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

Background: In osteoarthritic knee, flexion deformity is caused by synovial inflammation, posterior femoral and tibial osteophytes tenting onto the capsule, ligamentous contracture and hamstring shortening. This study aimed to evaluate the safe zone of joint line elevation for the treatment of flexion knee contracture preventing mid-flexion instability in total knee replacement.

Methods: 51 knees with varus osteoarthritis undergoing TKA were evaluated. 39 knees with flexion contracture < 15°and 12 knees with flexion contracture >15°. 2-mm joint line elevation was performed in just 4 knees with >15° flexion contracture. The extension and flexion gaps were measured with traditional spacer block. Stability in coronal plane (varus & valgus stress) was assessed at 0,30,60 & 90 degrees. Sampling Technique was non probability consecutive. SPSS 23 was used for statistical analysis.

Results: The study comprises 51 patients undergoing total knee replacement (TKA) for osteoarthritis, with a notable gender distribution (84.3% women, 15.7% men) and a mean age of 60.24±8.54 years. Of these, 41.2% had both knees affected, and joint elevation was performed in 23.5% with flexion contracture >15°. No instability was found in cases with joint line elevation. Flexion contracture analysis revealed asymmetry across sides, yet no statistically significant differences. Detailed comparisons show variability in flexion contracture and range of motion, emphasizing the complexity of side-specific outcomes. The study underscores the importance of tailored evaluation and intervention for flexion contracture >15° to optimize postoperative results.

Conclusion: This study has shown that in patients with varus osteoarthritis of the knee and flexion contracture > 15°, a 2-mm joint line elevation is safe to treat knee flexion contracture and is not associated with mid-flexion laxity. Level of evidence IV Cross sectional study.

Background: To determine the clinical profile of Childhood Lichen Planus (LP) in Pakistani patients presenting to Dermatology outdoors of a Tertiary Care Hospital. It was a cross-sectional study, conducted at the Dermatology Outpatient of a Tertiary Care Hospital in Pakistan from December 2021 to December 2023.

Methods: All new patients with either gender up to the age of 15 years with clinical diagnosis of LP were included. Clinical data was recorded for each patient separately. Physical examination was performed to determine the type of disease, presence or absence of Koebner phenomenon and the presence of other associated diseases. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 23.

Results: The mean age of onset was 9.792±2.774 and mean duration was 11.63±6.83 months. Pruritus was found in 51 (94.4%) patients. Classic LP was found in 35 (64.9%) cases, hypertrophic LP was found in seven (13.0%) cases and linear LP was found in six (11.1%) patients. Lichen planopilaris, actinic lichen planus and atrophic lichen planus were seen in one (1.9%) patient each. Nail involvement was seen in 5 (9.3%) patients with only one (1.9%) having nail only lichen planus. Similarly, mucosal involvement was seen in 7 (13.0%) patients and only two (3.7%) patients had mucosal only lichen planus.

Conclusions: Lichen planus is uncommon in children. Childhood LP largely resembles adult LP. There is no significant gender predominance. Nail Lichen planus and mucosal LP are rare and family history and associated systemic diseases are found very rarely.

Background: Local anaesthetics are the most important and most utilized agents in the dental profession today. Achieving effective pain control holds a prime importance for any dental procedure. The most commonly employed technique to achieve effective anaesthesia in mandibular molar teeth with irreversible pulpitis is Inferior Alveolar Nerve Block. However, in some cases this technique may not prove successful and the clinician may have to resort to alternative methods of achieving effective anaesthesia. Our study aims to compare two different techniques employed for anaesthesia, i.e., the conventional Inferior Alveolar Nerve Block and the alternative Gow Gates Technique in achieving effective anaesthesia in mandibular molar teeth.

Methods: We conducted a randomized controlled trial in the Operative Dentistry department of Rawal Institute of Health Sciences Islamabad. We selected 102 patients presenting with irreversible pulpitis in mandibular posterior teeth. The selected patients were randomly allocated into two groups. In each group, the subjects were given 1.8 ml of lidocaine (2%) with epinephrine 1: 100,000 (Medicainer Inj, HuonCo., Ltd, Korea) by using anaesthetic cartridges that had aspirating syringe.

