Journal of the Pakistan Medical Association最新文献

Objectives: To determine the association of fatty liver ultrasound grade with hepatic venous waveform, hepatic vein damping index and portal vein pulsatility index.

Methods: The cross-sectional, prospective, analytical study was conducted at the Radiology Department of the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, from January 1 to June 30, 2023, and comprised patients who underwent ultrasound scans with a low-frequency curvilinear transducer. Data was collected on fatty liver grade, middle hepatic vein waveform, middle hepatic vein damping index and portal vein pulsatility index. The relationship of fatty liver grades with hepatic vein waveform, hepatic vein damping index and portal vein pulsatility index. Data was analysed using SPSS 27.

Results: Of the 45 patients, 26(57.88%) were females and 19(42.22%) were males. The overall mean age was 43.16±11.55 years. Among the patients, 36(80%) had a grade-1 fatty liver, while 9(20%) had a grade-2 fatty liver. Mean middle hepatic vein damping index between grade 1 and grade 2 fatty liver patients was significant (p<0.001). The mean portal vein pulsatility index of grade 1 fatty liver patients was significantly different from grade 2 patients (p<0.001). Fatty liver sonological grade had a moderate and direct relationship with middle hepatic vein damping index (r=0.652), but an inverse relationship was observed between fatty liver sonological grade and portal vein pulsatility index (r=-0.427).

Conclusions: Significant correlations existed between ultrasound fatty liver grade and hepatic vein waveforms, hepatic vein damping index and portal vein pulsatility index.

Dengue fever is a common infectious disease that is caused by the dengue virus. This report presents the cases of two patients, a 20-year-old male with history of left renal transplant and a 34-year-old female with Acute Myeloid Leukaemia, who presented at Shifa International Hospital, Islamabad, with sudden, painless decreased vision following a dengue fever infection. The patients' clinical presentations, visual outcomes, fundus findings, and management approaches were carefully documented over six months. Both the patients were treated with non-steroidal anti-inflammatory eye drops, with Case 2 additionally receiving intravenous Methylprednisolone and surgical intervention for recurrent vitreous haemorrhage. They were regularly followed-up and were monitored with serial OCT scans. Both the patients showed improvement in subsequent fundus examinations, OCT scans revealed resolution of intra-retinal oedema and retinal thinning. However, there was only minimal improvement in best corrected visual acuity (BCVA) for both the patients. This case report highlights the importance of comprehensive ophthalmic evaluation, regular follow-up, and appropriate management in patients with post-dengue fever retinopathy.

Bone scintigraphy is primarily used for the assessment of osseous structures, soft tissue uptake of Tc-99m Methylene deoxy- phosphonate (MDP) is unusual in normal circumstances and may lead to unsuspected diagnosis. We present a case highlighting the importance of studying the soft tissues to assess for findings other than osseous on bone scintigraphy in a patient with prior history of breast carcinoma.

This opinion piece reviews the history of malnutrition related, or malnutrition modulated diabetes mellitus (MMDM). It reviews various terms used to describe this condition, and analyzes current efforts at renaming it as type 5 diabetes. It provides a simple, yet effective diagnostic checklist, based upon Ahuja's diagnostic criteria, for MMDM. While research is certainly required to define and describe this entity, renaming it will create confusion and chaos, rather than comprehension or clarity.

The vermiform appendix is a vestigial organ in humans. The congenital absence of the appendix was first described by Morgagni in 1719. Since then, more than a hundred such cases have been reported. The estimated incidence of this condition, based on autopsy studies and laparotomies, is 1 in 100,000, which is exceptionally rare. Nevertheless, given that acute appendicitis is one of the most common causes of abdominal pain, and is the most common indication for emergency abdominal surgery, the practising surgeon needs to be aware of this clinical entity as it can potentially lead to diagnostic confusion and even iatrogenic injuries. Hereby, we report the case of an 18-year-old girl, who presented with symptoms suggestive of acute appendicitis and was found to have congenital absence of the appendix intra-operatively.

Objective: To analyse clinical and radiological outcomes of central laminectomy and lateral mass screw fixation from C3 to C6 in multilevel cervical spondylotic myelopathy.

Methods: The retrospective cohort study was conducted at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, Pakistan, from March 1 to August 31, 2023, and comprised data of patients who underwent central laminectomy and lateral mass screw fixation from C3 to C6 by magrel technique between March 2015 and August 2022, and were followed up till 1 year. Clinical outcomes were evaluated according to the Nurik grade and the modified Japanese Orthopedic Association scoring system. Radiological outcomes were assessed by Cobb's method. Data was analysed using SPSS 27.

Results: Of the 66 patients, 56(86.2%) were males and 9(13.8%) were females. The overall mean age at the time of surgery was 56.81±10.96 years (range: 45-75 years). Mean preoperative cervical lordosis was 10.5±3.70 and postoperative lordosis was 21.44±8.20. The mean preoperative and postoperative modified Japanese Orthopedic Association scores were 4.21±1.79 and 7.08±2.64, respectively. There were 32(49.2%) patients in Nurik grade 0, 2(3%) in grade 1, 10(15.4%) in grade 4, 12(18.5%) in grade 5 and 10(15.4%) in grade 6. There were 5(7.6%) cases of intraoperative iatrogenic dural tears, which were repaired with 7.0 prolene, and 7(10.6%) patients' wound infections were treated with wound wash and intravenous antibiotics.

