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

Adenomyoepithelioma (AME) is a rare variant of breast neoplasm. It is a biphasic tumour characterized by small epithelial-lined spaces with inner luminal cells and outer of abluminal (myoepithelial) cells. Either - or both - of these two cells may rarely undergo malignant transformation. We present a case of a 61-year-old lady who arbored a mass in her right breast. She presented with few left sided pulmonary nodules as well and was initially diagnosed with extensive DCIS on core biopsy. Lung biopsy of nodule was diagnosed as epithelial myoepithelial neoplasm. Ultimately, modified radical mastectomy and pneumonectomy was performed. The final histopathological diagnosis turned out to be malignant. Adenomyoepithelioma with carcinoma; epithelial-myoepithelial carcinoma of breast with pulmonary metastasis. The malignant transformation of adenomyoepithelioma has been documented in only a limited number of cases. Benign AME often undergoes treatment through wide local excision, given its rare local recurrence. In contrast, the approach to malignant AME typically involves a mastectomy, with or without a lymph node biopsy. Metastases may manifest several years' post-primary diagnosis, even in cases of AMEs lacking atypical histological features. However, in our case metastasis was seen with in first four months of clinical presentation. Adenomyoepithelioma with carcinoma is an exceptionally rare neoplasm that may present with early metastasis, challenging the conventional findings of late metastasis as reported in studies. Consequently, the behaviour and prognosis of this entity remains a grey area, necessitating further exploration with a substantial sample size.

Background: Acute diarrhoea among children mainly due to infection must be treated prophylactically to reduce mortality. The objective of this study was to compare the outcome of using bacterial probiotics (Bifidobacterium and Lactobacillus) versus fungal probiotics (Saccharomyces) for acute diarrhoea among children aged 6 months to 5 years.

Methods: A non-randomized control trial was conducted at diarrhoea ward, the Children's Hospital, Lahore from 1st March 2022 to 1st March 2024. 200 children were recruited in the study using non-probability consecutive sampling technique which were divided equally into two groups receiving either bacterial probiotics or fungal probiotics. The children were followed up till resolution of diarrhoea. Diarrhoeal duration and stool frequency were noted. Data was entered and analysed using SPSS Version 26.

Results: Out of 200 children, 52.5% were male and 47.5% were female. Mean age of the sample was 2.24±1.54 years, mean baseline and follow up diarrhoea duration was 3.52±1.44 and 3.47±1.25 days and stool frequency at follow up was 3.75±1.15. Complete diarrhoeal resolution was seen among 95% of the children using bacterial probiotics while 87% of the children using fungal probiotics (p=0.048). Regarding diarrhoeal duration (days) among the two groups, the mean was 3.11±1.36 (bacterial probiotic group) and 3.88±1.02 (fungal probiotic group) (p<0.001) and regarding stool frequency, the mean was 2.97±0.55 (bacterial probiotic group) and 4.57±1.07 (fungal probiotic group) (p<0.001).

Conclusions: It can be concluded from this study that diarrhoeal resolution along with stool frequency was better among children using bacterial probiotics as compared to those using fungal probiotics.

Background: Surgeons specifically junior ones in our setup of third world country face the issue of diagnosing Acute Appendicitis (AA) as presentation usually is not typical. Cases presenting at odd hours may put residents & house officers in trouble, when sophisticated investigations are either un-available or expansive. Need for a structured diagnostic criterion is thus always there. Various scores have been designed to help out surgeon e.g. Alvarado score which got more popular & is practiced randomly. Aim of this study was to revisit Alvarado score for its efficacy in current era at Ayub Teaching Hospital (ATH) Abbottabad, i.e., by calculating negative appendicectomy rate.

Methods: This descriptive study was conducted at Surgical "B" Unit (ATH) from 1st September 2021 to 31st May 2022. 160 patients with pain RIF were included & evaluated by Alvarado score & consequently placed in 03 groups. Those having score 1-4 (Group-1) at presentation were discharged while the ones with score 5-6 (Group-2) were observed, re-evaluated at interval for re-grouping as Group-1 or 3 based on their final score. Patients with score 7-10 (Group-3), having score confirmed Acute Appendicitis were operated. Findings were recorded on a proforma. SPSS-version 26 was utilized for statistical analysis.