Results: Subjects in Group A were given inferior alveolar nerve block while those in Group B received Gow-Gates nerve block. The patients were then asked to rate their pre-operative and intra-operative pain on a visual analogue scale (VAS). Data analysis was done using SPSS-22, followed by comparison of efficacy between the two groups. anaesthesia was found to be effective among 36 subjects (69%) of Group-A and 44 subjects of (84%) Group-B. Hence, we concluded that the success rate of Gow-Gates technique and Inferior alveolar nerve block anaesthetic technique differs significantly.

Conclusions: Gow-Gates technique can be considered as an applicable alternative to the conventional Inferior alveolar nerve block technique while providing anaesthesia to patients presenting with irreversible pulpitis in mandibular posterior teeth, having a higher anaesthetic success of (84%) when compared with the conventional Inferior alveolar nerve block (69%).

Background: Androgenetic alopecia (AGA) affects up to 50% of males and 40% of females by the age of 50. It is the result of progressive, patterned hair loss that occurs in genetically predisposed individuals having hypersensitive androgen receptors in hair follicles. Due to the variable efficacy and adverse effect profile of FDA-approved drugs, newer and alternative modalities need to be utilized. As no prior study evaluated the efficacy of Procapil in combination with platelet-rich plasma (PRP), this study aimed to fill the research gap. The objectives were to assess the effectiveness of topical Procapil 5% combined with PRP vs PRP alone in androgenetic alopecia.

Methods: It was a Quasi-experimental clinical trial conducted at the Tehsil Headquarters Hospital Takhtbhai Mardan. One hundred and sixty patients with AGA were selected and divided into two groups, 80 in each. Group A received 4 sessions of PRP alone, 4 weeks apart while Group B was treated with PRP in combination with topical 5%procapil solution applied twice a day. Final results are calculated at the end of 6 months using 7- 7-point patient' satisfaction and dermatologist evaluation scoring systems.

Results: The mean age in Groups A and B was 29.34±5.3 & 30.22±4.8 respectively. Disease duration was comparable between both groups. At the final Assessment Greater proportion of patients in group B achieved better scores on Dermatologist evaluation and Patient satisfaction scales (p-value<0.05).

Conclusions: It has been established that combining PRP with 5% Procapil yields better results in treating AGA compared to PRP used alone.

Background: Autoimmune encephalitis (AIE) has been ranked as the third most common cause of encephalitis after viral encephalitis and acute disseminated encephalomyelitis. The estimated incidence is 5-8 cases per 100,000 population. The objective of this study was to develop a cost-effective test for detection of anti NMDA R antibodies by using in house prepared rodent brain tissue sections which could facilitate timely diagnosis and management of anti NMDA R Encephalitis, which if left undiagnosed may prove fatal.

Methods: A total of 500 samples sent for autoimmune encephalitis related antibody testing were included in this cross-sectional study from April 2019 to March 2021 at department of Immunology, Shifa International Hospital (SIH), Islamabad. Rodent brain was dissected to prepare tissue sections on which samples were tested by Indirect Immunofluorescence. Simultaneously samples were tested on cell-based assay (CBA) which is gold standard for testing anti NMDA R antibodies. Sensitivity, specificity, positive and negative predictive values were calculated.

Results: Median age of patients who tested positive for anti NMDA encephalitis was 19 years (range: 1 to 57). Out these 76% were female and 24% males. 5% patients tested positive for anti NMDA antibodies out of those suspected to be suffering from autoimmune encephalitis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of rodent brain IF for anti-NMDR antibodies taking CBA as gold standard was 92.6%, 98.5%, 78.1% and 99.6% respectively. The accuracy of the procedure was 98.2%.

Conclusions: Indirect immunofluorescence (IF) on rodent brain tissue sections can be useful as a cost-effective alternate for resource constrained laboratories for timely detection of anti NMDA R antibodies facilitating timely diagnosis and management of anti-NMDA receptor encephalitis patients.

