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

Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan.

Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan. An interviewer-administered questionnaire was used to collect data, from adults, on demographics, education and socioeconomic status, physical and mental health, reproductive health, child health, health-related quality of life, and self-reported cardiometabolic diseases including Diabetes, hypertension, renal disorders, cardiac failure, angina, and stroke.

Results: A total of 20,715 participants were recruited in the survey including 52.8% (n=10,943) males and 47.2% (n=9,772) females with a mean age of 41 (13.1) years. Data on TB status was available for a total of 14452 participants. The prevalence of TB in Khyber Pakhtunkhwa was found to be 0.49% (n=72) including an almost equal number of males and females [48% (n=34) vs 51% (n=36)], respectively. The mean age of the patients with TB was 47.5 (11.6) years. A higher proportion of people with TB had cardiometabolic diseases compared to people without TB (45.9% vs. 30.9%). Amongst the cardiometabolic disorders, self-reported hypertension (OR: 1.81, 95% CI 1.08-3.02, p=0.02), Diabetes (OR: 3.99, 95% CI 1.95-8.18, p=<0.002), and angina (OR: 3.88 95% CI 1.20-12.49, p=0.02) were positively associated with the occurrence of TB. In the adjusted analysis, only self-reported Diabetes was positively associated with the occurrence of TB (OR: 3.33, 95% CI 1.61-6.88, p=0.001).

Conclusions: There is a higher burden of self-reported cardiometabolic diseases among people with TB, suggesting that this high-risk group should be screened for cardiometabolic diseases, especially Diabetes.

Abstract: Chediak Higashi syndrome (CHS), a rare form of autosomal recessive disorder has been reported globally in less than 500 cases over the past two decades. It clinically manifests as repeated episodes of infection, haemorrhagic sequelae, partial albinism, photosensitivity and late neurological signs (neuropathy, cognitive impairment etc). The pathognomonic morphological finding is the presence of abnormally large intra-cytoplasmic granules, particularly in leucocytes. Almost 85% of CHS cases advance into an accelerated phase, characterized by cytopenias and hemophagocytosis, leading to multi-organ failure.

Presentation: The child in the present case had consanguinity and a positive family history of recurrent infections. She had repeated episodes of bacterial infections. She also had a history of photosensitivity. CBC reported cytopenias. Peripheral smear showed neutrophils with characteristic large sized abnormal intra-cytoplasmic granules. Bone marrow biopsy was performed which also showed similar granules in leucocytes along with hemophagocytosis. Other clinical and biochemical markers also pointed towards hemophagocytic lymphohistiocytosis (HLH), thus patient was diagnosed as CHS in an accelerated phase. She received eight doses of chemotherapy but eventually expired.

Conclusions: The definitive treatment is hematopoietic stem cell transplantation which improves the hematological and immune aspects of CHS but not the neurological. Steps should be taken for early diagnosis and to prevent advancement into the accelerated phase.

Background: Alcohol consumption can have detrimental effects on the liver, as it plays a crucial role in processing and detoxifying substances in the body, including alcohol. Alcohol has the potential to hinder the liver's capacity, which results in a variety of metabolic imbalances and deficiencies. This research aimed to investigate alterations in the liver tissue due to alcohol administered orally, along with exploring the potential protective effects of vitamin E against these alterations.

Methods: An assortment of male pet rabbits (totaling 18) was part of the study. The categorized groups included: Control group A, which received normal saline as a placebo treatment. Experimental group B, administered with an oral dose of a 30% ethanol solution mixed with normal saline. Experimental group C, given an oral dose of a combination containing a 30% ethanol solution, vitamin E, and normal saline. At the end of experiment, blood samples were obtained to assess ALT levels, and liver tissue sections were stained with Hematoxylin and Eosin for microscopic analysis of hepatocyte structure.

Results: Highly significant differences between the blood ALT levels, hepatocyte count/size/nuclear count/size, sinusoids size in control and experimental groups were observed. Vitamin treated rabbits showed preserved morphology of hepatocytes as compared to non-vitamin treated rabbits during alcohol consumption by showing less ballooning of hepatocytes and shrinkage of nuclei which are the main initial signs of hepatocytes damage.

Conclusions: Frequent alcohol intake leads to swift alterations in liver tissue and blood ALT levels over brief spans, yet these effects may be reduced through the antioxidative properties of vitamin E.

Background: Poison is defined as any substance that harms, endangers, or even kills a person irrespective of the quality or quantity. Pakistan is a developing country and farming is the major occupation of most of the population. Due to the easy availability and increased use of pesticides, accidental and suicidal poisoning is very common. The objective of the study is to find out the most common poison used by people in the general population and its frequency in our setup.

Methods: Casualty Department of the Ayub Teaching Hospital in Abbottabad, served as the site of this retrospective investigation. Registrations between January 1st and December 31st, 2023, provided the data. All cases with a history of poisoning were included. Using SPSS 22, the data was analyzed. Sample was limited to those who were admitted when they were still alive. Ethical permission was taken from hospital administration.

Results: The study revealed that poisoning was more common among females and the most common age group affected was 16-22years. 57.8% (52) cases were of suicidal intent while 40% (36) were accidental.

Conclusions: Female and young people are more prone to Aluminium Phosphide (wheat pill) poison. It is a dangerous and lethal poison, so healthcare workers at emergency department ought to be prepared for such cases. Furthermore, its routine use as a domestic pesticide has to be strictly prohibited by creating awareness among the public.

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: 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: 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%).