Jcpsp-Journal of the College of Physicians and Surgeons Pakistan最新文献

Objective: To identify the microorganisms responsible for superinfections in patients admitted with COVID-19 and evaluate the impact of empirical antibiotic regimen and comorbid disease on superinfections comparing COVID-19 patients with and without secondary infection.

Study design: A descriptive study. Place and Duration of the Study: Department of Microbiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from March to July 2020.

Methodology: This study was conducted with patients diagnosed with COVID-19 disease based on radiological or quantitative RT-PCR test results. Culture results, demographic characteristics, clinical variables, and therapeutic regimen were collected from medical records.

Results: Superinfection developed in 48 (26.96%) of 178 cultures (24 of 101 patients) followed up in the COVID-19 clinics. Infections were determined as 25 (52.08%) bloodstream, 11 (22.9%) urinary tract, 10 (20.8%) respiratory tract and 2 (4.16%) soft tissue infections, respectively. Secondary infectious agents were E.coli in 11 (22.9%), A.baumannii in 8 (16.7%), S.homminis in 7 (14.6%), S.epidermidis in 6 (12.5%), K.pneumoniae in 4 (8.3%), C.albicans in 2 (4.1%), and other bacterial and fungal agents in 10 (20.8%). The median range from admission to the hospital to detecting microorganism growth was the longest with piperacillin/tazobactam with moxifloxacin and azithromycin. Secondary microorganism detection was delayed, mostly due to the empirical use of moxifloxacin, azithromycin, and piperacillin/tazobactam.

Conclusion: Demographic characteristics, comorbidity and antibiotic use of patients were not directly related to secondary infections. In addition, the empirical use of azithromycin and moxifloxacin with piperacillin/tazobactam appeared to delay the development of superinfection.

Key words: Superinfection, COVID-19, Comorbidity.

Objective: To determine the precipitating factors and outcomes of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus.

Study design: An analytical study. Place and Duration of the Study: Department of Paediatrics, National Institute of Child Health, Karachi, Pakistan, from July to December 2022.

Methodology: Children of either gender aged up to 18 years and presenting with DKA with a known diagnosis of type-1 diabetes were enrolled. Demographic, clinical, and anthropometric characteristics of all children were noted. Laboratory investigations were sent to the institutional laboratory. Presenting features, precipitating factors, severity of DKA, and outcomes noted.

Results: Among 131 children, 101 (77.1%) were girls. The socio-economic status of 75 (57.3%) patients was the lower middle. Celiac disease was the commonest associated disease noted in 23 (17.6%) patients. A total of 123 (93.9%) children were using basal plus bolus types. Adherence to diabetes-related drug therapy was seen in 105 (80.2%) patients. At the time of presentation, vomiting, fever, abdominal pain, and respiratory distress were the most frequent presenting features reported in 77 (58.8%), 67 (51.1%), 42 (32.1%), and 34 (26.0%) patients, respectively. The most common precipitating factors for DKA were infection/illness (n=90, 68.7%) and missed insulin dose (n=16, 12.2%); no cause was identified in 25 (19.1%) patients. The mean duration of hospital stay was 5.25±2.4 days. Four patients could not survive.

Conclusion: The most common precipitating factor for the current episode of DKA were infection or illness, or missed insulin dose. Vomiting, fever, abdominal pain, and respiratory distress were the most frequent presenting features. In-hospital mortality was found to be 3% in DKA patients.

Key words: Diabetic ketoacidosis, Type-1 diabetes mellitus, Insulin, Vomiting, Abdominal pain.

Objective: To evaluate the histopathological results of conjunctival masses suspected to be malignant based on biomicroscopic examination.

Study design: Observational study. Place and Duration of the Study: Department of Ophthalmology, Celal Bayar University, Hafsa Sultan Hospital, Manisa, Turkiye, from November 2013 to February 2021.

Methodology: Patients who underwent excision for the diagnosis and treatment of conjunctival surface masses with clinical suspicion of malignancy were evaluated retrospectively. The masses were categorised as benign, premalignant, and malignant lesions according to the histopathological results. The distribution of conjunctival masses was analysed according to patients' gender and age groups.

Results: The study included 98 conjunctival masses in 98 patients (57.1% men, mean age 48.6±21.85 years). On pathological examination, 63 of the masses were found to be benign (64.3%), 22 were premalignant (22.4%), and 13 were malignant (13.3%). The most common benign lesion was nevus (n=21, 21.4%). All detected premalignant lesions were conjunctival intraepithelial neoplasms (CIN), detected in 22 patients (22.4%). Of these, 13 patients (13.3%) had carcinoma in situ (CIN III). Thirteen (13.3%) of the masses were malignant, the most common being squamous cell carcinoma (n=10, 10.2%). The frequency of premalignant and malignant lesions increased with age (p<0.001). There was no statistical relationship between malignancy and gender (p=0.619).

Conclusion: Most conjunctival masses in this series were benign, with nevi being the most common. The most common premalignant and malignant lesions were intraepithelial neoplasia and squamous cell carcinoma, respectively. Malignant conjunctival lesions were more common in older patients.

Key words: Conjunctival nevus, Conjunctival intraepithelial neoplasia, Squamous cell carcinoma.

Objective: To compare the higher order aberrations (HOA) between wavefront optimized (WFO) laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in myopic patients.

Study design: Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from December 2021 to December 2022.

Methodology: Forty-four patients underwent wavefront optimized PRK and fifty-seven patients underwent wavefront optimized LASIK. All variables were recorded before the procedure and at 1, 3, 6, and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), root mean square (RMS) of HOAs, spherical aberration (SA), and coma aberration (CA).

