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

Hydrometrocolpos (HMC) is a rare pediatric condition characterized by significant enlargement of the uterus and vagina due to the accumulation of fluid, generally caused by a blockage in the lower vagina. This disorder typically presents in newborns with the retention of normal genital tract secretions. The following case report highlights the clinical features, diagnostic process, and treatment of HMC in a newborn. A 3-day-old female presented to the emergency with dehydration, inability to pass stool, and feeding difficulties. Upon physical examination, dehydration and abdominal distention was observed. Initial treatments included hydration and antibiotics. Further investigations confirmed hydrocolpos, leading to an HMC diagnosis due to a congenital blockage in the reproductive tract. A pigtail catheter was used to drained 20ml fluid from the uterus and vagina. Significant clinical improvement as observed. After careful monitoring and treatment, including fluid management and nutritional support, the neonate was discharged on a full oral feed regimen, with plans for long-term nephrology follow-up. Conclusions: Early recognition of HMC is essential to prevent critical complications such as urinary obstruction, renal impairment, and potential rupture of the HMC. The clinical manifestations of HMC correlate with the degree of pressure exerted on adjacent organs, commonly causing hydronephrosis and abdominal swelling.

Background: The evolution of reconstructive surgery techniques has significantly improved the management of soft tissue defects across various anatomical regions. In 1972, McGregor et al. devised a pivotal method for generating a flap to cover hand defects. The benefits of this technique, which include a larger skin surface without the need for microsurgery and yielding an easily concealed donor site scar, quickly became a cornerstone in the field, evidencing its widespread acceptance and application. Objective was to compare outcomes such as wound infection, skin flap necrosis and hospital stay between primary closure and tensor fascia lata flap for the reconstruction of groin defects among patients presenting at tertiary care hospital, Karachi, Pakistan.

Methods: It was a prospective observational study carried out at the Department of plastic surgery, Dow University of Health Sciences, Civil hospital, Karachi, Pakistan from 23rd August 2023 to 25th January 2024. Patients who had groin defects after trauma or excision of lymph node of age 20-80 years of either gender were included and divided into two groups. Group A (n=30) had patients who had primary wound closure, while Group B (n=30) had patients who underwent a tensor fascia lata flap procedure for wounds coverage. Both groups were compared in terms of wound infection, skin flap necrosis, and hospital stay following surgery after 4 weeks. Data was analyzed using SPSS version 23.

Results: The overall average age of participants in the study was 35.7±11.18 years. Of 73.3% participants were male and 26.7% were female. Group B (TFL flap reconstruction) demonstrated significantly lower rates of wound infection (p=0.001) and skin flap necrosis (p=0.001) compared to Group A (primary closure). Additionally, the average hospital stay was significantly shorter for Group B than Group A (p=0.001).

Conclusions: TFL flap reconstruction for groin defects significantly reduces postoperative complications, including wound infection and skin flap necrosis, and shortens hospital stays compared to primary closure.

Background: Regadenoson is highly selective A2A adenosine receptors agonist used for stress myocardial perfusion scintigraphy. This study presents our initial experience utilizing Regadenoson as a myocardial perfusion stress agent, aimed to assess the safety of Regadenoson for stress myocardial perfusion scintigraphy.

Methods: Following Institutional Ethical Review Borad approval, adult patients presenting for myocardial stress perfusion scintigraphy were included using non-probability consecutive sampling. Exclusions included second or third-degree AV block, unstable angina, recent myocardial infarction, severe hypotension, or significant heart failure. Demographic data, co-morbidities, vitals, and adverse events were recorded.

Results: Sixty-three patients were included, predominantly male (63.5%), with a mean age of 56.81±12.95 years. Hyperlipidaemia was the most common co-morbidity (47.6%). Systolic and diastolic blood pressure decreased acutely but normalised by 60 minutes. No serious adverse effects occurred, though transient ST segment depression was noted in 8.3% of patients. The most common adverse effects were dyspnoea (23.8%) and headache (21.4%).

Conclusions: Regadenoson is associated with transient haemodynamic changes and non-serious transient adverse effects.

Background: Evaluation of opening pressure (OP) of CSF on lumbar puncture (LP) is an invasive procedure for the confirmation of diagnosis of idiopathic intracranial hypertension (IIH). Sonographic optic nerve sheath diameter (ONSD) measurement is a non-invasive method which can help in the estimation of intracranial pressure (ICP). The study was carried out to find out the correlation between ONSD and OP on LP in patients of IIH.

Methods: The Cross-sectional study was hosted by medical teaching institute, Gajju Medical College, Swabi and Frontier institute of Ophthalmology, Peshawar, from 1st June, 2021 to 31st May, 2023.Total participants were 50, 25 in Group A having diagnosis of IIH and 25 in Group B as control group from general population. The patients in Group A had ONSD assessment followed by measurement of OP and then the process was repeated at two weeks follow up. Participants in Group B had only one assessment of ONSD. Correlation between ONSD and OP was determined. Best cut-off-value for raised ICP was calculated.

