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

Mature cystic teratomas, commonly known as dermoid cysts, are prevalent benign ovarian tumors that originate from germ cells and mature into diverse tissue types. They are usually asymptomatic but can lead to complications like torsion, rupture, or malignant transformation. Endometriosis is a condition in which endometrial tissue grows outside the uterus and it is commonly associated with pelvic pain and infertility. We report a case of a 27-year-old woman who presented with a history of lower abdominal pain and dysmenorrhea. Initial ultrasonography revealed a complex cyst in the left ovary which, on a later Magnetic Resonance Imaging (MRI) scan, proved to be two distinct cystic lesions within the same ovary. Subsequently, a laparatomy and ovarian resection was done, and histopathologic examination confirmed the coexistence of a mature cystic teratoma and an endometrioma in the left ovary. This case report highlights the unique occurence of these two conditions simultaneously, the challenges of differentiating these coexisting conditions and emphasizes the importance of utilizing multiple imaging modalities to achieve an accurate pre-operative diagnosis.

Background: This research aims to assess the treatment outcomes and chemotherapy duration required for the normalization of Human chorionic gonadotropin (HCG) levels in patients diagnosed with Gestational Trophoblastic Neoplasia (GTN), encompassing both benign and malignant forms of the condition.

Methods: This retrospective study included GTD patients treated with chemotherapy in a single oncology clinic from January 2016 to May 2022. Clinical data were gathered from electronic records of the patients.

Results: During the study period, a total of 24 patients diagnosed with GTD underwent chemotherapy, with a median age of 32 years (range: 18-51). Intramuscular Methotrexate was the primary single-agent chemotherapy utilized in 20 cases (83%) for low-risk disease, while the EMA-CO regimen was the predominant combination chemotherapy employed in 3 cases (13%) for high-risk disease. The median number of chemotherapy cycles administered was 2 (range: 1-16), with a median duration of 4 weeks (range: 1-16) required for Human chorionic gonadotropin (HCG) normalization. Approximately half of the patients (n=10, 47.5%) transitioned to second-line combination chemotherapy, with a median normalization duration of 4 months. Four patients (40%) subsequently received third-line combination chemotherapy using the EMA-CO regimen. Initial complete response was achieved in 11 patients (47%) with first-line treatment, while 10 patients (43%) required second-line chemotherapy and 4 patients (17%) necessitated third-line EMACO chemotherapy. Of the 24 patients, 22 achieved complete response, while 2 patients are currently undergoing treatment.

Conclusions: All patients successfully attained complete response with chemotherapy. The median duration of chemotherapy for achieving normalization of HCG was 4 weeks, equivalent to 2 cycles. Notably, only 4 patients necessitated third-line chemotherapy following single-agent chemotherapy in the first and second lines.

Background: Since the 1980s, autologous fat grafting has been one of the most widely used methods in plastic surgery to treat volume and contour problems. There are many advantages of autologous fat, i.e., it is cheap, biocompatible, and readily available autologous tissue in large quantities, minimal morbidity. Objective was to compare the outcomes of fat grafting combined with STSGs and STSGs alone in patients with chronic non-healing wounds presenting at a tertiary care hospital.

Methods: It was a prospective cohort study carried out at the Department of plastic surgery, Civil hospital Karachi, Pakistan from 11th April to 12th October 2023. Patients aged 18-60 years with chronic non-healing wounds due to burn, trauma, or infection lasting at least six weeks were included. Group A received fat grafting followed by STSGs, while Group B received STSGs alone. Follow-up for both groups continued for 4-5 weeks, focusing on graft uptake and healing, with successful graft take defined as wound healing upon clinical examination. Data was analyzed by SPSS version 25.

Results: Overall, the mean age of the patients was 36.47±8.57 years. In Group A, the median width was 8.00 cm, and in Group B, it was 7.00 cm, this difference was statistically significant (p=0.005). The proportion of healing in group A was significantly higher as compared to group B (66.7% vs 30%, (p=0.001). The odds of wound healing were 0.21 times lower in group B as compared to group A (95% CI=0.07 to 0.63). After adjusting for duration and width of wound, the odds of wound healing in group B remains significantly lower as compared to odds of wound healing in group A (OR=0.13, 95% CI=0.03 to 0.54).

Conclusions: The combination of fat grafting with split-thickness skin grafts holds promising result for improved wound healing in patients with chronic non-healing wounds.