Results: A total of 101 eyes of 51 patients were considered in the final analysis. Patients were divided into two groups. Group A comprised of 44 (43.6%) eyes of 22 patients who underwent PRK while group B comprised of 57 (56.4%) eyes of 29 patients who underwent LASIK. UCVA significantly improved postoperatively at 3 and 6 months in both PRK and LASIK groups (p<0.001 for both groups). In this study, the increase in root mean square (RMS) of higher order aberrations from baseline value was 77% after PRK and 28% after LASIK, similar ratio was observed in spherical aberration (SA). The trend of rise in Coma aberrations was more in LASIK group 66.49% as compared to 46.2% in PRK group.

Conclusion: Both Wavefront Optimized PRK and LASIK are safe and have elicited comparable results of post-procedure visual recovery. There was a marked increase in RMS of HOAs in PRK group as compared to WFO LASIK group while coma aberration increased more in LASIK as compared to PRK postoperatively.

Key words: LASIK, PRK, RMSh, HOAs, Spherical aberration, Coma, Myopia.

Hypertension (HTN) is not recognised as an independent risk factor for primary open-angle glaucoma (POAG). A search of PubMed, Embase, Medline, Wanfang, and Cochrane Library databases from the time each database was established up to July 2022 was performed. All studies were pooled and assessed for heterogeneity and the quality of the literature. Five cross-sectional studies were included in the meta-analysis with 1144 individuals with POAG and 29, 373 without POAG. The combined analysis found that the incidence of HTN was higher among the individuals with POAG than among those without (OR 1.55; p <0.001). There was also a significant difference in the incidence of diabetes among individuals with POAG compared with those without (OR: 1.31; p=0.002). A meta-analysis of cross-sectional studies revealed that the incidence of HTN and diabetes was significantly greater among individuals with POAG. HTN and diabetes were found to be independent risk factors for POAG. Key Words: Primary open-angle glaucoma (POAG), Hypertension (HTN), Diabetes, Meta-analysis.

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The burden and the spectrum of neuro-developmental disabilities are well-established in the developed countries, however, they continue to be a challenge in the Low Middle-Income Countries. The aim of this study was to present the referral profile and trends of developmental disabilities in the child development centre of The Agha khan University, from 2012 to 2021. All children (1 month to 18 years), who had undergone diagnostic evaluations for suspected neurodevelopmental disabilities were included. A total of 1340 children were evaluated at the centre. The mean age of the children at the presentation was 5.4 ± 3.0 years. Male to female ratio was 3:1. Autism Spectrum Disorder (ASD) was the most common diagnosis (n=446, 33.3%). This study highlights a considerable burden and an increasing trend of children being referred for suspected developmental disabilities in Pakistan. Key Words: Developmental disabilities, Referral, Pakistan, Autism spectrum disorder.

Objective: To evaluate the histomorphological response of alpha-tocopherol co-administration with carboplatin chemotherapy.

Study design: A laboratory-based experimental study. Place and Duration of the Study: Anatomy Department, Army Medical College / National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from January to December 2021.

Methodology: Thirty adult Sprague-Dawley rats were divided into three groups of ten rats each. Control group A received normal diet and water, experimental group B was administered single injection of carboplatin 2.5 mg/Kg intraperitoneally; and experimental group C along with carboplatin injection also received alpha-tocopherol 62.7 mg/Kg daily. At the end of 12 weeks, the euthanasia of animals was done and kidneys were dissected out. Right-sided kidneys were stained with Haematoxylin and Eosin. Micrometry was done to measure the diameters of renal cortical tubules and renal corpuscles.

Results: The proximal and distal tubular and luminal diameter and transvertical diameter of renal corpuscle were increased in group B as compared to control group A. In group C, the proximal and distal tubular diameters were 5.175 ± 0.39 µm and 3.88 ± 0.364 µm, respectively; proximal and distal luminal diameters were 2.67 ± 0.35 µm and 1.64 ± 0.24 µm, respectively and transvertical diameter of renal corpuscle was 12.16 ± 0.870 µm. These values were less than experimental group B and closer to that of control group A.

Conclusion: Renal microscopic parameters showed improvement in the group administered with alpha-tocopherol. Therefore, alpha-tocopherol has ameliorative effects on carboplatin-induced renal damage.

Key words: Alpha-tocopherol, Carboplatin, Renal corpuscle, Tubules.

Objective: To compare the frequency of adverse maternal and perinatal outcomes associated with delta (B.1.617.2) and other variants of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2).

Study design: An observational study. Place and Duration of the Study: Bursa City Hospital, Bursa, Turkey, from March 2020 to February 2022.

Methodology: The study included 423 pregnant women diagnosed with COVID-19 based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing. The patients were divided into the delta variant (n=135) and other variants (n=288) (alpha, beta, gamma) groups, and maternal and perinatal outcomes were compared between the groups. Data including symptoms, laboratory findings, radiological findings, hospital and intensive care unit (ICU) stay, delivery outcomes, and mortality rates were recorded.

Results: The delta variant group demonstrated higher rates of moderate and severe pneumonia than the other variant group (p=0.005). According to the World Health Organization (WHO) classification, 49.6% and 18.5% of patients experienced moderate and severe disease, respectively in the delta variant group, compared to 38.5% and 10.1%, respectively in the other variant group (p=0.001). A total of 20.0% of the patients in the delta variant group and 8.3% of the patients in the other variant group required ICU stay. The length of ICU stay was significantly longer in the delta variant group (p=0.001).

Conclusion: The rates of maternal morbidity and mortality increased in the pregnant population with low rates of vaccination in the period of the fourth wave which was associated with the delta variant. No significant difference was observed in perinatal morbidity between the delta and other variants.

Key words: COVID-19, Delta variant, Maternal morbidity, Perinatal outcomes, Adverse pregnancy outcomes.