% were female and 24% males. 5% patients tested positive for anti NMDA antibodies out of those suspected to be suffering from autoimmune encephalitis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of rodent brain IF for anti-NMDR antibodies taking CBA as gold standard was 92.6%, 98.5%, 78.1% and 99.6% respectively. The accuracy of the procedure was 98.2%.

Conclusions: Indirect immunofluorescence (IF) on rodent brain tissue sections can be useful as a cost-effective alternate for resource constrained laboratories for timely detection of anti NMDA R antibodies facilitating timely diagnosis and management of anti-NMDA receptor encephalitis patients.

Background: Antibiotic resistance is one of the most urgent public health concerns. Biofilm formation is well linked with chronic wounds, chronic obstructive pulmonary disease, urinary tract infections, and cystic fibrosis. Our goal was to assess the biofilm activity of P. aeruginosa and the individual and combined anti-biofilm forming activity of probiotic Lactobacillus acidophilus and Pomegranate peel extract Punica granatum L., against P. aeruginosa.

Methods: A total of 150 swabs of urine, blood, pus, and CSF were collected from PNS Shifa Hospital Karachi, and P. aeruginosa was isolated and identified according to standard bacteriological methods. The ability of P. aeruginosa to form biofilms was assessed using a microtiter plate assay.

Results: The anti-biofilm forming activity of pomegranate peels extract against P. aeruginosa was 29.26±19.09 whereas the anti-biofilm forming activity of Lactobacillus acidophilus against P. aeruginosa was 0.5×106. When used in combination, there was significant synergistic activity between Punica granatum L. (pomegranate peel extract) and Lactobacillus acidophilus.

Conclusions: The unique synergistic mixture of natural product extracts and probiotics has demonstrated more efficiency against rapidly evolving pathogens, serving as promising candidates for developing biofilm inhibitors and perhaps proving as possible environmentally friendly agents against bacteria that produce antibiotic-resistant biofilms.

Background: Venous thromboembolism (VTE) ranks as the third most common cause of vascular death following myocardial infarction and stroke. VTE is a prevalent illness, particularly in the elderly, and is linked to a high recurrence rate, substantial healthcare costs, and reduced survival rates. The Objective of the study was to investigate the impact of using the VTE risk assessment (VTE-RA) tool and thromboprophylaxis (TP) on all adult patients hospitalized.

Methods: This study was conducted at a single centre using a prospective cross-sectional design to compare data before and after an intervention at a tertiary referral hospital in Pakistan from May 2019 to February 2020. All adult inpatients over the age of 18 were eligible for inclusion.

Results: A total of 1,200 patients were screened in the study. The majority of these patients were medical 701(58.42%) and 499(41.58%) were surgical. The mean age of patients was 59.02±1.40 years. The male patients were 690(57.55%) as compared with females were 510(42.5%). The average stay in hospital was 8.01±1.11 days. At that time, there was no official RA instrument implemented. Researchers documented any written proof of RA in patients' medical records as "RA completed." 190(15.83%) out of all charts evaluated had a recorded VTE risk assessment. TP was prescribed to 450(37.5%) patients, which accounts for of the total. Risk factors for VTE in high-risk patients.

Conclusions: VTE risk assessment, prescribing adequate thromboprophylaxis, and integrating it into practice is challenging. The majority of hospitalized patients investigated were at a high risk of having venous thromboembolism (VTE). The most prevalent risk factor for developing VTE is old age, however, only few hospitalized patients were actually given thromboprophylaxis.

Background: There is substantial number of youth's population belong to age group 18-25 years contributes 11% of the total population in Thailand. According to the ASEAN Youth Development Index (AYDI) ranking, Thailand is ranked 8th out of 10 countries in terms of improvement in health and well-being and social participation of youth in the country. Body mass index includes an appropriate weight and height for adult population, that is important indicator for healthy young subjects. The objectives of this study were to assess the prevalence of Body Mass Index (BMI) and affected factors among the university students.

Methods: This study was conducted on the sample of 300 students by multiple stage random sampling technique. A pretested and piloted questionnaire were used in this study. Factors affected BMI were analyzed by using Multiple Linear Regression (MLR). A written consent was taken prior to conduct the data collection.

Results: The variables that affected the student's BMI were Socio-demographic factors such as; gender and Body Mass Index of the mothers and health behavioural factors, including physical activity variables had a statistically significant effect on the student's BMI (p<0.001), which could explain 91.10 % of the variation in BMI. The mean of BMI was 21.50±4.655 SD. Lower than half of students (47%) had the normal BMI. However, the BMI of overweight /obese students was up to 26.67%.

Conclusions: Study concluded that the factors like; gender, maternal BMI, physical activity were significantly effects on the BMI of university students in Thailand.

Background: Temporomandibular joint (TMJ) disorders represent a significant health concern affecting a substantial portion of the population worldwide. The management of TMJ disorders often involves a multifaceted approach including physiotherapy techniques, manual exercise interventions, patient education, and medication therapy. The purpose of this research is to examine the "Effectiveness of manual therapy, and physical therapy in conjunction with patient education for temporomandibular disorders".

Methods: Forty patients with TMDS were randomized into two groups: one for home physical therapy and the other for manual therapy plus physical therapy. Patient education and counseling were done in both groups. the patient had assessments both before and after.

Results: The study made a comparison of two groups: one received physical therapy only (n=20) and the other group received a combination of physical and manual therapy (n=20). There were no significant differences between the two groups in terms of age, gender distribution, or the affected side of the face (p>0.05).