Background: With the global rise in obesity rates, bariatric surgery has emerged as an effective intervention for weight management and obesity-related comorbidities. Bariatric surgery offers transformative potential but demands lifelong adherence to multifaceted care, including nutritional supplementation and vigilant follow-up. Nutritional deficiencies affect 30% to 70% of patients, encompassing vital elements like vitamins (B12, D, folate), minerals (iron, zinc, calcium), and proteins, necessitating continuous monitoring to prevent complications. This comprehensive review explores the multifaceted challenges in post-bariatric surgery patient care, focusing on adherence to nutritional supplementation, follow-up care, and the prevalence of nutritional deficiencies.

Methods: A systematic synthesis of relevant literature was conducted, encompassing studies examining post-operative care practices, adherence to prescribed multivitamin supplements (MVS), rates of follow-up, and nutritional deficiencies in bariatric surgery patients. Nine key studies were analyzed and synthesized to extract critical insights.

Results: Findings revealed a complex landscape of post-bariatric surgery care, marked by both promise and pitfalls. Adherence to MVS regimens emerged as a significant challenge, influenced by factors such as forgetfulness, gastrointestinal side effects, cost concerns, and poor follow-up rate. Lost-to-follow-up rates varied across studies, raising concerns about the continuity of care. Nutritional deficiencies were prevalent, underscoring the importance of long-term monitoring. It highlights the need for tailored patient education, improved doctor-patient communication, and shared decision-making processes to enhance adherence and follow-up care.

Conclusions: This review underscores the intricate nature of post-bariatric surgery patient care, emphasizing the critical role of adherence, follow-up, and nutritional monitoring. Disparities in care among different regions of the world with varying healthcare systems are acknowledged as a significant challenge; addressing these challenges necessitates a collaborative effort among healthcare providers, patients, and policymakers to optimize the long-term well-being of individuals who undergo bariatric surgery.

Background: Heart failure is a long-term health condition that is characterized by multiple re-admissions throughout the patient's life. The economic burden and the impairment of quality of life are too prominent in patients with heart failure. The aim of the study was to determine re-admission rate and predictors of re-admission in patients with heart failure at Ayub Teaching hospital Abbottabad.

Methods: A data of 350 patients with heart failure who were admitted & readmitted to the coronary care unit with heart failure were included in this study. Data was collected to determine the common factors that may dictate their readmission to hospital.

Results: Over all re-admission rate was 58.28 %(n=204) for the patients in our study cohort. Regarding readmission rates within a 90-days period, 41.7% (n=146) of the sample had no readmission events, 35.1% (n=123) had one readmission, and 23.1% (n=81) experienced two or more readmissions. In terms of comorbid conditions, 36.9% (n=129) of the patients had a diagnosis of diabetes mellitus, while 57.7% (n=202) had hypertension. There was a statistically significant association between readmission within 90 days following first hospitalization for heart failure and diabetes mellitus, Increased Heart Rate, Nephropathy and an increased Neutrophil: Lymphocyte ratio (p<0.05).

Conclusions: Diabetes mellitus, elevated heart rate, the presence of nephropathy, and an increased neutrophil-lymphocyte ratio were found to be independent predictors of subsequent heart failure readmission. These risk factors could potentially serve as simple indicators for forecasting the likelihood of heart failure readmission following patient discharge.

Background: Reconstruction of the lids is a significant challenge for ocular plastic surgeons as it requires the greatest functional and cosmetic outcomes. This study aimed to share the experience of Tenzel rotational flap in upper and lower lid reconstruction of anterior lamella at a tertiary eye care hospital of Karachi, Pakistan.

Methods: 10 patients with upper and lower eyelid defects over a period of 6 months were a part of this prospective interventional clinical study. The examination on the subject was performed at tertiary care hospital of Karachi, Pakistan after ethical approval. Pre and post operation evaluation LPS (Levator palpebrae superioris) action MRD-1 (Margin Reflex Distance-1) values central vertical Palpebral Fissure Height (PFH) were recorded. Data was entered and analyzed on SPSS version 23.0.

