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

Background: Substance use disorder (SUD) presents a significant public health challenge globally, including Pakistan. Despite its high prevalence, there is limited research on the lived experiences of individuals with SUD in Pakistan, particularly in terms of cultural, social, and treatment challenges.

Methods: This qualitative study explores the experiences of 60 male individuals with SUD in the capital territory of Pakistan. Participants were recruited using snowball sampling and were interviewed using a semi-structured guide covering various aspects of their lives impacted by SUD. Data were analyzed using thematic content analysis, with translation and back-translation processes ensuring accuracy in capturing participants' narratives.

Results: The study identified four main themes: the impact of SUD on individuals' lives, causes of SUD, treatment experiences, and the social status of individuals with SUD. Participants reported significant financial and social hardships, strained interpersonal relationships, and severe physical and mental health issues. Causes of SUD included emotional distress, peer pressure, and abusive circumstances, while treatment options varied from medical interventions to spiritual healing. The stigma associated with SUD significantly impacted participants' social reintegration and recovery.

Conclusions: The findings highlight the complex interplay of socio-economic, psychological, and cultural factors influencing SUD in Pakistan. The study underscores the need for culturally sensitive, patient-centered approaches in the treatment and rehabilitation of individuals with SUD. Further research is needed to develop comprehensive strategies that address the specific needs of this population.

Background: Misusing alcohol can cause damage to different tissues in the body, resulting in conditions like alcoholic liver disease, pancreatitis, cardiomyopathy, neurotoxicity, muscle wasting, weakened immune system, hormonal disruptions, birth defects, and bone loss. The objective of this research was to evaluate how alcohol affects the exocrine pancreas histology and the levels of amylase in the blood serum. Additionally, it aimed to explore whether vitamin E provides a safeguard against alcohol-induced harm to the pancreas in rabbits.

Methods: A laboratory-based experimental investigation was carried out at Peshawar Medical College involving eighteen healthy adult male domestic rabbits weighing between one to one and a half kilograms each. The rabbits were divided into three groups. Group A, serving as the control, received normal saline as a placebo. Group B was administered a daily dose of 30 percent ethanol solution (30 ml/kg/day) in normal saline. Group C received a daily oral dose of 30% ethanol solution (30 ml/kg/day) in normal saline along with vitamin E (50 mg/kg/day). Blood samples were collected for serum amylase analysis, while morphological assessment of acinar cells involved evaluating cell count, acinar size, acinar cell size, and acinar nucleus size.

Results: Serum amylase levels did not exhibit a statistically significant variance between the control and experimental groups as p-value was >0.05. Furthermore, no notable distinctions were noted in the size and number of pancreas acini, cells of pancreatic acini, and pancreatic acinar cells nuclei between the control and experimental groups in both category E4 and Category E8, as p >0.05.

Conclusions: There were no significant variations noted in the size and number of acini in pancreas, cells in pancreatic acini, and nuclei of cells in pancreatic acini. Consequently, the protective role of vitamin E against alcohol-induced pancreatic damage was not conclusively identified.

Background: Hypokalemia is one of the most important precipitating factors of hepatic encephalopathy causing Hypokalemic Alkalosis which is the leading cause of increased levels of nonionic ammonia in blood that crosses the blood brain barrier with ease and accumulates in the Central Nervous System.

Methods: A descriptive study was conducted in the Department of Medicine, PAF Hospital, Islamabad from December 31, 2022, to January 1, 2024.The sample size was calculated using WHO sample size calculator and non-probability sampling technique was used. Calculation of mean and standard deviation for variables like Age, Potassium levels and Length of Hospital Stay was done. Frequencies and percentages were calculated for variables like Hypokalemia, Gender, and Ethnicity. Independent samples t-test was used to compare the means, duration of stay at the hospital for patients with and without hypokalemia, keeping the p-value <0.05 as significant.

Results: The mean age of patients was 36.76±9.52 years. Out of the total 179 patients considered, 109 patients were male while 70 were females. Sixty-three patients were found to have hypokalemia. Their mean Potassium level was 3.47±0.37 mEq/L. A significant difference (p=0.230) wasn't detected in patients presenting with hypokalemia with age greater than and less than 35 years of age whereas, a significant difference (<0.001) was detected in the age group of less than 35 years when mean length of hospital stay was calculated.

Conclusions: The mean length of hospital stay was significantly higher amongst patients having hypokalemia, compared to those with no hypokalemia.

Background: Forensic Medicine has challenging dynamics particularly in identification of gender from bones. Pelvic bone is one of them which is commonly used in gender estimation due to variety of its features. The greater sciatic notch is the best part of pelvic bone for gender determination as its location makes it resilience to trauma even for many years. The aim of this study was to validate the various features such as width, depth angles etc. of greater sciatic notch for sex determination of the deceased.

