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

Background: Acute renal colic is a common acute urologic conditions often caused by urolithiasis. However, diagnosis of obstruction due to urolithiasis sometimes becomes difficult especially when there is an insufficient dilation of urinary tract proximal to obstruction. In these situations, intrarenal artery doppler assessment may be utilized as a diagnostic modality.The aim of this study to evaluate intra-renal arterial Doppler parameters in patients presenting with unilateral acute renal colic, comparing obstructed and non-obstructed kidneys.

Methods: This case controled study was done at Azeem Ultrasound and Xray Center and was completed in 6 months from 12-12-2023 to 11-06-2024. Sixty individuals were included in the study. Pelvicalyceal system dilatation was examined in each kidney using USG images. For the evaluation of inter-lobar arteries, a minimum of 3 doppler spectra were taken, and their mean was calculated. Resistiv index (RI) was measured using the standard formula, and the mean RI value was determined for each kidney.

Results: The resistive index was elevated in the obstructed group (0.72±0.10) versus the unobstructed group (0.63±0.07; p<0.001). The predictive accuracy showed a sensitivity of 70.0%, a specificity of 86.67%, a postive pridictive value (PPV) of 78.97%, and an negatieve predictiev value (NPV) of 80.15%.

Conclusions: The comparison of Doppler indices between obstructed and unobstructed kidneys in patients with urolithiasis reveals significant differences. Elevated RI and PI values, along with increased PSV, highlight that hemodynamics is altered in the presence of renal obstruction. These findings support the use of Doppler ultrasound as a valuable diagnostic tool, helping in the timely identification and management of obstructive uropathy.

Background: The Office of Research, Innovation, And Commercialization (ORIC) of the Health Services Academy in Collaboration with the Punjab Employees Social Security Institution (PESSI) and the German Corporation for International Cooperation (GIZ) organized and conducted a 2-day training workshop on "Healthcare Financing". This was intended to learn about healthcare finance by analyzing government regulations, private companies, and international collaboration. Explore various funding sources for healthcare, observe how healthcare operates around the world, and devise effective money management strategies so that healthcare can expand and benefit everyone.

Aims: This paper reports on the training program, which aims to train healthcare providers on the concepts of healthcare financing and build their understanding and knowledge of healthcare systems, models, and implementation of intelligent financing strategies for sustainable financial growth and organizational success.

Methods: A team of experts developed the curriculum and its accompanying material. Initial training was given to the healthcare providers of all participating institutions. Staff from public and private hospitals enrolled in the training and other frontline healthcare workers were invited. Four types of educational material were produced and used; a guidance booklet, a training video, and a set of PowerPoint presentations to explain the HCF and its importance.

Results: A 2-day training workshop was conducted in which the pre- and post-knowledge regarding the HCF of all the participants was assessed. All the participants belonged to public health fields and all of the participants were public health experts.

Conclusions: With limited resources and in a short period, the ORIC with the collaboration of PESSI and GIZ trained a good amount of healthcare workers to address the complex challenges and opportunities within the industry and key aspects of healthcare financing, from the evolving payment mechanisms and emerging trends to the global perspective on funding health initiatives.

Background: Ewing sarcoma is a rare and aggressive bone or soft tissue cancer that primarily affects children and adolescents. Estimated incidence of Ewing sarcoma is reported to be 1.2-2.9 in one million individuals in England and 1 in one million in the US. Objective of the study was to determine the pattern, and influence of gender and age on chemotherapy-induced toxicities in children with Ewing sarcoma. This descriptive case series was carried out at the Department of Paediatric Oncology, CMH Rawalpindi, from January 2014 to June 2023.

Methods: Children of either gender aged less than 18 years and diagnosed cases of Ewing Sarcoma were enrolled. All patients were given VIDE (vincristine, ifosamide, doxorubicin, etoposide) chemotherapy and patients were observed for chemotherapy induced toxicities. Chi square test was used to analyze significance of age and gender on toxicity.

