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

Background: Typhoid is a major health concern. Drug-resistant cases of typhoid have given rise to new debates. Azithromycin has shown adequate results. The study is designed to determine the clinical efficacy of oral azithromycin versus other antimicrobial drugs in typhoid patients.

Methods: The studies included in the systematic review are randomized controlled trials, comparing the clinical efficacy of azithromycin to other antimicrobial drugs on typhoid patients. We searched 1180 articles from Google Scholar, PubMed Central, Cochrane Library, PLOS ONE, and JSTOR on 16th October, 2023. The risk of bias was analyzed by visualizing the funnel plot, Begg's and Egger's test, and plotting risk of bias graphs. Forest plots are created to display the findings.

Results: We identified 14 research articles (1556 participants). Odds ratios of the treatment outcomes were extracted. In a forest plot, the overall effect of the treatment outcome (CI=95%) of azithromycin, in comparison to fluoroquinolones appeared to be favourable (Random Effect Model (REM)=2.15, heterogeneity: I2=37%, τ2= 0.1729, p=0.15, the overall pooled effect was towards right side). Compared to chloramphenicol, azithromycin showed a high odds ratio (1.23). However, there was no difference in outcome among ceftriaxone and azithromycin groups (REM=0.67, heterogeneity: I2=0%, τ2=0%, p=0.78, the overall pooled effect touched the no-effect line).

Conclusions: Azithromycin is more clinically efficacious than fluoroquinolones and chloramphenicol. The drug has fewer documented relapses in comparison with other antimicrobial drugs. Fever clearance time of azithromycin is greater than ceftriaxone and chloramphenicol.

Garre's osteomyelitis is a rare form of chronic osteomyelitis characterized by sclerosing and periosteal reaction of the affected bone. We report a case of a 35-year-old woman who presented with left tibial pain and swelling for 18 months. She was diagnosed with Garre's osteomyelitis of the mid-shaft tibia based on radiological and histopathological findings. She underwent curettage, biopsy and culture of the lesion, which revealed oxacillin-sensitive staphylococcus species. She was treated with targeted antibiotics and showed clinical improvement. This case highlights the importance of considering Garre's osteomyelitis in the differential diagnosis of chronic tibial pain and the role of curettage and antibiotics in its management.

Background: Approximately 25% of all recognized pregnancies result in foetal loss. Women who will experience two consecutive foetal loss is less than 5%, while loss of three or more consecutive pregnancies in the first trimester, termed as Recurrent foetal loss (RFL), occurs in 1% of all pregnancies. RFL is often associated with cousin marriages. Keeping in view the social and psychological burden associated with RFL, it deems necessary to conduct further studies, to clear this ambiguity about the adverse effect of consanguinity on the foetal loss. The study was done with the objective to ascertain association of consanguinity with recurrent foetal loss.

Methods: A total of 432 individual were recruited in this case control study (216 each in case and control groups) and was conducted at the Armed Forces Institute of Pathology (AFIP) Rawalpindi. The Cases consist of women having recurrent foetal loss while controls were women who do not experience recurrent foetal loss.

Results: The Cases had mean parity level of 5.13 while controls 4.02. The difference in parity level of both cases and controls was statistically significant. The mean live births for all the participants were 2.35±1.915 ranging from 0-7. The cases had 0.72 mean live births while controls had 3.98 mean live births. The cases and controls were compared for consanguinity, i.e., if they had a blood relationship with their husbands. 67 (31.01%) of the cases had consanguinity while 62 (28.70%) of the controls had consanguinity. There was no statistically significant difference among cases and controls in terms of consanguinity.

Conclusions: Although our study does not show any significant harmful effect of consanguinity on foetal outcome, however more in-depth research is required to look for genetic loci which are contributing to the causation of RFL, especially those inherited recessively, since homozygosity is increased in consanguinity.

Background: Germs may infect an injured site via the tissues when the host's systemic and local defences are compromised. Pus discharge may be a sign of a significant wound infection, requiring a follow-up operation to ensure sufficient draining. Additionally, generalized symptoms may appear, and returning home may need to be postponed. Objective was to identify the prevalence of post-operative wound infections among orthopaedics patients with surgical implant tertiary care hospitals.

