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

Background: Dentin hypersensitivity is a common clinical problem all over the world and it is called the common cold of dentistry. This study aimed to compare the efficacy of glass ionomer cement and dentin bonding agent in management of dentin hypersensitivity in patients presenting to Peshawar Dental College.

Methods: This Quasi-experimental study was conducted on patients presented to the Department of Operative dentistry and Endodontics from February to August 2022.A total of 60 patients in the age range of 18-70 were selected based on convenience sampling. The patients were divided into 2 groups. Group A received glass ionomer cement and Group B received dentin bonding agent. The sensitivity was assessed before treatment using visual analogue scale and documented as baseline reading with both tactile and evaporative stimuli. It was then evaluated immediately after treatment, as well as at 1 week and 6 weeks post-treatment, using the visual analogue scale with tactile & evaporative stimuli.

Results: Thirty Patients in group A were treated with glass ionomer cement & 30 patients in Group B received treatment with dentin bonding agent. The pain scores in both groups decreased from severe to moderate to mild or no pain immediately after application compared to baseline (p=0.613). During the 1 week follow up, most patients in both groups reported mild or no pain (p=0.64). After 6 weeks, most patients in both groups experienced mild pain (p=0.338).

Conclusions: Comparison of glass ionomer cement and dentin bonding agent revealed a significant difference in pain scores immediately after application. However, at 1- week and 6-weeks follow-ups, there was no significant difference between the two groups, as most patients reported only mild pain.

Background: With rising conditions in immunocompromised states, the world is facing the challenge of fungal infections with mucormycosis which was rare previously. With the rise in diabetic patients, COVID-19-related immunosuppression, and steroid use, along with an increasing number of transplant and chemotherapy patients, there has been a notable surge in mucorales infections. Although patients with rhino-orbit-cerebral mucormycosis are the most common type of pulmonary rare ones.

Methods: Here, we are reporting 1st case of laryngeal mucormycosis in a 55-year-old male presented with respiratory distress in the ENT department of Shaikh Zayed Hospital, Lahore. He had a 4-year history of poorly controlled diabetes, with no other identifiable risk factors. An emergency tracheostomy was performed, pus was aspirated, and necrotic tissue was debrided to relieve the airway obstruction.

Conclusions: Laryngeal mucormycosis was diagnosed in the subglottic region via multiple biopsies through direct laryngoscopy under anesthesia. The emergence of new variants of mucormycosis is calling for vigilant identification and meticulous control of predisposing risks. Concomitant debridement and intravenous amphotericin B are recommended under current guidelines.

Hepatic disorders are generally silent, with slow progress, and are usually detected when the organ's function is severely affected. Several studies have shown that oral lichen planus (OLP) is one of the most Hepatitis C-associated diseases. The emergence of such an extrahepatic manifestation is frequent and can lead to an early diagnosis. Patients with chronic hepatitis C virus (HCV) infection exhibit extensive forms of OLP, with frequent periods of exacerbation of symptoms refractory to treatment, which is commensurate with the severity of the liver disease. When treating OLP in HCV patients, researchers have diverged results. This case report presents an extensive, erosive OLP in an HCV-positive female patient for whom clinical management was tremendous. Full remission was obtained after topical corticosteroid application and several sessions of oral cavity sanitation. This clinical case demonstrates that dentists play a major role in OLP diagnosing, managing, and malignant transformation preventing. They may also contribute to the screening of hepatitis C infection.

Background: The optimal management of breech presentation remains a debate among obstetricians worldwide. The Term Breech Trial (2000) highlighted elective caesarean section as a preferable method over vaginal delivery for breech presentations. This study investigates delivery modes in women who had an elective caesarean section for breech presentation in their first pregnancy. Objective was to evaluate delivery outcomes in the second pregnancy of women who had an elective caesarean section for breech presentation in their first pregnancy.

Methods: A cross-sectional study was conducted at Jinnah International Hospital Abbottabad from October 10, 2018, to April 10, 2019. Data was collected from 321 women who had an elective caesarean section for breech presentation during their first pregnancy. The study used per-abdominal examination and obstetrical ultrasound to assess foetal presentation and recorded the mode of delivery in the second pregnancy.