Results: In a total of 59 children 35 (59.3%) were male and 24 (40.7%) females. Out of these 11 children expired. The mean age was 7.59±3.87 years. Younger age was strongly associated with higher occurrence of toxicity specifically children under 5 years being most affected (p<0.05). Neutropenia, nausea and vomiting, thrombocytopenia, and diarrhoea were the most frequent adverse events observed in 53 (89.9%), 37 (62.7%), 36 (61.0%), and 36 (61.0%) patients respectively. There was no association of gender with chemotherapy induced toxicity. Neutropenic sepsis and diarrhoea were positively associated with mortality in the 11 children who expired (p<0.05).

Conclusions: Neutropenia, nausea and vomiting, mucositis, thrombocytopenia and diarrhoea were the most frequent chemotherapy induced toxicities in children with Ewing sarcoma. Younger children specifically under 5 years have a higher chance of chemotherapy induced toxicities however gender did not seem to influence related toxicities. Neutropenic sepsis was the major predictor of mortality warranting higher vigilance and aggressive management of infections.

Background: Labial gingival recessions are a common periodontal condition characterized by the apical migration of the gingival margin, which can impact dental aesthetics and health. The proclination of mandibular incisors following orthodontic treatment has been implicated as a contributing factor to the development or exacerbation of such recessions. This study investigates the relationship between post-treatment incisor proclination and the occurrence of labial gingival recessions to perform clinical strategies for minimizing periodontal complications. Objectives were to evaluate the relationship between the mandibular incisor's proclination and the emergence of gingival recession.

Methods: After obtaining ethical committee approval, this prospective cohort study was conducted at the Department of Orthodontics, Frontier College of Dentistry from March 2019 to March 2024, involving 180 participants that met the inclusion criteria and followed up after one year. Assessments included clinical crown height measurements, gingival recession presence, and cephalometric analysis. Crown heights were measured on plaster models at TS, T0, and T5 with an electronic caliper. Recessions were noted at T5 if the labial cement enamel junction was exposed. Cephalometric radiographs marked specific landmarks to assess incisor inclination at TS, T0, and T5. Participants were grouped based on post-treatment incisor inclination: <95°, 95°-100.5°, and >100.5°, with further analysis focusing on the non-proclined (<95°, N=60) and proclined (>100.5°, N=60) groups.

Results: The mean age of all the patients were 36.99±10.7 years. The mean elevation in clinical crown heights from T0 to T5 for mandibular incisors showed a range of 0.79 to 0.87 mm in the non-proclined group and the proclined group, respectively, with no significant P-value. The mean increase in clinical crown heights for the lower incisors post-treatment (from T0 to T5) varied from 0.58 mm to 1.32 mm in the Proclined group and 0.64 mm to 0.89 mm in the non-proclined group.

Conclusions: It was concluded that the inclination of mandibular incisors did not pose an elevated risk for the occurrence of gingival recession during a five-year observation period when compared to non-proclined teeth.

Leiomyosarcomas originating in the inferior vena cava (IVC) are rare vascular tumours characterized by gradual growth and subtle onset. The challenges associated with these tumours stem from their unfavourable prognosis and the absence of established treatment protocols. We present a case of a 52-year-old woman who presented with abdominal pain and was subsequently diagnosed with leiomyosarcoma in the second segment of the IVC. This case highlights the significance of adopting a multidisciplinary approach and emphasizes the necessity for timely identification and intervention in IVC leiomyosarcomas to improve patient outcomes. To our knowledge, this is the first reported case of leiomyosarcoma in the IVC from Pakistan. We believe this case will contribute valuable insights to the existing knowledge on the subject.

Background: The occurrence of a single beta thalassaemia allele is frequently related with microcytic hypochromic red blood cells and a rise in HbA2 levels. In some beta thalassaemia carriers, the outcome of this allele or its collaboration with other acquired or genetic defects may result in normal or borderline Haemoglobin bA2 levels. Objective was to establish the importance of molecular analysis in borderline HbA2 individuals and its significance in a population screening program.

Methods: It was a cross-sectional study conducted over a period of six months, from July-December 2023. All 123 individuals with borderline HbA2 levels between (3‒3.9%) diagnosed by High-performance liquid chromatography (HPLC)/Capillary Zone Electrophoresis underwent molecular testing using multiplex amplification refractory mutation system-Polymerase Chain Reaction (ARMS-PCR) to detect common beta thalassaemia mutations: Fr8-9, IVS1-5, Fr41-42, Cd15, Cd5, IVS1-1, IVS1-1, Cd30, Cd30, Fr16, IVSII-1, Del619, and CAP+1 in the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi .Statistical tests were applied to compare Red Blood Cell indices and Haemoglobin A2 values among beta thalassaemia carriers and non-carriers.