Methods: A cross-sectional study was conducted at a tertiary care hospital from July to December 2023, involving 180 patients with closed long bone fractures. The patients were immune-competent, not diabetic, and older than 10 years. All patients underwent surgery using implants, with general anaesthesia and a third-generation cephalosporin prophylactic antibiotic. Patients were monitored monthly for 6 months to monitor infection symptoms. Cultures were obtained from wound discharges, and patients experienced perioperative fever for two days following surgery. Data was collected and analyzed using the SPSS 22 version. The study aimed to improve the management of bone fractures.

Results: A total of 180 patients were selected for the current study including both males (65.60 %) and females (34.4 %) with closed fractures. Most of them were above 31 years of age, furthermore, 20.5 % and 24.4 % of them were 41-50 as well as above 60 years of age. 13 (7.22 %) of them had developed them post-operatively. 0.76 % had pre-operative stays in the hospital for more than 10 days. Staphylococcus aureus was the most frequent 5 (38.6 %) bacteria. 6 (46.15 %) were managed by frequent irrigation along with 4 (30.76 %) by the administration of antibiotics.

Conclusions: Post-operative infection is one most troublesome complication among implanted patients. in the current the prevalence of post-op infection is 7.22% which is comparable in developing nations, but far higher than that in developed countries. As a result, it should be managed with early detection and treatment, as well as by eradicating the prevalent causes of wound infections following surgery that the present research identified.

The flocculus, a small and distinct region of the cerebellum, plays a crucial role in coordinating eye movements, especially in stabilizing visual images on the retina during head movements. Damage or lesions in the flocculus can lead to a specific neurological syndrome called floccular syndrome. This syndrome is characterized by abnormalities in the vestibulo-ocular reflex (VOR), which helps coordinate eye movements with head movements to maintain clear vision. Progressive ataxia, particularly affecting the flocculus, combined with vestibulo-ocular reflex abnormalities, strongly suggests the presence of paraneoplastic cerebellar degeneration. In our case study, we described the clinical presentation of a middle-aged woman who experienced gradually worsening dizziness and ocular issues. Due to the subacute onset of cerebellar symptoms and normal neuroimaging evidence of cerebellar atrophy, we initiated a paraneoplastic workup, revealing positive anti-Yo antibodies. This prompted consideration of the diagnosis of PCD with floccular syndrome. The patient underwent steroid therapy, resulting in partial symptom improvement. Despite thorough investigations for hidden malignancies, no occult tumour was found. Our case report aims to underscore the rare and distinct features of PCD, as observed in this particular patient.

Hydrometrocolpos (HMC) is a rare pediatric condition characterized by significant enlargement of the uterus and vagina due to the accumulation of fluid, generally caused by a blockage in the lower vagina. This disorder typically presents in newborns with the retention of normal genital tract secretions. The following case report highlights the clinical features, diagnostic process, and treatment of HMC in a newborn. A 3-day-old female presented to the emergency with dehydration, inability to pass stool, and feeding difficulties. Upon physical examination, dehydration and abdominal distention was observed. Initial treatments included hydration and antibiotics. Further investigations confirmed hydrocolpos, leading to an HMC diagnosis due to a congenital blockage in the reproductive tract. A pigtail catheter was used to drained 20ml fluid from the uterus and vagina. Significant clinical improvement as observed. After careful monitoring and treatment, including fluid management and nutritional support, the neonate was discharged on a full oral feed regimen, with plans for long-term nephrology follow-up. Conclusions: Early recognition of HMC is essential to prevent critical complications such as urinary obstruction, renal impairment, and potential rupture of the HMC. The clinical manifestations of HMC correlate with the degree of pressure exerted on adjacent organs, commonly causing hydronephrosis and abdominal swelling.

Background: The evolution of reconstructive surgery techniques has significantly improved the management of soft tissue defects across various anatomical regions. In 1972, McGregor et al. devised a pivotal method for generating a flap to cover hand defects. The benefits of this technique, which include a larger skin surface without the need for microsurgery and yielding an easily concealed donor site scar, quickly became a cornerstone in the field, evidencing its widespread acceptance and application. Objective was to compare outcomes such as wound infection, skin flap necrosis and hospital stay between primary closure and tensor fascia lata flap for the reconstruction of groin defects among patients presenting at tertiary care hospital, Karachi, Pakistan.

Methods: It was a prospective observational study carried out at the Department of plastic surgery, Dow University of Health Sciences, Civil hospital, Karachi, Pakistan from 23rd August 2023 to 25th January 2024. Patients who had groin defects after trauma or excision of lymph node of age 20-80 years of either gender were included and divided into two groups. Group A (n=30) had patients who had primary wound closure, while Group B (n=30) had patients who underwent a tensor fascia lata flap procedure for wounds coverage. Both groups were compared in terms of wound infection, skin flap necrosis, and hospital stay following surgery after 4 weeks. Data was analyzed using SPSS version 23.

