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

Inflammatory biomarkers are molecules that can offer vital information on the intricate chain of happenings and molecular processes underpinning the pathophysiology of any inflammatory disease. They can be measured in various biological samples such as blood, urine, or saliva, and are used as indicators of the presence and severity of inflammation. Measuring salivary inflammatory biomarkers is a non-invasive and relatively easy way to monitor inflammation, and it has been shown to be a useful tool in the diagnosis and management of various oral and systemic inflammatory diseases. Irisin is a novel anti-inflammatory protein and its implication and diagnostic role in inflammation have been widely studied; however, not much have been studied in oral inflammation per se. Irisin is predominantly downregulated in several inflammatory conditions, including obesity, type 2 diabetes, periodontitis, and cardiovascular diseases. This suggests that irisin may be involved in the inflammatory process, but more research is needed, especially of salivary irisin to understand its precise role. Overall, the role of irisin as an inflammatory biomarker is still an area of active research, and more studies are needed to determine its diagnostic and therapeutic potential. This review highlights the diagnostic and therapeutic potential of irisin in various systemic and oral inflammatory conditions.

Background: Atrial Fibrillation is a heart arrhythmia causing stroke and associated with many modifiable risk factors. A number of strokes can be prevented by identifying these risk factors and adopting primary prevention and anticoagulation.

Methods: This Cross-Sectional observational study on 160 stroke patients; identified frequency and risk factors of Atrial Fibrillation and their prior anticoagulation status. Correlation of risk factors associated with Atrial Fibrillation in stroke was done through Chi Square test.

Results: Among 160 patients, 72 (45%) were males and 88 (55%) females. Mean age was 64.29±13.44SD with range of 31-92 years. Among patients, 113 (70.6%) had ischemic stroke, and 32(20%) had Atrial Fibrillation. Among risk factors, 136(85%) had hypertension, 37(23.1%) had diabetes, 52(32.5%) had ischemic heart disease, 27(16.9%) had valvular heart disease, 9 (5.6%) had hyperthyroidism, 37 (23.1%) had hyperlipidemia, 17(10.6%) had chronic respiratory disease, 19 (11.9%) were smokers, 61(38.1%) had family history of stroke, 12(7.5%) were obese. Only 8 of 32 with AF (25%) had prior anticoagulation. Correlation analysis of risk factors show ischemic heart disease (p=.000285), rheumatic heart disease (p=.000061), hyperlipidemia (p=.0004), chronic respiratory disease (p=.003175) and smoking (p=.00148) as significantly associated with Atrial Fibrillation.

Conclusions: Ischemic heart disease, hyperlipidemia, smoking and respiratory disease are significant risk factors for stroke in non-valvular atrial fibrillation. All these factors are modifiable so primary prevention and prophylactic anticoagulation should be emphasized.

Background: Giant cell tumour of bone (GCTB) is a rare, locally aggressive benign bone tumour with slight female sex predilection and affecting young adults 20-40 years of age. World health organization (WHO) has recently categorized GCTB as an intermediate malignant tumour. GCTB is known to be driven pathologically via expression of pro-osteoclastic signals by stromal cells. This is mediated precisely via the expression of RANKL by stromal cells acting in an autocrine fashion on RANK receptor-positive osteoclast-like giant cells and their precursors. While the treatment is primarily surgical, we hypothesized that preoperative denosumab therapy facilitates conversion to a less morbid procedure in an aggressive campanacci grade 3 GCTB, otherwise amenable to joint resection and reconstruction/arthrodesis.

Methods: A prospective, single arm, interventional study was conducted in Orthopaedics and radiation oncology department of combined military hospital (CMH) Rawalpindi. The duration of study was 36 months. Patients were recruited by purposive sampling technique as per inclusion/exclusion criteria. Denosumab was administered as preoperative adjuvant therapy for 3 months. Pain was assessed utilizing Brief Pain Inventory -Short Form (BPI-SF) and functional status was assessed as per Musculoskeletal tumour society score at baseline and 12 weeks after commencement of denosumab therapy. The intent of surgery pre and post denosumab therapy was ascertained.