Conclusions: Cental laminectomy and lateral mass screw fixation in multilevel degenerative spondylotic myelopathy were found to be safe and effective procedures with good to excellent results.

Objective: To compare the short-term clinical outcomes of manipulation under general anesthesia versus ultrasound-guided neuronal block in patients with primary frozen shoulder.

Methods: The retrospective, single-center study was conducted at the Department of Orthopedics, Yeniyuzyil University, Istanbul, Turkiye, from April 10 to May 10, 2021, and comprised data from January 1, 2010, to December 31, 2020, of patients having frozen shoulder. They were divided into manipulation under general anaesthesia group A, manipulation under ultrasound-guided neuronal block group B, and control group C that received selfadministered physical rehabilitation exercises. Preoperative passive range of motion and pain scores were recorded, and postoperative assessments were conducted at two different follow-up points. Data was analysed using SPSS 23.

Results: Of the 54 patients, there were 18(33.3%) in group A with mean age 43.88±12.48 years, 18(33.3%) in group B with mean age 48.67±13.57 years, and 18(33.3%) in group C with mean age 50.68±11.89 years. Each group had 10(55.5%) females and 8(44.4%) males (p>0.05). Groups A and B showed significant improvements compared to baseline measures (p<0.05). Group A demonstrated greater improvement in flexion immediately after the intervention (p<0.05), while group B showed superiority in abduction, external rotation and pain relief one week after the intervention (p<0.05). No major complications were observed in any group.

Conclusion: Manipulation under general anaesthesia and ultrasound-guided neuronal block were both effective treatment options for primary frozen shoulder, with potential advantages in specific outcomes.

Objective: To compare serum levels of spindle and kinetochore-associated complex subunit 1 in oral potentially malignant disorders and oral squamous cell carcinoma.

Methods: The analytical, cross-sectional study was conducted from July 2022 to April 2023 at the Department of Otolaryngology of Dr Ruth Pfau Civil Hospital, Karachi, Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi, and the histopathological section of the Dow Diagnostic Reference and Research Laboratory at the Dow University of Health Sciences, Karachi, and comprised serum samples of patients with oral squamous cell carcinoma and oral potentially malignant disorder. The concentrations of serum spindle and kinetochore-associated complex subunit 1 were determined using the enzyme-linked immunosorbent assay method. Data was analysed using SPSS 21.

Results: Of the 90 patients with age ranging 30-90 years, 45(50%) had oral squamous cell carcinoma; 34(75.6%) males and 11(24.4%) females. There were 45(50%) patients with oral potentially malignant disorders; 35(77.8%) males and 10(22.2%) females (p>0.05). The median serum spindle and kinetochore associated complex subunit 1 levels were significantly elevated in patients with oral squamous cell carcinoma compared to those with oral potentially malignant disorders (p<0.05).

Conclusion: Spindle and kinetochore-associated complex subunit 1 could be a promising non-invasive serum marker for the early detection of malignant transformation in oral potentially malignant disorders and for prediction of prognosis in oral squamous cell carcinoma cases.

Persons living with chronic disease present with a wide array of emotions. These range from affable and accepting, action- oriented attitude, to anxious, afraid or apathic, adynamic acceptance of disease. Yet others may be argumentative and angry, or openly aggressive and antisocial. Increasingly, primary care practitioners also encounter 'pseudo academic' or hyperaware' patients, who base their knowledge on non scientific social media. This communication describes the various array of emotions encountered in chronic diseases such as diabetes and obesity, and suggests an individualized approach to deal with them.

Objectives: To assess the risk factors regarding early cessation of breastfeeding.

Methods: The cross-sectional study was conducted at the Paediatrics Department of Ayub Medical Teaching Institute, Abbottabad, Pakistan, from June 2022 to February 2023, and comprised mother-child dyads who initiated the breastfeeding process at birth, but failed to continue over the subsequent 24 months. Data was collected using a structured proforma through interviews with mothers. Data was analysed using SPSS 26.

Results: There were 250 mothers with mean age 28.48±5.73 years, while the mean age of 250 children was 14.64±7.53 months. The mean duration of breastfeeding was 5.05±3.99 months. The major risk factors identified were a combination of breastfeed and bottle-feed in the first month of life in 198(79.2%) cases, maternal diet restriction postpartum 186(74.4%) and no counselling about breastfeeding 168(67.2%). Pacifier use (p= 0.002), combined bottle-feed and breastfeed in the first month of life (p=0.001) and mothers wrongly considering formula milk healthier than breastfeed (p=0.000) were significant predictors of shorter duration of breastfeeding.

Conclusions: All the reasons identified as potential risk factors for early discontinuation of breastfeeding were modifiable. Health education-based interventions are needed for optimising breastfeeding practices.