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

Background: This audit primarily assesses compliance with the British Thoracic Society guidelines (BTS) for oxygen prescriptions in the Respiratory Department at King's Mill Hospital. The results of this audit aim to guide the strategies to improve the oxygen prescription practices in the Trust.

Methods: We collected the data on oxygen prescriptions, from the electronic prescribing system, of all the patients admitted in the three respiratory wards of King's Mill Hospital over the period of one week. This data was then recorded and analysed using Audit management and Tracking© (AMAT).

Results: The overall compliance score to BTS guidelines for oxygen prescription was 12.2%. Out of the 152 patients, only 8 (5%) had oxygen therapy prescribed and a target oxygen saturation range was identified. No patient had an identifiable oxygen delivery method on their prescription.

Conclusions: The current practices of oxygen prescription at the respiratory department of King's Mill Hospital are suboptimal. These findings highlight the risk of serious potential consequences and the opportunity to implement safe prescribing measures for oxygen, like other prescribed medications.

Background: Admission for heart failure poses a significant risk of readmission. Evaluating readmission rates in settings lacking chronic disease management programs could provide valuable insights to advocate for the establishment of such services.

Methods: This study focused on patients admitted to the Cardiology Department of Ayub Medical Teaching Institute with acute decompensated heart failure. After excluding patients based on exclusion criteria, demographic and clinical data were recorded, including symptoms, signs, discharge medications, and readmission status within 6 months. Patients not readmitted were contacted via telephone at 1, 3, and 6 months. Readmission rates and time to first readmission or death were documented.

Results: A total of 222 patients were enrolled, with 60% being males. All patients exhibited pulmonary congestion, with 85% classified as NYHA Class III or IV. Comorbidities included hypertension (59%), history of myocardial infarction (45.49%), and diabetes (38.28%). Within 6 months, 21% of patients were readmitted, and 13% died before readmission, resulting in an overall death or readmission rate of 34% at 6 months. No significant differences were observed between readmitted and non-readmitted patients regarding sex, age, creatinine levels, haemoglobin levels, sodium levels, or ejection fraction. Utilization of guideline-directed medical treatment was low.

Conclusion: The high rate of readmission or death among patients admitted with acute decompensated heart failure underscores the necessity for implementing multidisciplinary care to closely monitor these patients.

Pyrexia of unknown origin (PUO) has remained a diagnostic challenge for medical professionals for decades as its aetiology remains elusive and requires extensive investigation. Hepatic Haemangioma (HH) is generally not considered a possible cause of PUO. HH is the most frequent, non-cancerous tumour in children usually presents as vague abdominal pain. We describe a case of 4-year-old female presented with the complaint of dull abdominal pain associated with low grade fever. Extensive workup was done to find out the cause. Her haemoglobin also dropped suggestive of bleeding haemangioma. She was treated with steroids (prednisolone) which significantly reduced her inflammatory markers prior to surgery. Later, hepatectomy was done after informed consent. The surgery was uneventful, and her PUO was also resolved.

Background: Diabetes mellitus is a leading cause of morbidity and mortality, with many ocular severe complications. This cross-sectional study determined adherence to proper eye care recommendations and regular eye examinations among local diabetic patients and factors associated with non-adherence.

Methods: This cross-sectional survey assed the knowledge, attitude, and practices of 200 type I and II diabetic patients. The frequency of patients' regular eye examinations, good knowledge of diabetic eye disease, and measures of the association of periodic eye examination with different variables were calculated.

Results: There were 116 (58%) males and 84 (42%) females (mean age=55.28 years, SD=13.928 years). The majority belonged to the lower socioeconomic group with little education. 114 (57%) had never had any eye examination. 107 were unaware of the importance of eye examination. Only 35 (17.5%) had good knowledge, and 146 (73%) patients had poor attitudes towards diabetes. Periodic eye examination was significantly associated with occupation, area of residence, and overall knowledge of diabetic eye complications. In contrast, it had no significant association with gender, type of diabetes, presence of eye symptoms, or presence of other diabetes complications.

Conclusions: The knowledge of our local population about diabetic eye disease is very deficient. An extensive campaign of educating diabetic patients about ocular complications is necessary to address this.