Results: Total patients were 160, males were 118 & female patients were 42. Discharged (Group-1) patients were 22. Group-2 patients (41 in number), were observed for 24-48 hour when score of 16 declined to ≤4 level & were discharged. 25 patients whose score increased to ≥7 levels were operated like other 97 patients of Group-3. Histopathology confirmed 109 of 122 patients as acute appendicitis while 13 turned out negative appendicectomies. Negative appendicectomy rate was therefore 10.65%, i.e., 13 out of 122, it was 06.17% in males (i.e., 05 of 81) & 19.51% (i.e., 08 of 41) in females.

Conclusions: Alvarado score again proved helpful even today in reducing the negative appendicectomy rate at surgery department of ATH, it should therefore be routinely adopted in diagnosis of suspected appendicitis cases in the third world countries (e.g. Pakistan) setup (facing scarcity of sophisticated resources).

Background: Oral squamous cell carcinoma (OSCC) is a prevalent malignancy that develops through a series of stages, ranging from high-grade dysplasia (HGD), microinvasive OSCC (MiOSCC) to frankly invasive OSCC. However, sometimes it is difficult to differentiate HGD from MiOSCC and invasive OSCC in histopathological morphology on routine staining. The aim of the study was to assess the expression patterns of D2-40 in these distinct stages of oral carcinogenesis, providing insights into its potential role as a biomarker for disease progression.

Methods: This cross-sectional study was carried out in the Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from 1st Dec 2023 to 5th Feb 2024. It involved the application of a D2-40 immunohistochemical marker on a total of thirty tissue samples, ten patients diagnosed with High-grade dysplasia (HGD), ten with Microinvasive Oral squamous cell carcinoma (OSCC), and ten invasive OSCC cases. SPSS was used for data analysis and a p-value < 0.05 was considered significant.

Results: The mean age of patients was 60.47±11.78 years, males were affected more (70%). D2-40 was expressed in different stages of oral carcinogenesis in increasing order as in 40% in HGD (4/10), and 90% in both microinvasive (9/10) and invasive OSCC (9/10) lesions. D2-40 IHC expression was associated with the patient's age and disease.

Conclusions: Podoplanin (D2-40) has the potential to be a novel biomarker for the timely identification of microinvasion in early oral epithelial pathologies with diagnostic dilemmas.

Background: Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract. Skin manifestations are frequently found with IBD yet they are not completely comprehended regarding how common they are and whether they reflect the seriousness of disease. Objective was to determine the prevalence, type and treatment of skin recall manifestations among a cohort of patients with CD and ulcerative colitis (UC).

Methods: A total of 250 IBD patients (140 CD and 110 UC) were enrolled in the study. Demographics of patients, disease duration, skin morphology were enrolled. We evaluated the frequency of skin manifestations, their association with disease activity, and course in response to therapy.

Results: Skin manifestations appeared in 31.2% of patients, and were more prevalent in CD (35%) compared to UC (26%) (p=0.04). The most common skin manifestations were erythema nodosum (11.2%), pyoderma gangrenosum (5.6%), and perianal skin tags (8%). Active disease demonstrated a significant association with skin manifestations (45% active disease vs 18% remission, p<0.001). Patients receiving anti-TNF therapy had fewer new skin manifestations (20%) when compared to patients receiving conventional therapy (36%) (p=0.03), however 5% of patients receiving biologic therapy reported developing paradoxical skin reactions. Management of skin manifestations consisted mainly of systemic corticosteroids therapy, which was effective in 80% of cases, while 10% of patients with more severe perianal disease underwent surgical intervention to treat their skin manifestations.

Conclusions: Skin manifestations appear to be common in patients with IBD, and a significant difference was observed between patients with CD and UC. The disease activity showed a strong association with the occurrence of skin manifestations. Anti-TNF therapy is likely to be associated with less frequent new skin manifestation, however it remains substantive that patients with biologic therapy can have paradoxical skin reactions.

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.