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

Background: Amphetamine use disorder (AUD) is a public health concern on a global scale and is a rising epidemic in Pakistan. Cognitive Behavioural Therapy (CBT) is a well-established treatment for substance use disorders, but its efficacy may be dependent on what is known as socio demographic and behavioural variables. The aims of this study are to provide evaluation of efficacy of CBT for AUD in Pakistani population and to find whether the presence of factors like education, job, duration of addiction, residence, age, family support, smoking and alcohol intake may affect treatment outcomes.

Methods: A quasi-experimental design was applied with 100 participants recruited from outpatient treatment centers and rehabilitation centers in Pakistan. A culturally adapted CBT program was delivered to 50 participants along with treatment as usual and standard treatment as usual (TAU) was given to control group with 50 participants. Addiction Severity, anxiety, depression, psychological wellbeing, quality of life, as well as relapse rates were measured using pre-test and post-test assessments. Descriptive statistics, paired t-tests, ANOVA, multiple regression and survival analysis were completed to analyze the data.

Results: The frequency of amphetamine use from pre to post change from 5.8 to 2.3 days per week (p<0.001) and ASI, addiction severity index scores from pre to post change from 30.2 to 18.7 (p<0.001) was significant in the CBT group. On the behavioural as well as on the psychological measures, improvements were observed, as evidenced by a decrease in the BDI from 22.4 to 14.1 (p<0.001) and a decrease in the GAD-7 from 18.5 to 11.3 (p<0.001). Significantly higher Quality of Life (WHOQOL-BREF) scores improved from 45.3 to 62.0 (p<0.001). But the TAU group also got better, just not as much as the CBT group. Positive associations were found with socio-demographic factors (such as higher education, stable employment and strong family support) and negative associations with unemployment, longer duration of addiction and regular alcohol intake.

Conclusions: Both the effectiveness of CBT and its suitability to reduce amphetamine use, enhance psychological wellbeing, and improve quality of life among individuals with AUD in Pakistan were demonstrated. The significance of incorporating social demographic factors, and behavioural factors in the development of CBT interventions to ensure maximal treatment effect is underscored.

Background: Acne vulgaris is a common skin condition, involving upto 90% of the teenage population, being more common in women than in men. Post acne scars are the sequelae, leading to low esteem and self confidence in the affected individuals.

Methods: Thirty patients participated in the study. On each patient, over the left side of the face, microneedling was done using topical insulin as a medium, while on the right side of the face, simple microneedling was done. Four such sessions, a month apart, were done in all the patients. They were called for follow up and the response was based on the "Acne scar assessment scale", in which Grade-0 referred to no improvement, Grade-1 referred to an improvement of less than 25%, Grade-2 was an improvement between 25-50%, Grade-3 meant an improvement between 50-75%, and, Grade-4 referred to an improvement of greater than 75%.

Results: After completion of the sessions, over the left side of the face, where microneedling was done with insulin 11 (36.7%) patients showed Grade-2 improvement, while 19 (63.3%) patients showed Grade-3 improvement. On the right side of the face where simple microneedling was done, 10 (33.3%) patients showed an improvement of Grade-0, and 20 (66.6%) patients showed an improvement of Grade-1.

Conclusions: After this study, we conclude that microneedling combined with topical insulin, shows better results in patients with scarring. It can be a breakthrough in the treatment of post acne scars, due to easier availability and lesser cost of insulin.

Pyloric atresia is a rare congenital condition marked by obstruction of the gastric outflow because the pylorus is absent or severely narrowed. Blistering and fragility of the skin and mucous membranes are symptoms of the hereditary condition epidermolysis bullosa (EB). It is highly uncommon for pyloric atresia and epidermolysis bullosa to co-occur, and this presents substantial diagnostic and treatment difficulties. We describe a case of a newborn who was born with pyloric atresia and epidermolysis bullosa, focusing on the clinical presentation, the diagnostic procedure, and the surgical therapy. The complex interactions between these two dissimilar illnesses highlight the value of a multidisciplinary approach combining neonatologists, dermatologists, and paediatric surgeons for precise diagnosis and thorough care. By sharing this case report, we hope to add to the limited literature on this particular set of congenital defects and highlight the importance of increased clinical awareness and team-based treatment approaches when dealing with cases this complicated.

