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

Background: Temporomandibular joint (TMJ) disorders represent a significant health concern affecting a substantial portion of the population worldwide. The management of TMJ disorders often involves a multifaceted approach including physiotherapy techniques, manual exercise interventions, patient education, and medication therapy. The purpose of this research is to examine the "Effectiveness of manual therapy, and physical therapy in conjunction with patient education for temporomandibular disorders".

Methods: Forty patients with TMDS were randomized into two groups: one for home physical therapy and the other for manual therapy plus physical therapy. Patient education and counseling were done in both groups. the patient had assessments both before and after.

Results: The study made a comparison of two groups: one received physical therapy only (n=20) and the other group received a combination of physical and manual therapy (n=20). There were no significant differences between the two groups in terms of age, gender distribution, or the affected side of the face (p>0.05).

Conclusions: For TMJ issues, physical therapy patient education is a useful therapeutic method. Moreover, combining these modalities with manual therapy improves results beyond what would be achieved with just these modalities alone.

Background: Keratoconus is a progressive ectatic disease of the cornea leading to central corneal thinning, protrusion and permanent visual impairment in untreated cases. It is affecting young children with strong association to vernal keratoconjunctivitis a common disease of Asian countries. Corneal collagen cross linkage (CXL) is standard procedure to stop progression of keratoconus. In this research article we used trans-epithelial accelerated corneal cross-linking to check its efficacy in stopping the progression of disease as quick and safe procedure with less chances of complication than standard CXL protocol.

Methods: The study was carried out in Khyber Teaching Hospital from November 2022-October 2023. The sample size calculated was 36 with sampling technique of non-probability consecutive convenience sampling method.

Results: The mean age of the patients was 19.157±3.53 years. Post corneal cross-linking, at 6 months follow-up showed that in 94.44% of the patients, no progression of keratoconus was noted. Improvement in vision was recorded in 44.44% of patients. A positive correlation was detected between pre- and post-treatment patients in visual acuity, keratometry and pachymetry.

Conclusions: The trans-epithelial accelerated corneal collagen crosslinking is a safe and quick procedure for stopping the progression of keratoconus associated with less morbidity and complications.

Surgical site infections are a common complication of surgery with a high prevalence in lower middle-income countries (LMICS). Excessive focus on antibiotic prophylaxis to prevent surgical site infections while neglecting other precautions like aseptic measures, patient nutrition, proper wound care has resulted in the emergence of antibiotic resistant microbials. Such organisms are a menace to healthcare. They cause prolonged hospital stay, use of expensive drugs, increased mortality and morbidity and overall, greatly increased cost of care per patient. We present a case of extreme drug resistant Acinetobacter spp causing surgical site infection following abdominal surgery, from Peshawar, Pakistan. Our patient was an 18-year-old lady who had undergone abdominoplasty following which she developed high grade fever, pain in abdomen and wound discharge. Empiric antibiotics treatment did not improve her condition. Culture and sensitivity report showed the growth of Acinetobacter spp. Which was resistant to almost all of the commonly used antibiotics, with the exception of tigecycline. Patient was treated with tigecycline which resolved her fever and wound infection and she was discharged in a stable condition. We believe our case highlights the importance of antibiotics stewardship and is a wakeup call to healthcare professionals and policy makers to take necessary steps to herald the danger of antibiotics resistance before it is too late.

Background: Palate, a midface bone, shapes the face and supports buttresses. Palatine process of maxilla and horizontal plate of palatine bone constitute it. Palatal bone is thicker anteriorly and laterally than posteriorly and centrally. Palatal fractures occur with maxillary fractures. Palatal-maxillary fractures occur 8-46.4% of the time.2,5 Palatal fractures can cause palatal ecchymosis in closed fractures and lacerations of upper lip, palatal mucosa, incisor tooth loss, or occlusal disruption in displaced fractures. The objective was to determine the surgical outcome of palatal fractures with locking plates as external fixator vs. alveolar plating in terms of frequency of oronasal fistula formation.

Methods: A Randomized control trial was carried out in Department of Oral and Maxillofacial surgery, Pakistan Institute of Medical Sciences, Islamabad. between 14th July, 2017 to 14th July, 2018. Lottery split patients into groups A and B. Data was collected on designed questionnaire and was entered and analyzed using SPSS v22. Chi-square was applied to check the association.