Methods: This validation study was carried out in department of Forensic Medicine and Anatomy of Ayub Medical College from June 2023 to December 2023. A sample of 70 dry unidentified pelvic bones were studied by measuring the width, depth, anterior and posterior segments, anterior and posterior angles of the greater sciatic notch. Based on these measurements, the bones were then segregated as male and female bones. After initial gender identification, the standard features of the pelvic bones as per Krogman's classification were used for final confirmation of the gender.

Results: Result showed width, Anterior segment and posterior angle of greater sciatic notch greater in females while depth of notch deeper, posterior segments, anterior angle greater in males. These parameters and measurements give a unique importance for determining the gender of individual.

Conclusions: Our study shows that there is a significant difference between gender on the basis of different mentioned parameters of estimation. By using these parameters of greater sciatic notch anthropometric measurements, investigators can easily conclude important milestones of identity and determine the truth.

Adenomyoepithelioma (AME) is a rare variant of breast neoplasm. It is a biphasic tumour characterized by small epithelial-lined spaces with inner luminal cells and outer of abluminal (myoepithelial) cells. Either - or both - of these two cells may rarely undergo malignant transformation. We present a case of a 61-year-old lady who arbored a mass in her right breast. She presented with few left sided pulmonary nodules as well and was initially diagnosed with extensive DCIS on core biopsy. Lung biopsy of nodule was diagnosed as epithelial myoepithelial neoplasm. Ultimately, modified radical mastectomy and pneumonectomy was performed. The final histopathological diagnosis turned out to be malignant. Adenomyoepithelioma with carcinoma; epithelial-myoepithelial carcinoma of breast with pulmonary metastasis. The malignant transformation of adenomyoepithelioma has been documented in only a limited number of cases. Benign AME often undergoes treatment through wide local excision, given its rare local recurrence. In contrast, the approach to malignant AME typically involves a mastectomy, with or without a lymph node biopsy. Metastases may manifest several years' post-primary diagnosis, even in cases of AMEs lacking atypical histological features. However, in our case metastasis was seen with in first four months of clinical presentation. Adenomyoepithelioma with carcinoma is an exceptionally rare neoplasm that may present with early metastasis, challenging the conventional findings of late metastasis as reported in studies. Consequently, the behaviour and prognosis of this entity remains a grey area, necessitating further exploration with a substantial sample size.

Background: Acute diarrhoea among children mainly due to infection must be treated prophylactically to reduce mortality. The objective of this study was to compare the outcome of using bacterial probiotics (Bifidobacterium and Lactobacillus) versus fungal probiotics (Saccharomyces) for acute diarrhoea among children aged 6 months to 5 years.

Methods: A non-randomized control trial was conducted at diarrhoea ward, the Children's Hospital, Lahore from 1st March 2022 to 1st March 2024. 200 children were recruited in the study using non-probability consecutive sampling technique which were divided equally into two groups receiving either bacterial probiotics or fungal probiotics. The children were followed up till resolution of diarrhoea. Diarrhoeal duration and stool frequency were noted. Data was entered and analysed using SPSS Version 26.

Results: Out of 200 children, 52.5% were male and 47.5% were female. Mean age of the sample was 2.24±1.54 years, mean baseline and follow up diarrhoea duration was 3.52±1.44 and 3.47±1.25 days and stool frequency at follow up was 3.75±1.15. Complete diarrhoeal resolution was seen among 95% of the children using bacterial probiotics while 87% of the children using fungal probiotics (p=0.048). Regarding diarrhoeal duration (days) among the two groups, the mean was 3.11±1.36 (bacterial probiotic group) and 3.88±1.02 (fungal probiotic group) (p<0.001) and regarding stool frequency, the mean was 2.97±0.55 (bacterial probiotic group) and 4.57±1.07 (fungal probiotic group) (p<0.001).

Conclusions: It can be concluded from this study that diarrhoeal resolution along with stool frequency was better among children using bacterial probiotics as compared to those using fungal probiotics.

Background: Surgeons specifically junior ones in our setup of third world country face the issue of diagnosing Acute Appendicitis (AA) as presentation usually is not typical. Cases presenting at odd hours may put residents & house officers in trouble, when sophisticated investigations are either un-available or expansive. Need for a structured diagnostic criterion is thus always there. Various scores have been designed to help out surgeon e.g. Alvarado score which got more popular & is practiced randomly. Aim of this study was to revisit Alvarado score for its efficacy in current era at Ayub Teaching Hospital (ATH) Abbottabad, i.e., by calculating negative appendicectomy rate.