Migraine is a common clinical entity; however, its dermatological manifestations are rarely reported. We report two young Pakistani female patients with asymptomatic, linear and round erythematous non blanchable patches on their forehead that were temporally associated with their migraine attacks. The local and systemic examination as well as extensive investigations, of both the patients, were all normal. The lesion resolved within a few days following abortion of migraine attacks in these patients. With Pathophysiology of cutaneous manifestations of migraine is still unknown due to their rare presentation, research is required to establish their significance in the long-term outcome of migraine.

Background: The advent of modern technology has dramatically influenced the availability of resources for students to learn and gain knowledge as well as improve their skills.

Methods: Over six months, a randomized control trial (pretest-post-test design) was conducted at Khyber College of Dentistry, Peshawar. The aim was to compare the traditional method with YouTube learning to enhance students' diagnostic skills in lateral cephalometry and benefit the local dental community.

Results: Seventy-four participants took part, with an average age of approximately 23 years having 35.1% male and 64.9% female participants. The control group's pre-test mean score was 5.54, significantly increasing to 13.62 in the post-test. The experimental group's pre-test mean score was 4.08, significantly rising to 15.29 in the post-test. The experimental group outperformed the control group in the post-test, with mean scores of 15.29 and 13.62, respectively. Participants showed overall satisfaction with course content, materials, instructor knowledge, and YouTube learning, though opinions on class location and equipment varied, with some expressing less satisfaction in this aspect.

Conclusions: This current study signifies the use of YouTube as a teaching tool. YouTube based learning had a superior efficacy to traditional based learning for instruction of cephalometric landmarks identification.

Background: Post acne and post burn facial scarring are more common in young generation leading to disfigurement and unpleasing result. These scars have major aesthetic, functional, and social effects on the affected person. Aim of the study was to establish the role of Autologous Nanofat grafting in treating post acne & post burn facial scarring in terms of pleasing aesthetic appearance of face & patient satisfaction.

Methods: A total no. of 24 patients with mean age of 23 years was enrolled in the study. Thirteen patients were of post acne face scarring and 11 patients were suffering from post-burn face scarring. There were 10 male and 14 female patients. All patients were treated with Nanofat grafting with an average of 3 sessions at an interval of 4-6 weeks. The results were assessed after 6 months from the last session by comparison of pre procedure & post procedure pictures and patient satisfaction.

Results: Scars started improving after first session of Nanofat grafting and significant improvement in the scars was noted after 3rd session in terms of pigmentation, scar thickness and softness. Overall appearances of the scar were aesthetically improved a lot with a higher patient satisfaction rate.

Conclusions: Autologous Nanofat grafting is a potential effective treatment modality for post-acne and post burn facial scarring with a good aesthetic outcome and higher patient satisfaction rate.

Background: Prostate cancer ranks the second most frequent cancer encountered worldwide in men. Radiotherapy has been effectively used to treat localized prostate cancer. Over the years more effective radiation techniques like 3D-Conformal Radiation Therapy (3D-CRT), Proton Therapy, Intensity Modulated Radiation Therapy (IMRT), and Brachytherapy has been evolved and effectively used to deliver radiation therapy. Herein, we compare serological outcomes of two radiation treatment techniques intensity modulated radiation therapy (IMRT) and 3- dimensional conformal radiation therapy (3DCRT) in localized prostate adenocarcinoma.

Methods: It is a cohort study conducted at Department of Oncology, Dr Ziauddin Hospital, Karachi. Patients with localized prostate adenocarcinoma meeting the inclusion criteria were recruited from July 2016 to June 2022, underwent treatment with a total dose >74 Gy using two different advanced radiotherapy techniques, i.e., IMRT and 3D-CRT. Serum PSA levels were assessed prior to treatment, and 6 weeks and 12 months after treatment. Paired t-Test was applied to identify the difference in PSA levels before, and after the treatment. p-value less than 0.05 was taken as significant at 95% confidence interval.

Results: A total of 78 patients with 39 in each group. The mean age of patients in 3D-CRT group was 68±10 years while in IMRT group was 68±07 years. Six weeks after initiation of treatment, we observed that both the treatment methods, i.e., 3D-CRT and IMRT reduced the PSA levels significantly p-value = 0.001 respectively. There was no significant difference in the mean of PSA levels on 06th week and 12th months. Furthermore, the analysis of PSA levels at 12th months when compared with the baseline PSA levels came highly significant in both the groups as depicted in paired-t teat analysis of PSA levels with acceptable toxicity.

Conclusions: Radiation therapy modalities 3D-CRT and IMRT both showed a significant serological response with minimal or acceptable gastrointestinal and genitourinary toxicities in the 3D-CRT group in comparison to the IMRT group. Although the sample size is relatively smaller, but the results of this study are encouraging to treat those patients on 3D-CRT, who cannot afford more expansive radiotherapy treatment technique like IMRT.