Results: The overall average age of participants in the study was 35.7±11.18 years. Of 73.3% participants were male and 26.7% were female. Group B (TFL flap reconstruction) demonstrated significantly lower rates of wound infection (p=0.001) and skin flap necrosis (p=0.001) compared to Group A (primary closure). Additionally, the average hospital stay was significantly shorter for Group B than Group A (p=0.001).

Conclusions: TFL flap reconstruction for groin defects significantly reduces postoperative complications, including wound infection and skin flap necrosis, and shortens hospital stays compared to primary closure.

Background: Regadenoson is highly selective A2A adenosine receptors agonist used for stress myocardial perfusion scintigraphy. This study presents our initial experience utilizing Regadenoson as a myocardial perfusion stress agent, aimed to assess the safety of Regadenoson for stress myocardial perfusion scintigraphy.

Methods: Following Institutional Ethical Review Borad approval, adult patients presenting for myocardial stress perfusion scintigraphy were included using non-probability consecutive sampling. Exclusions included second or third-degree AV block, unstable angina, recent myocardial infarction, severe hypotension, or significant heart failure. Demographic data, co-morbidities, vitals, and adverse events were recorded.

Results: Sixty-three patients were included, predominantly male (63.5%), with a mean age of 56.81±12.95 years. Hyperlipidaemia was the most common co-morbidity (47.6%). Systolic and diastolic blood pressure decreased acutely but normalised by 60 minutes. No serious adverse effects occurred, though transient ST segment depression was noted in 8.3% of patients. The most common adverse effects were dyspnoea (23.8%) and headache (21.4%).

Conclusions: Regadenoson is associated with transient haemodynamic changes and non-serious transient adverse effects.

Background: Evaluation of opening pressure (OP) of CSF on lumbar puncture (LP) is an invasive procedure for the confirmation of diagnosis of idiopathic intracranial hypertension (IIH). Sonographic optic nerve sheath diameter (ONSD) measurement is a non-invasive method which can help in the estimation of intracranial pressure (ICP). The study was carried out to find out the correlation between ONSD and OP on LP in patients of IIH.

Methods: The Cross-sectional study was hosted by medical teaching institute, Gajju Medical College, Swabi and Frontier institute of Ophthalmology, Peshawar, from 1st June, 2021 to 31st May, 2023.Total participants were 50, 25 in Group A having diagnosis of IIH and 25 in Group B as control group from general population. The patients in Group A had ONSD assessment followed by measurement of OP and then the process was repeated at two weeks follow up. Participants in Group B had only one assessment of ONSD. Correlation between ONSD and OP was determined. Best cut-off-value for raised ICP was calculated.

Results: The mean ONSD was 5.91±0.63 in Group A and 5.07±0.50 in Group B (p=0.00). The mean OP in Group A was 31.64±3.81 cm H2O initially. The mean ONSD and OP at follow up were 5.18±0.42 and 19.64±3.52 cm H2O respectively. The best cut-off-value was 5.60 mm of ONSD for estimation of raised ICP (sensitivity 88% and specificity 88%).

Conclusions: Sonographic ONSD has a positive correlation with OP on LP in IIH patients and can be used as a non-invasive tool for the assessment of ICP in IIH patients.

Immune mediated necrotising myopathy (IMNM) is a rare autoimmune disease of the muscles belonging to the subset of the idiopathic inflammatory myopathies (IIM). This disease entity has classically been associated with myositis specific antibodies. The hallmark feature in clinching the diagnosis of IMNM would be a muscle biopsy showing muscle necrosis and regeneration in the absence of significant inflammatory infiltrates, interpreted in an appropriate clinical context. The term 'neuromyositis' was previously coined in the year 1893 to describe a concomitant polyneuropathy in patients with polymyositis or dermatomyositis. However, a combined polyneuropathy with IMNM has never been reported in previous literature. We describe a case of a 35-year-old gentleman who presented with a 5-day history of symmetrical bilateral lower limb pain and weakness. Despite a negative autoimmune work-up, his muscle biopsy was suggestive of IMNM. A nerve conduction study done had also revealed a superimposed non-length dependant axonal polyneuropathy. The patient had responded well to steroids and is now under remission. This case serves to highlight a rare entity of seronegative IMNM superimposed with an axonal polyneuropathy.