Results: Among those tested, 47.1% (n=58) were found to carry Beta thalassaemia mutations. The most prevalent mutations were IVS1-5 (n=19,15.4%) and Fr8-9 (n=19,15.4%) followed by Fr41-42 (n=08,6.5%). Subjects with mutations exhibited significantly lower mean corpuscular volume and mean corpuscular haemoglobin compared to those without mutations (p-value= <0.001). Beta thalassaemia mutations were seen more frequently when HbA2 was in range of 3.5-3.9% (n=37,63.8%), as compared to HbA2 that was 3-3.4% (n=21,36.2%) and this difference was found to be significant (p-value= <0.001). The CAP+1 mutation was associated (n=02,1.6%) with normal mean MCV and MCH compared to other identified mutations.

Conclusions: It is concluded that molecular study for the common beta thalassaemia mutations in Pakistani population plays a pivotal role in confirmation of borderline HbA2 thalassaemia carriers, specifically in areas with a high prevalence of the disease. Molecular testing for beta thalassaemia should be offered to all individuals with borderline HbA2 with values especially between 3.4‒3.9% and having microcytic hypochromic indices.

Background: There is significant discussion over the most effective surgical approach for treating lumbar spondylolisthesis, despite the recommendation of a number of surgical approaches. The aim of this study was to explore the Outcomes of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in managing single-level lumbar spondylolisthesis.

Methods: the current study was conducted at the department of orthopaedic and neurosurgery at Hayatabad Medical Complex, Peshawar from January 2022 to February 2023 after taking approval from the ethical committee of the institute. Those individuals who had experienced a single-level condition with a low-grade categorization (grades I or II) in the Meyerding grading system were included in the study. A total of 52 patients were enrolled in this study and were divided in to group A and B. 26 received PLIF, and were placed in group A while 26 had done TLIF and were placed in group B. The two groups' mean operating times, blood loss, VAS scores for back and leg discomfort, and complications were compared.

Results: A total of 52 individuals were enrolled in this investigation, distributed evenly into two groups. The mean age of the participants was 35.14±7.76 years. Out of 52 patients male were 30(57.6% and 22(42.30) were females. Patients in group B underwent TLIF while patients in group A got PLIF. With respect to the results for the two groups, individuals in the group A had mean operative time 126.44±12.03 minutes and Group B had a considerably shorter duration of 113.32±8.48 minutes (p<0.05). In group A, the average blood loss was 440±76.33 cm3 but Group B experienced a much lower value of 371.40±39.2 cm³ (p<0.05). Concerning postoperative VAS leg pain, there was no difference between the two groups (p>0.05) while group B experienced considerably less postoperative pain in the back on the VAS than group A did (p<0.05). Dural tear was noted in 4 participants in group A, while 2 in group B. 3 patients in group A experienced a neurologic impairment, but in group b there was no neurologic deficit noted. 3 individuals in group A experienced wound infections, whereas none of the patients in group B did.

Conclusions: Based on our research, TLIF is better than PLIF in terms of functional result and rate of complications in patients with grade I/II single-level lumbar spondylolisthesis.

Background: Antibiotic resistance is on an increasing trend, particularly in gram-negative bacteria. The production of metallo β-lactamase (MBL) puts the health sector at great risk as it further limits the treatment option for MDR strain. The current study aims to determine the prevalence, antibacterial sensitivity pattern, and molecular characterization of MBL in Uropathogenic E. coli from clinical samples of hospitalized patients in Khyber Pakhtunkhwa.

Methods: From tertiary care hospitals in Peshawar, 250 Urine samples were collected from indoor hospitalized patients. Gold standard microbiological methods were used to identify UPEC from these clinical samples.For that,urine samples was inoculated onto Cysteine Lactose Electrolyte. Deficient (CLED) agar plate, and MacConkey Agar.Positive growth of E. coli identified through Gram staining, colony morphology, Biochemical Tests and E.coli 16srRNA gene amplification .Antibiotic sensitivity was determined by the disc diffusion method on Muller Hinton agar. For the detection of MBL production double disc synergy, and a combination disc test of the antibiotics were used. Furthermore, multiplex PCR was used for the molecular characterization of the MBL (blaIMP, blaVIM, and blaNDM) genes.

