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

Background: An inflammation of the nasal and paranasal sinus mucosa that lasts longer than three months is known as chronic rhinosinusitis. When corticosteroids and other medicinal treatments fail to relieve a patient's symptoms, then functional endoscopic sinus surgery (FESS) is a commonly performed procedure to alleviate the symptoms. The aim of the study was to evaluate the impact of oral steroids given prior to surgery on intraoperative bleeding in patients having functional endoscopic sinus surgery for chronic rhinosinusitis.

Methods: The study was conducted in ENT Department of Shifa Foundation Community Health Centre (SFCHC) and Shifa International Hospital (SIH) Islamabad, in a period of three years from June 2019 to June 2021. A total of 72 patients consisting of 36 patients in study group and 36 in control group, fulfilling the inclusion criteria were included in the study. Per-operative bleeding was assessed by measuring the amount of blood collected in suction bottle at the end of the procedure (the amount of saline used during the procedure was subtracted) and the number of surgical gauzes stained with blood (1 partially stained gauze = 5 ml and 1 completely stained gauze = 10 ml). The surgeon performing the surgery was unaware of the study group of the patient. All the collected data was entered and analyzed with SPSS v. 25.

Results: The mean age of group A (35.39±13.86 vs. 29.83±15.86, p-value > 0.05) was similar to group B. There was male dominance in both group (69.4% vs. 72%) males in group A and group B. Nasal obstruction and nasal discharge was observed in all patients of both groups. Post nasal drip (88.9% vs. 88.9%), headache (97.2% vs. 91.7%) and facial pain (97.2% vs. 94.4%) was present in majority patients of both groups without any significant (p-value >0.05) difference. Both the groups were compared on the basis of amount of blood loss per-operatively and it was seen that the mean blood loss in group A was (164.03±42.99 ml) significantly (p-value <0.05) lower as compared to (215.83±39.397 ml) in group B.

Conclusions: This study showed that individuals with nasal polyps receiving preoperative steroids could successfully lower their perioperative morbidity, specifically intraoperative haemorrhage, after undergoing functional endoscopic sinus surgery.

Background: Actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions. Nowadays sexual assault is considered a major public health issue all over the world, especially in developing countries. Sexual abuse is declared as a medical emergency. Sexual abuse cases are examined in Pakistan by medico-legal officers and their findings are presented to the court as evidence and medico-legal officers present to the court as witness. The objectives were to find out the prevalence of sexual assault cases presented to the forensic medicine department Khyber Medical College Peshawar and to find out the most prevalent pattern of genital and extragenital injury. To find out the association between sexual assault and its associated demographic factors such as age, gender, and drug history.

Methods: This descriptive cross-sectional was conducted in the Department of Forensic Medicine and Toxicology from 1st January 2023 to 31st December 2023. All cases of any gender and age were included in the study and cases referred from other districts and with incomplete documentation were excluded.

Results: In 90 subjects, the males were 35.6% (n=32), whereas females were 64.4% (n=54). Of the subjects, 72.2% (n=65) had attempts of sexual assault, out of which 43.3% (n=39) went through rape and 28.9% (n=26) went through sodomy. 17.8% (n=16) had associated genital injuries with the assault while 10.0% (n=9) had extragenital injuries. The concurrent poisoning seen was 2.2% (n=2) which was merely benzodiazepine in cases of sexual assault.

Conclusions: Our data concluded that sexual assault was more prevalent in females than in males. Most of the individuals were from urban areas rather than rural areas. Of the subjects, rape was more prevalent than sodomy. The most common pattern of genital injury is anal tear while extragenital injuries vary from bruises to abrasions on various parts of the body. The most common drug used was benzodiazepines.

Background: The Model for End-Stage Liver Disease (MELD) score, introduced in 2002 by the United Network for Organ Sharing (UNOS), is a vital tool for predicting mortality for liver transplant candidates. Comprising serum creatinine, serum bilirubin, and international normalized ratio (INR), the MELD score includes kidney, liver, and coagulation pathway function, providing a comprehensive prognostic tool. Recent studies suggest broader prognostic implications, extending beyond organ allocation. Despite its benefits, around 15-20% of patients may not experience accurate survival predictions.

Methods: This retrospective single-center study, covering January 2016 to September 2023 with 87 patients, explores the correlation between pre-transplant MELD scores and 30 to 60-day post-transplant survival.