Results: Total of 23 patients were a part of this study. Mean pain scores and MSTS scores prior to and after denosumab were statistically significant with p-value <0.01. Pre-denusomab, there was inclination towards resection arthroplasty as the treatment procedure (56.5%). After denusomab therapy, intralesional curettage was choice of procedure with intent executed for 78.3% of cases.

Conclusions: Denosumab has potential role for giant cell tumour of bone, it makes a less morbid surgery technically feasible. However, recurrence needs to be probed in long term follow up studies.

Prevotella species are usually seen in the intestinal tract including oral cavity as commensal bacteria and can lead to periodontal infections in immunocompetent patients. However, in patients who are immunocompromised, Prevotella can cause infections at other sites. A 35-year-old gentleman presented with 1-month history of high-grade fever and right sided pleuritic chest pain. On examination, he was in discomfort due to pain, with temperature 103 oF, pulse 104 beats per minute, blood pressure 130/90 mmHg, respiratory rate 22 breaths per minute and O2 saturation 94% on room air. Oral cavity revealed poor hygiene with left lower carious incisor. There was reduced chest expansion in right sub-scapular region with reduced vocal fremitus, dull percussion note, absent breath sounds and reduced vocal resonance. WBC count was raised at 43,600 per cm. X-ray followed by HRCT chest demonstrated peripheral opacifications with air-fluid level in right lower zone due to loculated pyopneumothorax and pleural thickening. Ultrasound guided chest tube thoracostomy in the loculated pyoneumothorax aspirated 1200 ml of foul-smelling reddish-tinged pus which revealed growth of anaerobic gram-negative rods of Prevotella Intermediata on culture, which was sensitive to amoxicillin-clavulanate and metronidazole. Work up of immunosuppressive causes was negative. The patient responded well to treatment and was asymptomatic at follow-up after 6 weeks.

Background: Urinary catheterization is considered as one of the most common, frequently performed and basic skill in patient care while catheter associated urinary tract infections (CAUTI) in the most common nosocomial infection. Catheter material plays an important part in terms of infection and bacterial colonization. With this study, we aim to compare the rate of bacterial colonization in two most commonly used catheter type; Latex and Silicone indwelling catheters in males with acute urinary retention.

Methods: This 2-arm randomized control trial was conducted in Allied Hospital Faisalabad over the period of 2 months, from Jan 2023 to February 2023. Seventy-two male patients with acute urinary retention were included in this study. Patients were divided into 2 groups. Intervention groups was catheterized with silicon indwelling catheter and control groups was catheterized with latex indwelling catheter. Patients were discharged without antibiotics prescription and at 5th day catheter was removed and tip of catheter was sent for culture and sensitivity. Result was received on OPD basis and added in the record.

Results: In comparison to the latex catheter, the silicone catheter showed significantly reduced bacterial colonization. In the Silicon indwelling catheter group, out of 36, 8 patients catheters showed bacterial growth while 28 exhibited no growth. In the Latex indwelling catheter group, out of 36, 17 patients catheters showed bacterial growth while 19 exhibited no growth.

Conclusions: The findings showed that, on the fifth day of catheterization, silicone indwelling catheters significantly reduced the rate of bacterial colonization when compared to latex indwelling catheters.

Background: Soft tissue defects around the knee and proximal leg represent a challenging clinical scenario for plastic and reconstructive surgeons. These defects can arise from a variety of causes, including traumatic injuries, such as crush injuries and road traffic accidents, thermal injuries like burns, and surgical complications such as infection. Objective of the study was to evaluate the success of proximally based sural artery flap for soft tissue defects around the knee and proximal leg in patients presenting to our tertiary care hospital.