Results: Participants' ages ranged from 18 to 49 years, with a mean age of 28.87±4.07 years. The average interval between deliveries was 1.92±0.92 years, labour duration averaged 5.56±2.41 hours, and foetal head engagement averaged 2.92±1.35. Of the participants, 18.7% achieved a vaginal delivery, while 81.3% had a repeat caesarean section. Reasons for repeat caesarean included recurrent breech presentation in 44.9% and foetal distress in 32.4%.

Conclusions: Approximately 18.7% of women who had an elective caesarean section for breech presentation in their first pregnancy achieved vaginal delivery in their second pregnancy, whereas the majority underwent another elective caesarean section.

Background: Endometrial cancer ranks as the sixth frequently detected cancer and the 14th highest contributor, to cancer-related fatalities, among women globally. High-grade endometrial carcinomas encompass a diverse array of clinically aggressive tumours, including FIGO grade 3 endometrioid adenocarcinoma, uterine papillary serous carcinoma (UPSC), clear cell carcinoma, undifferentiated carcinoma, dedifferentiated carcinoma, and carcinosarcoma. The classification and diagnosis of these tumours pose challenges due to the absence of well-established molecular markers or panels. The main purpose of this study is to assess and compare the clinicopathological characteristics of and survival rates of undifferentiated endometrial carcinoma (UEC), dedifferentiated carcinoma (DEC), and carcinosarcoma (CS) in the Pakistani population at SKMCH&RC.

Methods: All patients diagnosed with DEC, UEC, and CS were analyzed from January 2011 and December 2022. Clinicopathological and survival data was retrospectively reviewed and analyzed using SPSS version 27. Kaplan-Meier analysis was used to calculate overall survival (OS) and disease-free survival (DFS).

Results: Among 71 selected patients, 47.9% had CS, 29.6% had DEC, and 22.5% had UEC. Mean±SD age at diagnosis was 58.18±11.35 years. A statistically significant association of DEC, UEC, and CS was identified (p-value <0.05) with myometrial invasion (p=0.02), lympho-vascular invasion(p=0.006), positive margins(p=0.003), and involvement of adnexa/ parametria/ vaginal /adnexa/ parametria/ vaginal /another organ (p=0.01). The commonest pathological stage was pT1 38(53.5%). 56.3% of patients received chemotherapy, 29.6% received radiotherapy, and 38.0% received a combination of chemotherapy and radiation treatment. Recurrence occurred in 19.7% and death occurred in 37.7% of patients. The highest 5-year OS rate for pathological stage 1 was 59.1% (95% C.I: 42.9-81.3%) and 5-year-DFS was 62.2% (95% C.I: 42.9-81.3%).

Conclusions: Patients diagnosed at an early pathological stage demonstrate better survival outcomes compared to an advanced stage, as documented in previous studies. Nevertheless, survival rates remain lower than Western population, indicating a necessity for gathering additional clinical data and alter the management strategies in our population.

Background: Misusing alcohol can cause damage to different tissues in the body, resulting in conditions like alcoholic liver disease, pancreatitis, cardiomyopathy, neurotoxicity, muscle wasting, weakened immune system, hormonal disruptions, birth defects, and bone loss. The objective of this research was to evaluate how alcohol affects the exocrine pancreas histology and the levels of amylase in the blood serum. Additionally, it aimed to explore whether vitamin E provides a safeguard against alcohol-induced harm to the pancreas in rabbits.

Methods: A laboratory-based experimental investigation was carried out at Peshawar Medical College involving eighteen healthy adult male domestic rabbits weighing between one to one and a half kilograms each. The rabbits were divided into three groups. Group A, serving as the control, received normal saline as a placebo. Group B was administered a daily dose of 30 percent ethanol solution (30 ml/kg/day) in normal saline. Group C received a daily oral dose of 30% ethanol solution (30 ml/kg/day) in normal saline along with vitamin E (50 mg/kg/day). Blood samples were collected for serum amylase analysis, while morphological assessment of acinar cells involved evaluating cell count, acinar size, acinar cell size, and acinar nucleus size.

Results: Serum amylase levels did not exhibit a statistically significant variance between the control and experimental groups as p-value was >0.05. Furthermore, no notable distinctions were noted in the size and number of pancreas acini, cells of pancreatic acini, and pancreatic acinar cells nuclei between the control and experimental groups in both category E4 and Category E8, as p >0.05.