Background: Language is a very important aspect for the adaptation and translation process. For many people, their native language is not just a means of communication but a vessel of cultural identity and emotional expression. When individuals are experiencing the difficulties of life, they should have the chance to address them using a language that truly connects with their personal experiences. Adapting and translating therapeutic modules to align with cross-cultural settings is important to ensure effectiveness and practicality among different populations. The objective of this article is to provide the guidelines for the process of cross-cultural adaptation and translation-back-translation of the therapeutic modules, and also provide the guidelines to test the reliability and validity of the translated version of therapeutic modules.

Methods: The Back-to-Back translation model (10) was used in this study for the guidelines of adaptation and translation of therapeutic modules. Following the instructions in this document made the process of adaptation and translation simpler.

Results: Results showed that the (10) is a significant model and provided a systematic and comprehensive way for adaptation and translation of therapeutic module with make little changes in reaction to feedback and cultural awareness.

Conclusion: At the end, it emphasised how important it is to conduct an extensive study to determine the effectiveness and cultural compatibility of the updated modules. However, these principles ultimately enhance effective and inclusive health care, providing health professionals with a foundation for adapting and translating therapeutic processes to diverse cultural conditions.

Background: Accurate and comprehensive documentation during emergency admissions is crucial for ensuring patient safety. This is especially important in high-risk environments such as neurosurgery. Traditional freehand clerking methods often result in incomplete or inconsistent records, potentially compromising patient care. This study aimed to evaluate the impact of introducing a structured surgical clerking proforma on the quality of emergency admission clerking in a tertiary care neurosurgery unit.

Methods: A three-phase comparative audit was conducted, comprising an initial audit of traditional clerking methods (Cycle 1), the implementation of a surgical clerking proforma, and a subsequent re-audit using the proforma (Cycle 2). Data were collected retrospectively from 40 patient records in Cycle 1 and prospectively from 30 patient records in Cycle 2. The completeness of documentation was assessed across 31 key parameters, and statistical significance was determined using paired t-tests on simulated data.

Results: The introduction of the surgical clerking proforma resulted in significant improvements in documentation completeness, particularly for parameters such as the Consultant Responsible and Reviewing Doctor, which saw increases of 30% and 32.5%, respectively (p<0.05). These improvements underscore the effectiveness of the proforma in standardizing and enhancing the reliability of clinical documentation.

Conclusions: The structured surgical clerking proforma significantly improved the quality of emergency admission documentation in the neurosurgery unit. The findings support the broader adoption of such proformas across various medical specialties to enhance the accuracy, consistency, and reliability of clinical records, ultimately contributing to improved patient care and safety.

Background: Basal cell carcinoma (BCC) is the most common skin cancer. Its annual incidence in US is 2 million per year with an increase of 0.87%. The objective was to report intraoperative frozen section clearance rate of tumour margins and depth for excised basal cell carcinoma in a tertiary care centre and find the frequency of tumour in surgical margins with respect to location, size, and surgical reconstruction technique.

Methods: It was a prospective open-label interventional study conducted at the Dermatology department of tertiary care hospital Rawalpindi (Pakistan) in liaison with the histopathology department from January 2023 to April 2024. The patients with clinical diagnosis of basal cell carcinoma, of 10-35 mm located on the face were included as per inclusion/ exclusion criteria. An intraoperative frozen section for tumour margins and depth was taken from a histopathologist. The surgical defect was reconstructed after the negative report. p-value of <0.05 was considered significant for margin involvement, surgical technique, and location.

Results: A total of 36 patients of BCC were enrolled. Tumour-free margins and depth were attained in 77.77% of cases. Tumour excision with a frozen section concerning surgical technique had a chi-square p-value ≤0.51, location ≤0.24, and size ≤0.84.

Conclusions: Intraoperative frozen section for basal cell carcinoma is a reliable technique for complete tumour excision. This technique is resource-intensive and time-consuming. It should be reserved for tumours at high-risk sites, and require complex reconstruction. Patients should be educated for follow up in case of induration, morphological changes, or new developments in surgical scar.

Background: Scars are inevitable after effect of wound healing, a natural process that restores tissue integrity following injury, burns or surgery. They can be aesthetically displeasing and functionally impairing, depending on their location, size, and depth. Depending on the severity of the injury, scars can be hypertrophic, atrophic, or keloid. These variations can lead to pain, itching, contractures (limited movement), and psychological distress, impacting a patient's quality of life. Objective was to evaluate the efficacy of autologous fat grafting in improving the appearance and quality of scars, with a focus on patients presenting with facial scars due to burns, trauma, surgery or acne at a tertiary care hospital in Karachi, Pakistan.