Methods: This prospective observational study was conducted at the Department of Plastic & Reconstructive Surgery, Civil Hospital, Karachi, Pakistan. The study included patients with soft tissue defects around the knee and proximal leg, excluding those with specific comorbidities, high BMI, or active smoking. Non-probability convenience sampling was employed. After ethical review committee approval and informed consent, if needed wounds were optimized with thorough debridement then patients underwent proximal-based sural artery flap surgery for soft tissue defects around knee and proximal leg. Flap survival and complications were assessed over three to six weeks.

Results: The study included 37 patients, with a median age of 30 years. The most frequent cause of defects was road traffic accidents (73%). Of the patients, 73% were male, and 27% were female. The median duration of soft tissue injury was 5 weeks, and the median duration of surgery was 90 minutes. Flap survival was 97.3%, with 28 flaps surviving without any complications. One patient with a 20-year-old chronic defect experienced partial flap failure.

Conclusions: The use of the proximally based sural artery flap represents a promising approach for the successful reconstruction of soft tissue defects around the knee and proximal leg.

Background: Gynaecological laparoscopic surgery is a minimally invasive surgical technique that can cause pain and discomfort in the postoperative period. To manage this pain, various analgesic techniques have been employed, including rectus sheath block (RSB). Bupivacaine is a long-acting local anaesthetic that has been used in bilateral rectus sheath block (BRSB) for postoperative pain relief after laparoscopic surgery. The objective of this study was to assess the impact of bupivacaine's bilateral rectus sheath block (BRSB) on post-laparoscopic pain relief with its intraperitoneal (IP) administration.

Methods: This prospective randomized, double-blind, clinical trial was done at the department of obstetrics and gynaecology Patel hospital Karachi, from September 2022 to February 2023. All the adult female patients aged 18 years or older undergoing elective gynecological laparoscopic surgery and willing to receive RSB as a postoperative analgesic technique were included. After taking informed consent, the patients were randomly allocated into two groups. In group I, BRSB was performed with 25 mg of bupivacaine and in group II was given 25 mg of bupivacaine intraperitoneal. Visual analogue pain score (VAS) was used to evaluate the postoperative pain at 1st, 6th, 10the and 24the hours postoperatively. Data was collected via study proformas.

Results: The study comprises 60 patients who underwent gynaecological laparoscopic surgeries, with group I having an average age of 38.10±11.19 years and an average was BMI of 27.07±5.15 kg/m2, and group II having a mean age of 41.36±11.18 years and an average BMI of 27.51±4.22 kg/m2. Average (VAS) was significantly lower in group I compared to group II at 1st, 6th, 10th, and 24th hour, with a statistically significant p-value of 0.001. The average duration of surgery was statistically insignificant in both groups, as an average duration in group I was 32.14±12.20 minutes and in group II was 31.0±19.21 minutes.

Conclusions: The use of bupivacaine in a bilateral rectus sheath block (BRSB) with was observed to be more effective for post-laparoscopic pain relief compared to 25 mg of bupivacaine intraperitoneal administration.

Background: Increased serum Cholesterol level is a known risk factor for cardiovascular diseases. Derangements in serum Cholesterol levels will affect normal hepatic Cholesterol homeostasis resulting in hypercholesterolemia. Non-Alcoholic fatty liver disease (NAFLD) initially asymptomatic but can lead to cirrhosis and hepatocellular carcinoma from mild steatosis to non-alcoholic steatohepatitis. The objective of this study is to find out hypercholesterolemia as a causative risk factor in NAFLD patients. This will help to prevent the development and progression of the disease.

Methods: This cross-sectional study was conducted from 16th August 2021 to 16th August 2022 at Ayub Medical institute Abbottabad. Random sampling technique was used. Sample size was 100, in which 50 were diagnosed cases of liver disease and 50 normal subjects diagnosed on ultrasound. A questionnaire was designed. Subjects between 40-65 years age group were selected after informed consent and confidentiality. Data was collected from the out-patient department of medical and surgical unit and analysed with the help of SPSS-22.00. Chi-square test was used. Enzymatic kit method was used for serum cholesterol and triglycerides estimation. BMI was derived from the mass (weight) and height of the person.