Conclusions: There were no significant variations noted in the size and number of acini in pancreas, cells in pancreatic acini, and nuclei of cells in pancreatic acini. Consequently, the protective role of vitamin E against alcohol-induced pancreatic damage was not conclusively identified.

Background: Substance use disorder (SUD) presents a significant public health challenge globally, including Pakistan. Despite its high prevalence, there is limited research on the lived experiences of individuals with SUD in Pakistan, particularly in terms of cultural, social, and treatment challenges.

Methods: This qualitative study explores the experiences of 60 male individuals with SUD in the capital territory of Pakistan. Participants were recruited using snowball sampling and were interviewed using a semi-structured guide covering various aspects of their lives impacted by SUD. Data were analyzed using thematic content analysis, with translation and back-translation processes ensuring accuracy in capturing participants' narratives.

Results: The study identified four main themes: the impact of SUD on individuals' lives, causes of SUD, treatment experiences, and the social status of individuals with SUD. Participants reported significant financial and social hardships, strained interpersonal relationships, and severe physical and mental health issues. Causes of SUD included emotional distress, peer pressure, and abusive circumstances, while treatment options varied from medical interventions to spiritual healing. The stigma associated with SUD significantly impacted participants' social reintegration and recovery.

Conclusions: The findings highlight the complex interplay of socio-economic, psychological, and cultural factors influencing SUD in Pakistan. The study underscores the need for culturally sensitive, patient-centered approaches in the treatment and rehabilitation of individuals with SUD. Further research is needed to develop comprehensive strategies that address the specific needs of this population.

Background: Hypokalemia is one of the most important precipitating factors of hepatic encephalopathy causing Hypokalemic Alkalosis which is the leading cause of increased levels of nonionic ammonia in blood that crosses the blood brain barrier with ease and accumulates in the Central Nervous System.

Methods: A descriptive study was conducted in the Department of Medicine, PAF Hospital, Islamabad from December 31, 2022, to January 1, 2024.The sample size was calculated using WHO sample size calculator and non-probability sampling technique was used. Calculation of mean and standard deviation for variables like Age, Potassium levels and Length of Hospital Stay was done. Frequencies and percentages were calculated for variables like Hypokalemia, Gender, and Ethnicity. Independent samples t-test was used to compare the means, duration of stay at the hospital for patients with and without hypokalemia, keeping the p-value <0.05 as significant.

Results: The mean age of patients was 36.76±9.52 years. Out of the total 179 patients considered, 109 patients were male while 70 were females. Sixty-three patients were found to have hypokalemia. Their mean Potassium level was 3.47±0.37 mEq/L. A significant difference (p=0.230) wasn't detected in patients presenting with hypokalemia with age greater than and less than 35 years of age whereas, a significant difference (<0.001) was detected in the age group of less than 35 years when mean length of hospital stay was calculated.

Conclusions: The mean length of hospital stay was significantly higher amongst patients having hypokalemia, compared to those with no hypokalemia.

Background: Forensic Medicine has challenging dynamics particularly in identification of gender from bones. Pelvic bone is one of them which is commonly used in gender estimation due to variety of its features. The greater sciatic notch is the best part of pelvic bone for gender determination as its location makes it resilience to trauma even for many years. The aim of this study was to validate the various features such as width, depth angles etc. of greater sciatic notch for sex determination of the deceased.

Methods: This validation study was carried out in department of Forensic Medicine and Anatomy of Ayub Medical College from June 2023 to December 2023. A sample of 70 dry unidentified pelvic bones were studied by measuring the width, depth, anterior and posterior segments, anterior and posterior angles of the greater sciatic notch. Based on these measurements, the bones were then segregated as male and female bones. After initial gender identification, the standard features of the pelvic bones as per Krogman's classification were used for final confirmation of the gender.

Results: Result showed width, Anterior segment and posterior angle of greater sciatic notch greater in females while depth of notch deeper, posterior segments, anterior angle greater in males. These parameters and measurements give a unique importance for determining the gender of individual.

Conclusions: Our study shows that there is a significant difference between gender on the basis of different mentioned parameters of estimation. By using these parameters of greater sciatic notch anthropometric measurements, investigators can easily conclude important milestones of identity and determine the truth.