Methods: In this quasi-experimental study, 30 patients of age 18 years to 60 years, irrespective of gender having facial scar because of burn, trauma, surgery or acne were included in the study. A comprehensive scar assessment was performed using the Patient and Observer Scar Assessment Scale (POSAS) before treatment, and follow-up evaluations were conducted on the seventh day, at three months, and at six months post-fat grafting. Fat grafting was executed using a tumescent technique based on Klein's formula, with the aspirated fat injected into the subdermal plane of the scar. Data analysis was performed using SPSS version 23.

Results: The patient cohort had a mean age of 26.77 years, with a predominance of female participants (73.3%). Trauma was the most common cause of scars (50%), with the forehead being the most frequent location (36.67%). Significant improvements in scar quality were observed, with both patient and observer POSAS scores showing notable reductions from baseline to 6 months (p<0.05). All patients (100%) demonstrated an improvement in scar appearance.

Conclusions: Fat grafting presents a promising treatment for improving the appearance and quality of facial scars.

Background: The aim was to assess the clinical outcome of non-anatomic rotator-cuff repair in large tears not amenable to anatomic repair and to assess the preoperative factors that affect the result of such repairs. A retrospective case-series at Ghurki Trust Teaching Hospital, Lahore. Twenty-seven cases that underwent non-anatomic rotator-cuff repair at GTTH over the last 5 years and met inclusion criteria were assessed over a three-month study period (from 01/10/2023 to 31/12/2023).

Methods: Outcome was assessed in terms of improvement in pain as per visual-analog-scale (VAS), UCLA, as well as Constant score. Furthermore, patients' satisfaction was also assessed to measure subjective efficacy of the procedure.

Results: Most commonly cases of rotator cuff tear present with pain, weakness, and restriction of shoulder range of motion. Pain improved significantly (p<0.001) from preoperative score of 3.68 to 1.45. Analysis of the objective assessment showed statistically significant (p=001) improvement in Constant score from a preoperative average score of 63.63 to a postoperative average of 77.27, with significant improvement (p=0.05) in each individual scoring criteria as well. The other scoring studied: UCLA also improved significantly (p=0.001) from 25.36 to 30.18. Despite this, on subjective assessment 40.9% of the sample was very satisfied and 27.3% were satisfied with the outcome.

Conclusions: Non-anatomic repair is very effective at treating the presenting complaints of the rotator cuff tear patients. Thus, alongside good clinical outcome, patient satisfaction can be predicted after the procedure.

Background: Many drugs have been associated with hepatotoxicity worldwide. This hepatotoxicity occurs due to oxidative stress generated by those drugs. Hence, different plants, which have antioxidant effects, can be used to prevent hepatotoxicity. The objective was to find out the hepatoprotective effect of mint, against chloroquine induced hepatotoxicity, due to its antioxidant potential.

Methods: For that randomized controlled trial study, ninety male albino mice were obtained and were divided randomly into three groups, with each group containing 30 mice. Group A was the control group. So, no intervention was done on mice of Group A. Group B and C were the experimental groups. Group B mice were given chloroquine only. The mice of Group C were given both chloroquine and mint extract. The single oral dose of chloroquine, 970 mg/ kg of body weight, was given to the mice of group B, on the 9th day of the experiment. The ethanolic extract of mint, at the dose of 1 gm/kg, was given consecutively from day 1 to day 8 of the experiment to Group C mice. Then chloroquine (970 mg/kg of the body weight) was given on nineth day to Group C. The ethanolic extract was then continuously given from day 10 to day 16 of the experiment, followed by chloroquine administration, to those mice. The blood samples were collected on 17th day by terminal intracardiac sampling technique. Data analysis was done by SPSS version 20.

Results: Group B mice showed highly significant rise in serum ALP and significant decrease in serum albumin, as compared to those of group A. Serum AST and ALT, however, raised insignificantly. Hence, mild hepatotoxicity was induced in group B mice. On the other hand, malondialdehyde, was found to be highly significantly raised in group B mice. While, serum glutathione peroxidase was found to be declined highly significantly in group B mice, which showed oxidative stress induction. The mice of group C showed highly significant decrease in serum ALP and significant decline in serum AST. They showed significant raise in serum albumin. Serum malondialdehyde, however, declined highly significantly and serum glutathione peroxidase raised highly significantly in group C. These results in group C occur due to antioxidant action of mint.

Conclusions: Mint revealed hepatoprotective effect due to its antioxidant potential, against chloroquine induced mild hepatotoxicity.