Results: It was found that 48% study subjects with NAFLD shows high serum Cholesterol levels while 52% subjects with NAFLD were found within normal limits but 10% individuals with no fatty infiltration had high serum Cholesterol levels while 90% without NAFLD had shown normal serum Cholesterol levels. Significant p-value of <0.001 was found between presence of NAFLD and high serum Cholesterol levels. Significant association was also found among serum Cholesterol and serum Triglyceride levels showing strong association of serum cholesterol levels with NAFLD and raised serum triglycerides levels with p-value 0.001. Similarly, significant association was found between serum cholesterol levels and BMI with p-value ˂0.001.

Conclusions: Highly significant association was found between Hypercholesterolemia and non-alcoholic fatty liver disease. It suggests hypercholesterolemia as a causative risk factor for NAFLD.

Background: Lung cancer is a leading cause of death related to cancer worldwide, surpassing the number of deaths caused by breast, colon and prostate cancers. Objective of the study was to determine the frequency immunohistochemical expression of PD-L1 in non-small cell lung carcinoma (NSCLC). It was a descriptive cross-sectional study, carried out at the Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from January 2020 to July 2021.

Methods: We inducted total of 145 diagnosed cases of NSCLC irrespective of age, gender, histological grade and stage of carcinoma. Immunohistochemical staining of PD-L1 was done using Leica kit. Patients with no expression for PD-L1 were considered negative, whereas immunohistochemical expression of ≥1% is considered positive. PD-L1 statuses of all patients was determined. The data was analyzed by using SPSS version 25.

Results: In our study age ranges from 31 to 85 years with mean age of 64.20±10.90 years. Out of the 145 patients, 126 (86.90%) were male and 19 (13.10%) were females. 108 (74.50%) were squamous cell carcinoma and 37 (25.50%) were adenocarcinoma. Most of them were histological grade II, 88 (60.70%), followed by grade I in 26 (17.9%). Immunohistochemical expression of PD-Ll in NSCLC was found in 35 (24.13%) patients. Of all the positive cases, PD-L1 expression was slightly higher in adenocarcinoma 27.02% as compared to squamous cell carcinoma 23.14%.

Conclusions: PD-L1 expression is associated with increased aggressiveness, enhanced tumor progression and shorter survival in patients of NSCLC. This study concluded that frequency of positive immunohistochemical expression of PD-L1 in NSCLC is though low, yet significant in adenocarcinoma as compared to squamous cell carcinoma.

Background: Potassium levels play a significant role in cardiovascular patients, with hypokalemia and hyperkalemia having profound effects on the mortality rate. The aim of this study was to investigate the correlation of admission serum potassium levels and in-hospital mortality in patients suffering from acute ST-elevation myocardial infarction (STEMI).

Methods: The study was conducted in the Department of Cardiology, Ayub Teaching Hospital Abbottabad, and involved 225 patients with STEMI who underwent thrombolysis with streptokinase. The serum potassium levels of patients were recorded at the time of admission, and its correlation was observed with the short-term outcomes, i.e., discharge to home versus those who did not survive during the hospital stay of 72 hrs.

Results: The mean level of serum potassium at admission was 4.2 mmol/dL and 74.2% patients were discharged alive. T test indicated that a higher risk of death was associated with old age. No significant association between gender, serum potassium levels, systolic blood pressure, heart rate, and outcomes was seen. Logistic regression analysis further showed that age had a significant association with the outcome of death.

Conclusions: In our study, age had a significant impact on predicting the mortality of patients with STEMI and whereas the serum potassium levels at the time of admission did not exhibit any significant predictive value. Further research is needed to elucidate the complex interplay of various factors in predicting mortality, to improve the management practices of AMI.