Conclusions: For TMJ issues, physical therapy patient education is a useful therapeutic method. Moreover, combining these modalities with manual therapy improves results beyond what would be achieved with just these modalities alone.

Background: Keratoconus is a progressive ectatic disease of the cornea leading to central corneal thinning, protrusion and permanent visual impairment in untreated cases. It is affecting young children with strong association to vernal keratoconjunctivitis a common disease of Asian countries. Corneal collagen cross linkage (CXL) is standard procedure to stop progression of keratoconus. In this research article we used trans-epithelial accelerated corneal cross-linking to check its efficacy in stopping the progression of disease as quick and safe procedure with less chances of complication than standard CXL protocol.

Methods: The study was carried out in Khyber Teaching Hospital from November 2022-October 2023. The sample size calculated was 36 with sampling technique of non-probability consecutive convenience sampling method.

Results: The mean age of the patients was 19.157±3.53 years. Post corneal cross-linking, at 6 months follow-up showed that in 94.44% of the patients, no progression of keratoconus was noted. Improvement in vision was recorded in 44.44% of patients. A positive correlation was detected between pre- and post-treatment patients in visual acuity, keratometry and pachymetry.

Conclusions: The trans-epithelial accelerated corneal collagen crosslinking is a safe and quick procedure for stopping the progression of keratoconus associated with less morbidity and complications.

Surgical site infections are a common complication of surgery with a high prevalence in lower middle-income countries (LMICS). Excessive focus on antibiotic prophylaxis to prevent surgical site infections while neglecting other precautions like aseptic measures, patient nutrition, proper wound care has resulted in the emergence of antibiotic resistant microbials. Such organisms are a menace to healthcare. They cause prolonged hospital stay, use of expensive drugs, increased mortality and morbidity and overall, greatly increased cost of care per patient. We present a case of extreme drug resistant Acinetobacter spp causing surgical site infection following abdominal surgery, from Peshawar, Pakistan. Our patient was an 18-year-old lady who had undergone abdominoplasty following which she developed high grade fever, pain in abdomen and wound discharge. Empiric antibiotics treatment did not improve her condition. Culture and sensitivity report showed the growth of Acinetobacter spp. Which was resistant to almost all of the commonly used antibiotics, with the exception of tigecycline. Patient was treated with tigecycline which resolved her fever and wound infection and she was discharged in a stable condition. We believe our case highlights the importance of antibiotics stewardship and is a wakeup call to healthcare professionals and policy makers to take necessary steps to herald the danger of antibiotics resistance before it is too late.

Background: Palate, a midface bone, shapes the face and supports buttresses. Palatine process of maxilla and horizontal plate of palatine bone constitute it. Palatal bone is thicker anteriorly and laterally than posteriorly and centrally. Palatal fractures occur with maxillary fractures. Palatal-maxillary fractures occur 8-46.4% of the time.2,5 Palatal fractures can cause palatal ecchymosis in closed fractures and lacerations of upper lip, palatal mucosa, incisor tooth loss, or occlusal disruption in displaced fractures. The objective was to determine the surgical outcome of palatal fractures with locking plates as external fixator vs. alveolar plating in terms of frequency of oronasal fistula formation.

Methods: A Randomized control trial was carried out in Department of Oral and Maxillofacial surgery, Pakistan Institute of Medical Sciences, Islamabad. between 14th July, 2017 to 14th July, 2018. Lottery split patients into groups A and B. Data was collected on designed questionnaire and was entered and analyzed using SPSS v22. Chi-square was applied to check the association.

Results: A total of 130 patients were enrolled in the trial based on the predefined inclusion criteria. The average age of participants in the research was 41.16 years with a standard deviation of 10.44. Of the total participants, 88 (67.7%) were male and 42 (32.3%) were female, as per the inclusion criteria. The occurrence rate of oronasal fistula development in both groups, namely palatal fractures treated with locking plates as an external fixator vs alveolar plating, was 1 (1.5%) and 7 (10.8%) respectively. This difference was found to be statistically significant with a p-value of 0.029.

Conclusions: Osteosynthesis using 2.0 mm locking plates as external fixator had a lower rate of oronasal fistula than alveolar plating. Future investigations at numerous configurations are needed to determine which approach is best. such that a regular strategy will reduce infection, fistula development, and necrosis afterwards.

Background: Scabies is a significant skin problem in the developing countries due to its increased incidence, complications and financial implications. The aim of this study is to highlight the endemicity of scabies in our population and its clinical manifestations including various complications. The study was conducted to determine the frequency and clinical manifestations of scabies in patients presented to dermatology outpatient department (opd), Ayub teaching hospital, Abbottabad.

Methods: This cross-sectional study was conducted on 1404 patients suspected to have scabies. The demographic and clinical features of scabies presentation was recorded on a questionnaire by interview. The skin scrapings were observed under microscope after preparing 10% KOH mount.

Results: During the study period, out of 1404 patients, 339 patients with scabies were identified, with frequency 24.14%. The mean age calculated was 21.18 years. The frequency of scabies was 56% (190) in males while 44% (149) in females. All studied patients had pruritis (male =190. female =149). 89.1% had papules, 39.8% had excoriations on their bodies, 15.6% had impetiginization, 12.7% had eczema and only 3.2% of total had blisters. It was observed that complications like impetigo, eczema, blisters were more in patients living in unfavorable conditions.

Conclusions: The results of the study showed that scabies is a common skin infestation in our population. It is recommended that awareness programs be implemented at primary healthcare level so that necessary measures can be taken to control this preventable and communicable disease.