Results: The mean ONSD was 5.91±0.63 in Group A and 5.07±0.50 in Group B (p=0.00). The mean OP in Group A was 31.64±3.81 cm H2O initially. The mean ONSD and OP at follow up were 5.18±0.42 and 19.64±3.52 cm H2O respectively. The best cut-off-value was 5.60 mm of ONSD for estimation of raised ICP (sensitivity 88% and specificity 88%).

Conclusions: Sonographic ONSD has a positive correlation with OP on LP in IIH patients and can be used as a non-invasive tool for the assessment of ICP in IIH patients.

Immune mediated necrotising myopathy (IMNM) is a rare autoimmune disease of the muscles belonging to the subset of the idiopathic inflammatory myopathies (IIM). This disease entity has classically been associated with myositis specific antibodies. The hallmark feature in clinching the diagnosis of IMNM would be a muscle biopsy showing muscle necrosis and regeneration in the absence of significant inflammatory infiltrates, interpreted in an appropriate clinical context. The term 'neuromyositis' was previously coined in the year 1893 to describe a concomitant polyneuropathy in patients with polymyositis or dermatomyositis. However, a combined polyneuropathy with IMNM has never been reported in previous literature. We describe a case of a 35-year-old gentleman who presented with a 5-day history of symmetrical bilateral lower limb pain and weakness. Despite a negative autoimmune work-up, his muscle biopsy was suggestive of IMNM. A nerve conduction study done had also revealed a superimposed non-length dependant axonal polyneuropathy. The patient had responded well to steroids and is now under remission. This case serves to highlight a rare entity of seronegative IMNM superimposed with an axonal polyneuropathy.

Inflammatory biomarkers are molecules that can offer vital information on the intricate chain of happenings and molecular processes underpinning the pathophysiology of any inflammatory disease. They can be measured in various biological samples such as blood, urine, or saliva, and are used as indicators of the presence and severity of inflammation. Measuring salivary inflammatory biomarkers is a non-invasive and relatively easy way to monitor inflammation, and it has been shown to be a useful tool in the diagnosis and management of various oral and systemic inflammatory diseases. Irisin is a novel anti-inflammatory protein and its implication and diagnostic role in inflammation have been widely studied; however, not much have been studied in oral inflammation per se. Irisin is predominantly downregulated in several inflammatory conditions, including obesity, type 2 diabetes, periodontitis, and cardiovascular diseases. This suggests that irisin may be involved in the inflammatory process, but more research is needed, especially of salivary irisin to understand its precise role. Overall, the role of irisin as an inflammatory biomarker is still an area of active research, and more studies are needed to determine its diagnostic and therapeutic potential. This review highlights the diagnostic and therapeutic potential of irisin in various systemic and oral inflammatory conditions.

Background: Atrial Fibrillation is a heart arrhythmia causing stroke and associated with many modifiable risk factors. A number of strokes can be prevented by identifying these risk factors and adopting primary prevention and anticoagulation.

Methods: This Cross-Sectional observational study on 160 stroke patients; identified frequency and risk factors of Atrial Fibrillation and their prior anticoagulation status. Correlation of risk factors associated with Atrial Fibrillation in stroke was done through Chi Square test.

Results: Among 160 patients, 72 (45%) were males and 88 (55%) females. Mean age was 64.29±13.44SD with range of 31-92 years. Among patients, 113 (70.6%) had ischemic stroke, and 32(20%) had Atrial Fibrillation. Among risk factors, 136(85%) had hypertension, 37(23.1%) had diabetes, 52(32.5%) had ischemic heart disease, 27(16.9%) had valvular heart disease, 9 (5.6%) had hyperthyroidism, 37 (23.1%) had hyperlipidemia, 17(10.6%) had chronic respiratory disease, 19 (11.9%) were smokers, 61(38.1%) had family history of stroke, 12(7.5%) were obese. Only 8 of 32 with AF (25%) had prior anticoagulation. Correlation analysis of risk factors show ischemic heart disease (p=.000285), rheumatic heart disease (p=.000061), hyperlipidemia (p=.0004), chronic respiratory disease (p=.003175) and smoking (p=.00148) as significantly associated with Atrial Fibrillation.

Conclusions: Ischemic heart disease, hyperlipidemia, smoking and respiratory disease are significant risk factors for stroke in non-valvular atrial fibrillation. All these factors are modifiable so primary prevention and prophylactic anticoagulation should be emphasized.