Methods: This descriptive study was conducted at Surgical "B" Unit (ATH) from 1st September 2021 to 31st May 2022. 160 patients with pain RIF were included & evaluated by Alvarado score & consequently placed in 03 groups. Those having score 1-4 (Group-1) at presentation were discharged while the ones with score 5-6 (Group-2) were observed, re-evaluated at interval for re-grouping as Group-1 or 3 based on their final score. Patients with score 7-10 (Group-3), having score confirmed Acute Appendicitis were operated. Findings were recorded on a proforma. SPSS-version 26 was utilized for statistical analysis.

Results: Total patients were 160, males were 118 & female patients were 42. Discharged (Group-1) patients were 22. Group-2 patients (41 in number), were observed for 24-48 hour when score of 16 declined to ≤4 level & were discharged. 25 patients whose score increased to ≥7 levels were operated like other 97 patients of Group-3. Histopathology confirmed 109 of 122 patients as acute appendicitis while 13 turned out negative appendicectomies. Negative appendicectomy rate was therefore 10.65%, i.e., 13 out of 122, it was 06.17% in males (i.e., 05 of 81) & 19.51% (i.e., 08 of 41) in females.

Conclusions: Alvarado score again proved helpful even today in reducing the negative appendicectomy rate at surgery department of ATH, it should therefore be routinely adopted in diagnosis of suspected appendicitis cases in the third world countries (e.g. Pakistan) setup (facing scarcity of sophisticated resources).

Background: Oral squamous cell carcinoma (OSCC) is a prevalent malignancy that develops through a series of stages, ranging from high-grade dysplasia (HGD), microinvasive OSCC (MiOSCC) to frankly invasive OSCC. However, sometimes it is difficult to differentiate HGD from MiOSCC and invasive OSCC in histopathological morphology on routine staining. The aim of the study was to assess the expression patterns of D2-40 in these distinct stages of oral carcinogenesis, providing insights into its potential role as a biomarker for disease progression.

Methods: This cross-sectional study was carried out in the Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from 1st Dec 2023 to 5th Feb 2024. It involved the application of a D2-40 immunohistochemical marker on a total of thirty tissue samples, ten patients diagnosed with High-grade dysplasia (HGD), ten with Microinvasive Oral squamous cell carcinoma (OSCC), and ten invasive OSCC cases. SPSS was used for data analysis and a p-value < 0.05 was considered significant.

Results: The mean age of patients was 60.47±11.78 years, males were affected more (70%). D2-40 was expressed in different stages of oral carcinogenesis in increasing order as in 40% in HGD (4/10), and 90% in both microinvasive (9/10) and invasive OSCC (9/10) lesions. D2-40 IHC expression was associated with the patient's age and disease.

Conclusions: Podoplanin (D2-40) has the potential to be a novel biomarker for the timely identification of microinvasion in early oral epithelial pathologies with diagnostic dilemmas.

Background: Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract. Skin manifestations are frequently found with IBD yet they are not completely comprehended regarding how common they are and whether they reflect the seriousness of disease. Objective was to determine the prevalence, type and treatment of skin recall manifestations among a cohort of patients with CD and ulcerative colitis (UC).

Methods: A total of 250 IBD patients (140 CD and 110 UC) were enrolled in the study. Demographics of patients, disease duration, skin morphology were enrolled. We evaluated the frequency of skin manifestations, their association with disease activity, and course in response to therapy.

Results: Skin manifestations appeared in 31.2% of patients, and were more prevalent in CD (35%) compared to UC (26%) (p=0.04). The most common skin manifestations were erythema nodosum (11.2%), pyoderma gangrenosum (5.6%), and perianal skin tags (8%). Active disease demonstrated a significant association with skin manifestations (45% active disease vs 18% remission, p<0.001). Patients receiving anti-TNF therapy had fewer new skin manifestations (20%) when compared to patients receiving conventional therapy (36%) (p=0.03), however 5% of patients receiving biologic therapy reported developing paradoxical skin reactions. Management of skin manifestations consisted mainly of systemic corticosteroids therapy, which was effective in 80% of cases, while 10% of patients with more severe perianal disease underwent surgical intervention to treat their skin manifestations.

Conclusions: Skin manifestations appear to be common in patients with IBD, and a significant difference was observed between patients with CD and UC. The disease activity showed a strong association with the occurrence of skin manifestations. Anti-TNF therapy is likely to be associated with less frequent new skin manifestation, however it remains substantive that patients with biologic therapy can have paradoxical skin reactions.