Background: Antibiotic resistance is one of the most urgent public health concerns. Biofilm formation is well linked with chronic wounds, chronic obstructive pulmonary disease, urinary tract infections, and cystic fibrosis. Our goal was to assess the biofilm activity of P. aeruginosa and the individual and combined anti-biofilm forming activity of probiotic Lactobacillus acidophilus and Pomegranate peel extract Punica granatum L., against P. aeruginosa.

Methods: A total of 150 swabs of urine, blood, pus, and CSF were collected from PNS Shifa Hospital Karachi, and P. aeruginosa was isolated and identified according to standard bacteriological methods. The ability of P. aeruginosa to form biofilms was assessed using a microtiter plate assay.

Results: The anti-biofilm forming activity of pomegranate peels extract against P. aeruginosa was 29.26±19.09 whereas the anti-biofilm forming activity of Lactobacillus acidophilus against P. aeruginosa was 0.5×106. When used in combination, there was significant synergistic activity between Punica granatum L. (pomegranate peel extract) and Lactobacillus acidophilus.

Conclusions: The unique synergistic mixture of natural product extracts and probiotics has demonstrated more efficiency against rapidly evolving pathogens, serving as promising candidates for developing biofilm inhibitors and perhaps proving as possible environmentally friendly agents against bacteria that produce antibiotic-resistant biofilms.

Background: Venous thromboembolism (VTE) ranks as the third most common cause of vascular death following myocardial infarction and stroke. VTE is a prevalent illness, particularly in the elderly, and is linked to a high recurrence rate, substantial healthcare costs, and reduced survival rates. The Objective of the study was to investigate the impact of using the VTE risk assessment (VTE-RA) tool and thromboprophylaxis (TP) on all adult patients hospitalized.

Methods: This study was conducted at a single centre using a prospective cross-sectional design to compare data before and after an intervention at a tertiary referral hospital in Pakistan from May 2019 to February 2020. All adult inpatients over the age of 18 were eligible for inclusion.

Results: A total of 1,200 patients were screened in the study. The majority of these patients were medical 701(58.42%) and 499(41.58%) were surgical. The mean age of patients was 59.02±1.40 years. The male patients were 690(57.55%) as compared with females were 510(42.5%). The average stay in hospital was 8.01±1.11 days. At that time, there was no official RA instrument implemented. Researchers documented any written proof of RA in patients' medical records as "RA completed." 190(15.83%) out of all charts evaluated had a recorded VTE risk assessment. TP was prescribed to 450(37.5%) patients, which accounts for of the total. Risk factors for VTE in high-risk patients.

Conclusions: VTE risk assessment, prescribing adequate thromboprophylaxis, and integrating it into practice is challenging. The majority of hospitalized patients investigated were at a high risk of having venous thromboembolism (VTE). The most prevalent risk factor for developing VTE is old age, however, only few hospitalized patients were actually given thromboprophylaxis.

Background: There is substantial number of youth's population belong to age group 18-25 years contributes 11% of the total population in Thailand. According to the ASEAN Youth Development Index (AYDI) ranking, Thailand is ranked 8th out of 10 countries in terms of improvement in health and well-being and social participation of youth in the country. Body mass index includes an appropriate weight and height for adult population, that is important indicator for healthy young subjects. The objectives of this study were to assess the prevalence of Body Mass Index (BMI) and affected factors among the university students.

Methods: This study was conducted on the sample of 300 students by multiple stage random sampling technique. A pretested and piloted questionnaire were used in this study. Factors affected BMI were analyzed by using Multiple Linear Regression (MLR). A written consent was taken prior to conduct the data collection.

Results: The variables that affected the student's BMI were Socio-demographic factors such as; gender and Body Mass Index of the mothers and health behavioural factors, including physical activity variables had a statistically significant effect on the student's BMI (p<0.001), which could explain 91.10 % of the variation in BMI. The mean of BMI was 21.50±4.655 SD. Lower than half of students (47%) had the normal BMI. However, the BMI of overweight /obese students was up to 26.67%.

Conclusions: Study concluded that the factors like; gender, maternal BMI, physical activity were significantly effects on the BMI of university students in Thailand.