Results: Our analysis reveals no significant impact of MELD scores on survival during this period, challenging existing literature (p=0.068). The study underscores the need for nuanced risk assessment beyond MELD scores, considering diverse clinical scenarios and patient-specific variables.

Conclusions: Our findings contribute to refining predictive models and advocate for larger-scale investigations, emphasizing a holistic approach to optimize liver transplantation outcomes.

Background: Intussusception is a common cause of bowel obstruction in children, and early diagnosis is crucial to prevent complications. Ultrasonography is widely used to diagnose intussusception, but its validity parameters in children have not been well-established. The objective of this study is to determine the validity parameters of ultrasonography in diagnosing intussusception in children, taking surgical findings as the gold standard.

Methods: This cross-sectional validation study was conducted at the diagnostic radiology and surgery departments of Ayub Teaching Hospital, Abbottabad. This study duration spans from September 2022 to December 2023, and 127children of both sex with ages in the range of 3 months to 12 years suspected to have intussusception on ultrasound as per operational definition were included, and patients managed conservatively were excluded. Ultrasound scan was performed with Toshiba Xario-100 machine using high frequency 8.5 MHz probe. All data, including patients' demographics were recorded on a proforma. Data analysis was conducted using SPSS version 25.

Results: The mean age of patients was 6.50±3.38 years. The diagnostic accuracy of ultrasonography was 85.83%, with sensitivity of 82.93%, specificity of 91.11%, positive predictive value (PPV) of 94.44%, and negative predictive value (NPV) of 74.55%.

Conclusions: The use of ultrasonography as a first-line diagnostic tool for intussusception in children can help in early diagnosis and prompt management of the condition, which can significantly reduce the risk of complications.

Background: The anterior cruciate ligament (ACL) is a vital structure in the knee responsible for preventing anterior translation; and countering rotational and valgus stress. The anteromedial and posterolateral bundles of the ACL, which are distinguished by their attachments at the tibia and femur, respectively, make up the ACL. The study is designed to evaluate the diagnostic parameters of lever sign in acute settings when compared against MRI as investigation of choice and compare them with the conventional tests. Furthermore, effect of examination-under-anaesthesia and training level of the examiner on the diagnostic accuracy will be assessed. It was a prospective observational was performed. All the patients that presented to out-patient department of GTTH, Lahore from January to July 2023 and had a final diagnosis of ACL tear were included.

Methods: Assessment was done by both undergraduates and postgraduates and those who underwent arthroscopy were placed in surgical cohort and arthroscopic findings were included in final analysis.

Results: Eightythree patients were assessed. Inferential analysis demonstrated that Lelli's test had highest sensitivity (85.9%), NPV (64%) and diagnostic accuracy (85.5%). However, Lachman was most specific (94.7%) and had highest PPV (98.1). MRI itself is highly accurate (95.83%) when compared to arthroscopic findings. Though the results of each test when performed by postgraduates and under anaesthesia were significantly better; however, least difference was noted in case of Lelli test among awake and anesthetized and pre- and post-graduates' exams.

Conclusions: The Lelli's test is highly sensitive and accurate when compared to the three conventional tests for ACL injuries. Furthermore, the manoeuvre and its interpretation are simple and reproducible; thus, can be used by highly trained healthcare professionals on awake patients with minimal discomfort. However, further research is needed to validate its biomechanics and role in partial ACL and multi-ligamentous injuries.

Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan.

Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan. An interviewer-administered questionnaire was used to collect data, from adults, on demographics, education and socioeconomic status, physical and mental health, reproductive health, child health, health-related quality of life, and self-reported cardiometabolic diseases including Diabetes, hypertension, renal disorders, cardiac failure, angina, and stroke.

Results: A total of 20,715 participants were recruited in the survey including 52.8% (n=10,943) males and 47.2% (n=9,772) females with a mean age of 41 (13.1) years. Data on TB status was available for a total of 14452 participants. The prevalence of TB in Khyber Pakhtunkhwa was found to be 0.49% (n=72) including an almost equal number of males and females [48% (n=34) vs 51% (n=36)], respectively. The mean age of the patients with TB was 47.5 (11.6) years. A higher proportion of people with TB had cardiometabolic diseases compared to people without TB (45.9% vs. 30.9%). Amongst the cardiometabolic disorders, self-reported hypertension (OR: 1.81, 95% CI 1.08-3.02, p=0.02), Diabetes (OR: 3.99, 95% CI 1.95-8.18, p=<0.002), and angina (OR: 3.88 95% CI 1.20-12.49, p=0.02) were positively associated with the occurrence of TB. In the adjusted analysis, only self-reported Diabetes was positively associated with the occurrence of TB (OR: 3.33, 95% CI 1.61-6.88, p=0.001).