Results: A total of 130 patients were enrolled in the trial based on the predefined inclusion criteria. The average age of participants in the research was 41.16 years with a standard deviation of 10.44. Of the total participants, 88 (67.7%) were male and 42 (32.3%) were female, as per the inclusion criteria. The occurrence rate of oronasal fistula development in both groups, namely palatal fractures treated with locking plates as an external fixator vs alveolar plating, was 1 (1.5%) and 7 (10.8%) respectively. This difference was found to be statistically significant with a p-value of 0.029.

Conclusions: Osteosynthesis using 2.0 mm locking plates as external fixator had a lower rate of oronasal fistula than alveolar plating. Future investigations at numerous configurations are needed to determine which approach is best. such that a regular strategy will reduce infection, fistula development, and necrosis afterwards.

Background: Scabies is a significant skin problem in the developing countries due to its increased incidence, complications and financial implications. The aim of this study is to highlight the endemicity of scabies in our population and its clinical manifestations including various complications. The study was conducted to determine the frequency and clinical manifestations of scabies in patients presented to dermatology outpatient department (opd), Ayub teaching hospital, Abbottabad.

Methods: This cross-sectional study was conducted on 1404 patients suspected to have scabies. The demographic and clinical features of scabies presentation was recorded on a questionnaire by interview. The skin scrapings were observed under microscope after preparing 10% KOH mount.

Results: During the study period, out of 1404 patients, 339 patients with scabies were identified, with frequency 24.14%. The mean age calculated was 21.18 years. The frequency of scabies was 56% (190) in males while 44% (149) in females. All studied patients had pruritis (male =190. female =149). 89.1% had papules, 39.8% had excoriations on their bodies, 15.6% had impetiginization, 12.7% had eczema and only 3.2% of total had blisters. It was observed that complications like impetigo, eczema, blisters were more in patients living in unfavorable conditions.

Conclusions: The results of the study showed that scabies is a common skin infestation in our population. It is recommended that awareness programs be implemented at primary healthcare level so that necessary measures can be taken to control this preventable and communicable disease.

Ecthyma gangrenosum is a rare and severe skin disease that is typically accompanied by a systemic infection caused by Pseudomonas aeruginosa bacteria. It manifests as painful, necrotic lesions surrounded by redness and including a noticeable black eschar in the centre. The majority of ecthyma gangrenosum instances occur in immunocompromised individuals, such as those with significant underlying medical conditions or those who are neutropenic. We present a case of 5-month-old vaccinated female child, treated for dengue fever 2 weeks back presented to the ER at our facility in a critical state with complaints of pus draining from the right ear, right thigh discoloration and swelling, and swelling of the left cheek, along with difficulty in feeding. On examination, she was afebrile, capillary refill test of more than 4 seconds and random blood sugar of 192 mg/dL. On physical examination, her GCS was 8/15, her pupils were reactive to light, and she was responsive to pain, she appeared pale, and her skin and peripheries were cold. Following the detailed history and physical examination findings, a provisional diagnosis of septic shock and Ecthyma Gangrenosum was established.

Background: Urothelial carcinoma is a subtype of urinary bladder cancer which carries a higher morbidity and mortality worldwide. It is estimated that 90% of the patients presenting to the hospitals with history of bladder cancer are diagnosed with urothelial carcinomas. Objective of the study was to evaluate the strength of EGFR expression and its prognostic role in urothelial carcinoma. It was a cross-sectional study conducted at the Rehman Medical Institute Peshawar from July 2022 to February 2023.

Methods: A total of 98 specimens of patients diagnosed with urothelial carcinoma were examined in histopathology department. Patients with other malignancies were excluded. Demographic characteristics of participants, tumour grading, invasion of the surrounding structures and EGFR expression was recorded, and data analysis was performed with SPSS-23.

Results: Mean age of the participants was 58.68±8.61 years. Gender distribution revealed 67(68.4%) males and 31(31.6%) females with a male to female ratio of 2.1:1. A total of 61 (62.2%) patients exhibited low grade of urothelial carcinoma while 37(37.8%) patients showed high grade malignancy. Expression of EGFR was not observed in 04 (4.1%) specimens while 62(63.3%) specimens revealed weak to moderate expression and 32(32.7%) showed strong expression of EGFR. Out of 61 patients with low grade of tumour, 04 (6.6%) patients exhibited no expression, 50(80%) patients exhibited weak to moderate expression and 07(11.5%) patients revealed strong expression of EGFR. Out of 37 patients with high tumour grade, 12(32.4%) revealed weak to moderate and 25 (67.6%) revealed strong expression of EGFR. Higher tumour grades and tumours with deeper penetration revealed a strong expression of EGFR with a p-value of <0.001.