Background: Giant cell tumour of bone (GCTB) is a rare, locally aggressive benign bone tumour with slight female sex predilection and affecting young adults 20-40 years of age. World health organization (WHO) has recently categorized GCTB as an intermediate malignant tumour. GCTB is known to be driven pathologically via expression of pro-osteoclastic signals by stromal cells. This is mediated precisely via the expression of RANKL by stromal cells acting in an autocrine fashion on RANK receptor-positive osteoclast-like giant cells and their precursors. While the treatment is primarily surgical, we hypothesized that preoperative denosumab therapy facilitates conversion to a less morbid procedure in an aggressive campanacci grade 3 GCTB, otherwise amenable to joint resection and reconstruction/arthrodesis.

Methods: A prospective, single arm, interventional study was conducted in Orthopaedics and radiation oncology department of combined military hospital (CMH) Rawalpindi. The duration of study was 36 months. Patients were recruited by purposive sampling technique as per inclusion/exclusion criteria. Denosumab was administered as preoperative adjuvant therapy for 3 months. Pain was assessed utilizing Brief Pain Inventory -Short Form (BPI-SF) and functional status was assessed as per Musculoskeletal tumour society score at baseline and 12 weeks after commencement of denosumab therapy. The intent of surgery pre and post denosumab therapy was ascertained.

Results: Total of 23 patients were a part of this study. Mean pain scores and MSTS scores prior to and after denosumab were statistically significant with p-value <0.01. Pre-denusomab, there was inclination towards resection arthroplasty as the treatment procedure (56.5%). After denusomab therapy, intralesional curettage was choice of procedure with intent executed for 78.3% of cases.

Conclusions: Denosumab has potential role for giant cell tumour of bone, it makes a less morbid surgery technically feasible. However, recurrence needs to be probed in long term follow up studies.

Background: Gynaecological laparoscopic surgery is a minimally invasive surgical technique that can cause pain and discomfort in the postoperative period. To manage this pain, various analgesic techniques have been employed, including rectus sheath block (RSB). Bupivacaine is a long-acting local anaesthetic that has been used in bilateral rectus sheath block (BRSB) for postoperative pain relief after laparoscopic surgery. The objective of this study was to assess the impact of bupivacaine's bilateral rectus sheath block (BRSB) on post-laparoscopic pain relief with its intraperitoneal (IP) administration.

Methods: This prospective randomized, double-blind, clinical trial was done at the department of obstetrics and gynaecology Patel hospital Karachi, from September 2022 to February 2023. All the adult female patients aged 18 years or older undergoing elective gynecological laparoscopic surgery and willing to receive RSB as a postoperative analgesic technique were included. After taking informed consent, the patients were randomly allocated into two groups. In group I, BRSB was performed with 25 mg of bupivacaine and in group II was given 25 mg of bupivacaine intraperitoneal. Visual analogue pain score (VAS) was used to evaluate the postoperative pain at 1st, 6th, 10the and 24the hours postoperatively. Data was collected via study proformas.

Results: The study comprises 60 patients who underwent gynaecological laparoscopic surgeries, with group I having an average age of 38.10±11.19 years and an average was BMI of 27.07±5.15 kg/m2, and group II having a mean age of 41.36±11.18 years and an average BMI of 27.51±4.22 kg/m2. Average (VAS) was significantly lower in group I compared to group II at 1st, 6th, 10th, and 24th hour, with a statistically significant p-value of 0.001. The average duration of surgery was statistically insignificant in both groups, as an average duration in group I was 32.14±12.20 minutes and in group II was 31.0±19.21 minutes.

Conclusions: The use of bupivacaine in a bilateral rectus sheath block (BRSB) with was observed to be more effective for post-laparoscopic pain relief compared to 25 mg of bupivacaine intraperitoneal administration.

Background: Urinary catheterization is considered as one of the most common, frequently performed and basic skill in patient care while catheter associated urinary tract infections (CAUTI) in the most common nosocomial infection. Catheter material plays an important part in terms of infection and bacterial colonization. With this study, we aim to compare the rate of bacterial colonization in two most commonly used catheter type; Latex and Silicone indwelling catheters in males with acute urinary retention.

Methods: This 2-arm randomized control trial was conducted in Allied Hospital Faisalabad over the period of 2 months, from Jan 2023 to February 2023. Seventy-two male patients with acute urinary retention were included in this study. Patients were divided into 2 groups. Intervention groups was catheterized with silicon indwelling catheter and control groups was catheterized with latex indwelling catheter. Patients were discharged without antibiotics prescription and at 5th day catheter was removed and tip of catheter was sent for culture and sensitivity. Result was received on OPD basis and added in the record.

Results: In comparison to the latex catheter, the silicone catheter showed significantly reduced bacterial colonization. In the Silicon indwelling catheter group, out of 36, 8 patients catheters showed bacterial growth while 28 exhibited no growth. In the Latex indwelling catheter group, out of 36, 17 patients catheters showed bacterial growth while 19 exhibited no growth.

Conclusions: The findings showed that, on the fifth day of catheterization, silicone indwelling catheters significantly reduced the rate of bacterial colonization when compared to latex indwelling catheters.