Conclusions: There is a higher burden of self-reported cardiometabolic diseases among people with TB, suggesting that this high-risk group should be screened for cardiometabolic diseases, especially Diabetes.

Abstract: Chediak Higashi syndrome (CHS), a rare form of autosomal recessive disorder has been reported globally in less than 500 cases over the past two decades. It clinically manifests as repeated episodes of infection, haemorrhagic sequelae, partial albinism, photosensitivity and late neurological signs (neuropathy, cognitive impairment etc). The pathognomonic morphological finding is the presence of abnormally large intra-cytoplasmic granules, particularly in leucocytes. Almost 85% of CHS cases advance into an accelerated phase, characterized by cytopenias and hemophagocytosis, leading to multi-organ failure.

Presentation: The child in the present case had consanguinity and a positive family history of recurrent infections. She had repeated episodes of bacterial infections. She also had a history of photosensitivity. CBC reported cytopenias. Peripheral smear showed neutrophils with characteristic large sized abnormal intra-cytoplasmic granules. Bone marrow biopsy was performed which also showed similar granules in leucocytes along with hemophagocytosis. Other clinical and biochemical markers also pointed towards hemophagocytic lymphohistiocytosis (HLH), thus patient was diagnosed as CHS in an accelerated phase. She received eight doses of chemotherapy but eventually expired.

Conclusions: The definitive treatment is hematopoietic stem cell transplantation which improves the hematological and immune aspects of CHS but not the neurological. Steps should be taken for early diagnosis and to prevent advancement into the accelerated phase.

Background: Alcohol consumption can have detrimental effects on the liver, as it plays a crucial role in processing and detoxifying substances in the body, including alcohol. Alcohol has the potential to hinder the liver's capacity, which results in a variety of metabolic imbalances and deficiencies. This research aimed to investigate alterations in the liver tissue due to alcohol administered orally, along with exploring the potential protective effects of vitamin E against these alterations.

Methods: An assortment of male pet rabbits (totaling 18) was part of the study. The categorized groups included: Control group A, which received normal saline as a placebo treatment. Experimental group B, administered with an oral dose of a 30% ethanol solution mixed with normal saline. Experimental group C, given an oral dose of a combination containing a 30% ethanol solution, vitamin E, and normal saline. At the end of experiment, blood samples were obtained to assess ALT levels, and liver tissue sections were stained with Hematoxylin and Eosin for microscopic analysis of hepatocyte structure.

Results: Highly significant differences between the blood ALT levels, hepatocyte count/size/nuclear count/size, sinusoids size in control and experimental groups were observed. Vitamin treated rabbits showed preserved morphology of hepatocytes as compared to non-vitamin treated rabbits during alcohol consumption by showing less ballooning of hepatocytes and shrinkage of nuclei which are the main initial signs of hepatocytes damage.

Conclusions: Frequent alcohol intake leads to swift alterations in liver tissue and blood ALT levels over brief spans, yet these effects may be reduced through the antioxidative properties of vitamin E.

Background: Poison is defined as any substance that harms, endangers, or even kills a person irrespective of the quality or quantity. Pakistan is a developing country and farming is the major occupation of most of the population. Due to the easy availability and increased use of pesticides, accidental and suicidal poisoning is very common. The objective of the study is to find out the most common poison used by people in the general population and its frequency in our setup.

Methods: Casualty Department of the Ayub Teaching Hospital in Abbottabad, served as the site of this retrospective investigation. Registrations between January 1st and December 31st, 2023, provided the data. All cases with a history of poisoning were included. Using SPSS 22, the data was analyzed. Sample was limited to those who were admitted when they were still alive. Ethical permission was taken from hospital administration.

Results: The study revealed that poisoning was more common among females and the most common age group affected was 16-22years. 57.8% (52) cases were of suicidal intent while 40% (36) were accidental.

Conclusions: Female and young people are more prone to Aluminium Phosphide (wheat pill) poison. It is a dangerous and lethal poison, so healthcare workers at emergency department ought to be prepared for such cases. Furthermore, its routine use as a domestic pesticide has to be strictly prohibited by creating awareness among the public.