Background: Noncommunicable Diseases (NCDs) are considered as major public health threats and contributes a high burden of diseases on health system of Thailand. Around 74% of deaths occur due to NCDs, and more than 40,000 people die annually in Thailand due to this problem. Objectives of the study were to know the blood lipid level and its determinants among university students and employees of Thailand.

Methods: This study was cross-sectional to determine the relationship between various factors with blood lipid level among university students and employees. A total 219 participants were invited and included randomly in this study. Only those respondents who had their lipid profile checked recently during one of time were included and those who had other associated diseases were excluded in this study. Chi-square and Binary logistic regression were used to assess the factors associating with blood lipid level among the study participants. Study was ethically approved from the ethical review board of university and written consent was taken prior to start the data collection.

Results: Total 219 respondents were included in this study, majority 84% were females. The mean age of participants was 26.18 (SD±9.81) years. About three-fifth (63%) had normal blood lipids, when we considering those with abnormal blood lipids, it was found that the sample group had the most abnormal cholesterol 37.44% and LDL 28.77%. Study found that only the variable of age was statistically significant in bivariate analysis. By people aged 26 and over had abnormal blood lipid 2.953 times more than those age 20-25 years. The income variable was found to have no relationship with blood lipid status at p>0.05.

Conclusion: This study concludes that the university students and employees are on high risk to develop the cardiac diseases and the factor like age has a greater impact on abnormal blood lipids.

Background: Early Onset Neonatal Sepsis (EONS) is a serious blood infection mainly microbial in nature and has worse health complications. Metabolic acidosis is one of such complications that occur due to acid-base imbalance and may result in lectic acidosis, myocardial depression, hypo-perfusion, shock and even death in severe cases. Despite of its significance, limited local literature is available in this regard. Aims were to determine frequency of metabolic acidosis in early onset neonatal sepsis among neonates presenting in a tertiary care hospital. This was cross sectional study.

Methods: Present study was conducted in department of Children's Hospital and Institute of Child Health Lahore. The data was collected through Non probability consecutive sampling from 242 neonates aged ≤72 hours of either gender diagnosed as EONS. Data was entered and analyzed in SPSS 22. For association, Chi-square test was applied and p-value ≤0.05 was considered as significant.

Results: The mean age of patients was 36.49±18.33 hours with 137(56.61%) male and 105(43.39%) female cases in this study. The frequency of metabolic acidosis was 67(27.69%) of the cases with no association with age, birth weight, gestational age and gender (p-values >0.05).

Practical implication: Even recently, no local study has published the frequency of metabolic acidosis or found its association directly with EONS in Pakistan. Therefore, metabolic acidosis if found in EONS neonates, then in future every patient with early onset sepsis should be screened and can be managed timely.

Conclusions: It is concluded that very high statistics of metabolic acidosis, i.e., 27.69% so every patient with early onset sepsis should be screened for metabolic acidosis to reduce worse health outcomes.

Background: Coronary interventions, including percutaneous coronary intervention (PCI), have significantly improved management of coronary artery disease by restoration of coronary blood flow to myocardium. However, despite of so many advancements in PCI procedural techniques, there is still a significant and challenging complication known as the "no-reflow" phenomenon exists which worst effect the PPCI outcome.

Methods: It was Cross sectional study conducted at Department of Cardiology, Lady Reading Hospital Peshawar. Study was conducted from 1/1/2023 to 30/6/2023 for six months. All patients who developed no reflow were subjected to intracoronary Tirofiban. Those who do not responded to Tirofiban were given intracoronary adrenalin and effect was noted. Data were analyzed using SPSS Version 23.0. Mean and standard deviation were calculated for quantitative variables like age. Frequencies and percentages were calculated for categorical variables like gender. The p-value less than 0.05 was considered significant.

Results: Among 151 participants, 18% experienced the no-reflow phenomenon. Intracoronary adrenaline and Tirofiban individually showed a significant positive impact on TIMI flow. It was found that 40% patients with no reflow responded to Tirofiban administration. Remaining patients with no reflow were subjected to intracoronary adrenalin therapy and 74% of these patients had improved TIMI flow. It was also found that combine effect of Tirofiban and adrenalin was found in 84% of patients.

Conclusions: No reflow phenomenon is common finding in Primary PCI and can be effectively managed by Tirofiban and intracoronary adrenalin administration in most cases.