Results: Of the 250 samples, only 110 samples were confirmed as Uropathogenic E. coli based on colonial morphology, biochemical testing, and molecular level by targeting the 16SrDNA. Female was found more susceptible to UTI compared to male. High prevalence was found in the age group 45-65 years. UPEC was found highly resistance to Ciprofloxacin (90%), followed by Cefotaxime and Ceftriaxone (86%), Ceftazidime and Augmentin (81%), Tazobactam (61%). while the lowest resistance was reported against Meropenum (20%) Imipenem (18%) and Amikacin (37%). PCR-based confirmed prevalence of MBL encoding genes was blaNDM (42%), blaVIM (32%), and blaIMP (26%).

Conclusions: The study proposed a higher prevalence of urinary tract infections (UTIs) in females aged group 54-65 years compared to males. An analysis of antibiotic sensitivity revealed Imipenem and Meropenem to be the most effective antimicrobial agents, while Ciprofloxacin, Cefotaxime and Amoxicillin were found to be the less effective. UPEC were found highly resistance to Ciprofloxacin 91%, and ceftazidime 86%, while comparatively less resistance to meropenem, and imipenem,20% and 18% respectively. Genotype BlaNDM of the MBL is highly prevalent (42%) among UPEC.Furthermore, the presence of MBL genes was detected in over 19% of UPEC, and in different combinations.The upraise of the MBLs resistance in uropathogenic E. coli is an alarming sign for clinicians to decide on treatment options for complicated UTIs.

Amphetamine abuse leads to severe psychiatric and cardiovascular complications-psychosis, hallucinations and aggressive behavior. A 34-year-old male of five years noted history of amphetamine abuse and presented with amphetamine psychosis characterized by hallucinations, violent ideations and a recent suicide attempt is described in this case report. Previously under the influence of amphetamines, two years prior, the patient committed homicide. Patient had periods of very severe disorientation and agitation, history of suicidal ideation and violent thoughts toward others. Toxicology screenings were done, all were consistent with amphetamine presence. Diagnostic studies included cardiac biomarker elevations and abnormal electrolyte levels. Management was immediate and involved sedation, antipsychotic therapy and cardiovascular support, followed by long term psychiatric care and substance abuse rehabilitation. Here, chronic amphetamine abuse is shown to have profound psychiatric and behavioral effects and to require integrated treatment strategies to meet the complex needs of such patients.

Background: Acute coronary ischemia is one of the most fatal cardiovascular events, presenting with tremendously high morbidity and mortality, especially in cases involving a completely occluded artery, leading to acute myocardial infarction (AMI). The study aimed to ascertain the efficacy and safety of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors in Pakistani patients who present late for thrombolysis or primary percutaneous coronary intervention (PCI).

Methods: The trial was conducted at a tertiary care hospital in Islamabad, including 200 patients, with GP IIb/IIIa inhibitors used in 40% of infarct-related artery (IRA) cases.

Results: The analysis revealed that GP IIb/IIIa inhibitors reduced major adverse cardiac events (MACE) by 9%, recurrent myocardial infarction (MI) by 7.5%, and improved thrombus resolution by 25%, as well as myocardial salvage by 12%. However, there was a higher rate of bleeding complications (p<.05) associated with their use. No other significant adverse events, such as in-hospital mortality, length of stay, or renal complications, were identified.

Conclusions: These results suggest that GP IIb/IIIa inhibitors should not be used as a one-size-fits-all therapy. Proper patient selection, along with robust monitoring under dose-adjusted Eptifibatide or Tirofiban infusion regimens to target coagulation levels appropriately, is crucial. Although this treatment could be valuable in managing AMI, particularly in regions where advanced cardiac care is less accessible, further large-scale, multicenter studies are needed to determine its long-term safety and efficacy. This study provides a framework for further investigations into the use of GP IIb/IIIa inhibitors in similar patient populations.