Conclusions: Strong expression of EGFR in tumours with higher grade validates its prognostic role and can be utilized for targeted therapy with potentially lifesaving consequences in patients presenting with urothelial carcinoma.

Background: Exhumation of bodies for forensic purposes serves as a pivotal tool in medico-legal investigations, yet there is scant data on the practice within the Pakistani context, particularly in the District of Hyderabad. Aim & Objective were to investigate the prevalence and outcomes of exhumations in Hyderabad, contributing to the knowledge base and understanding the cultural and legal factors influencing post-mortem examinations.

Methods: A descriptive, observational, and retrospective analysis of 95 medicolegal exhumations carried out over two years, examining demographic data, the interval between death and exhumation, putrefactive changes, and the determination of the cause of death.

Results: Of the 95 exhumations, 58 were male and 37 were female, with the majority of the deceased being under 40 years of age. Nearly half of the exhumations occurred within three months post-mortem, and advanced decomposition was a significant obstacle in determining the cause of death, which remained undetermined in 61.05% of cases.

Conclusions: The study revealed a need for timely forensic interventions and highlighted the impact of decomposition on determining the cause of death. It underscores the necessity of advanced forensic methods to improve post-mortem examinations' outcomes. Advance technics are virtual autopsy but we are using old conventional autopsy.

Background: To evaluate the effectiveness of the two flap/incision techniques, viz. the comma incision versus modified ward's incision in mandibular third molar surgery.

Methods: This randomized research comprised of 126 participants, 63 in every group. Male and female patients between the ages of 20 and 45 who had mesio-angular impacted mandibular third molar till the age of 20 to 24 years were enrolled in the research. Patients with specific problems, that is pregnancy, trismus, pericoronitis, horizontally impacted wisdom teeth, and disto-angular impaction, and limited mouth opening in which there was difficulty in access to third molar region due to any reason were omitted from the study. The independent t-test were used to evaluate the mouth opening over groups, and the chi-square test were used to evaluate the pain and edema.

Results: The participants average age was 31.16±9.29 years. On the first day, the comma shaped group reported significantly mild pain (47.6%) compared to the Modified Ward's group (30.2%) (p=0.230). On the seventh day, the comma shaped group reported significantly greater mild pain (63.5%) and decreased severe pain (1.6%) compared to the Modified Ward's group, which reported decrease mild pain (55.6%) and more severe pain (4.8%) (p=0.032). On the first, third and seventh days, mouth opening was also considerably higher in the comma-shaped group than in the Modified Ward's group. On the third and seventh days, swelling was much decreased in the comma-shaped group than in the Modified Ward's group.

Conclusions: Our study delivers some proofs that the comma-shaped incision is more effective than the modified Widman's incision at promoting good mouth opening and decrease post-operative edema and discomfort after flap surgery.

Background: The purpose of the study was to compare the mean post-operative pain in patients undergoing phacoemulsification for cataract with topical anaesthesia vs. retrobulbar anaesthesia.

Methods: An interventional study was carried out in a tertiary care hospital of Islamabad. The study duration was from 30th March 2021 to 29th September 2021. The adopted sampling technique was consecutive sampling. The sample size was 180 subjects divided into two groups of 90 each. Through the use of a lottery, patients were split into two groups of 90 each. Patients in group A received topical anaesthesia, whereas individuals in group B received retrobulbar anaesthesia. An Ophthalmologist performed a retrobulbar block on Group B using a 23-gauge needle and 5 mL of 2% Lidocaine. The researcher observes the patients for post-operative pain. SPSS 25 version was used for statistical analysis.

Results: The research study included 180 patients in total. Participants ranged in age from 40 to 70, with a mean age of 56.26±6.31 years, and 46% male vs. 54 % females. The study found the post-operative pain at 45 minutes after topical anaesthesia was 0.60±0.67 and after retrobulbar anaesthesia was 1.40±0.90 in patients undergoing phacoemulsification for cataract surgery. The results showed that Group A feel less pain compare to Group B and the significance value was (p .0001).

Conclusions: The study concluded that topical anaesthesia is usually a best alternative for retrobulbar anaesthesia. The patient feel less pain with topical compared to retrobulbar anaesthesia.