Results: For the upper eyelid the preoperative measurements of MRD-1, LPS action, central palpebral aperture were -1.6±1.63 mm, 4.33±1.21 mm and 4.33±1.33 respectively. The postoperative measurements of these parameters were 3.83±0.25 mm, 13.16±1.17 mm and 10.83±0.68 mm respectively. For the lower eyelid the Mean±SD of MRD-1, LPS action, central palpebral aperture preoperatively was 3.62±0.25 mm, 12.75±0.50 mm and 10.75±0.95 mm respectively. Postoperative values of MRD-1, LPS action, central palpebral aperture before operation were 3.83±0.25 mm, 12.75±0.50 mm and 10.75±0.95 mm respectively. The mean incision length in the upper and lower eyelid was 8.50±0.83 and 9.50±0.91 respectively.

Conclusions: Tenzel rotational flap not only helps to heal the upper and lower eyelids but also there is no further requirement of additional surgery for posterior lamella. The study concluded that this technique provides both cosmetically and functionally aesthetics outcomes.

Background: Haemophilus influenza persists as a well-known root of ill health in children throughout the entire world. Before the introduction of the vaccine, Haemophilus influenza remained a well-known and eminent source of septic arthritis, pneumonia, and epiglottitis. Haemophilus influenza, Neisseria meningitides, and staphylococcus pneumonia spreads through respiratory droplets and cause diseases such as meningitis, pneumonia, and other secondary infections related to respiratory diseases. Objective was to analyze the 3D structure of the protein of Haemophilus influenzae by homology modelling to design antibiotics.

Methods: For the effective study of protein, computational tools were used to investigate protein structure and function, Comprehensive microbial resource (CMR) for comparative modelling, Interproscan, BLAST for sequence similarity searching, MODELLER 9.10 for homology modeling, Procheck and Protein Structure Analysis (ProSA) software for assessing model quality and structural validation.

Results: The model showed that it consists of three alpha helices (red) and one beta-sheet. Ramachandran Plot statistics show that 97.4% of the debris is in the favoured region, 0% in the additional allowed region, 2.65% in the generally allowed part, and 0% in the disallowed part. Stability and energy were checked through ProSa. Z score was highly negative which showed that the model is highly stable. The greater the negative value, the more will be the stability of the model.

Conclusions: Cell division protein H11025 was selected. The structure was modelled which has provided all the required information to design antibiotics to control the harmful effects regarding that protein.

Plastic surgeons face unique challenges in reconstructing eyebrows due to their complex anatomy and gender variations. We report a case of a 16-year-old female who presented with post-burn bilateral eyebrow alopecia. Bilateral eyebrow reconstruction was performed with scalp island flaps based on the posterior branch of the superficial temporal artery, which showed good postoperative outcomes. This case showed that the superficial temporal artery island flap continues to be a versatile option for managing eyebrow alopecia, especially in cases of deep burns of the face.

This case report is of a 10-year-old female who presented with complaints of blood in her stool and colicky abdominal pain for the last 1.5 years. Biopsy samples from the rectum and left-sided colon were taken during a colonoscopy, revealing numerous histiocytes having calcified bodies (Michaelis-Gutmann bodies). Diagnosis of Malakoplakia was confirmed with no evidence of dysplasia, malignancy, or granuloma.

Background: Surgical site infections (SSIs) pose significant challenges in healthcare, leading to prolonged hospital stays, increased morbidity, and economic burden. Understanding the interplay between risk factors, preventive measures, and management strategies is crucial for effective infection control in general surgery. This study aimed to comprehensively assess the impact of various risk factors, preventive measures, and management strategies on surgical site infections in the context of general surgery.

Methods: The study was conducted at Jinnah International Hospital, involving a study population of 120 patients undergoing general surgical procedures from May 2023 to April 2024. A retrospective analysis of patient records was performed to identify risk factors associated with SSIs. Additionally, preventive measures implemented preoperatively, intraoperatively, and postoperatively were evaluated. Management strategies employed for treating SSIs were also reviewed.

Results: The analysis revealed several significant risk factors contributing to the development of SSIs, including comorbidities, prolonged surgical duration, and inadequate preoperative preparation. Preoperative measures such as appropriate patient screening and optimization, intraoperative techniques like strict aseptic protocols, and postoperative interventions such as timely wound care significantly influenced SSI rates. Furthermore, effective management strategies such as early detection, antimicrobial therapy, and surgical debridement played pivotal roles in controlling SSIs and reducing associated complications.

Conclusions: Our findings underscore the importance of a multifaceted approach involving identification of risk factors, implementation of preventive measures, and prompt management strategies to mitigate the incidence and impact of surgical site infections in general surgery. Comprehensive infection control protocols tailored to individual patient needs are essential for optimizing surgical outcomes and enhancing patient safety.