Journal of Rawalpindi Medical College
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Evaluation Of Genexpert Performance Assays In Sputum Samples In Cavitary Pulmonary TB/Role Of Genexpert In Diagnosing Pulmonary Tuberculosis
Full text linkObjective: This study evaluated the diagnostic performance of GeneXpert MTB/RIF in sputum samples from Pakistani patients with cavitary TB, using mycobacterial culture as the gold standard and comparing it to sputum smear microscopy.
Methods: In this cross-sectional study conducted at a tertiary hospital in Rawalpindi, 187 HIV-negative adults (18–60 years) with cavitary pulmonary TB were enrolled. Sputum samples were analyzed by smear microscopy, GeneXpert, and culture at baseline, 2, 5, and 6 months of therapy. Diagnostic accuracy indices (sensitivity, specificity, PPV, NPV) were compared with culture results.
Results: Among 187 patients (mean age 44.1 ± 17.1 years; 93.6% female), 32% had baseline culture-confirmed TB. GeneXpert detected 91.7% of culture-positive cases versus 28.3% by smear. After 2 months, 43.3% remained culture-positive, while GeneXpert and smear positivity were 35.3% and 32.6%, respectively. All patients achieved culture negativity by treatment completion; however, GeneXpert and smear remained positive in 49.2% and 41.7% due to non-viable bacilli.
Conclusion: GeneXpert MTB/RIF demonstrated superior sensitivity to smear microscopy in detecting cavitary TB and monitoring therapeutic response, but showed reduced specificity post-treatment due to residual DNA. Combining GeneXpert with culture improves reliability for therapy monitoring and outcome prediction.
Keywords: Tuberculosis, Mycobacterium tuberculosis; Polymerase Chain Reaction; Sputum; Sensitivity and Specificity; Treatment Outcom
Close Reduction And Percutaneous Pinning (Crpp) Versus Open Reduction And Internal Fixation (Orif) For Fracture Of Lateral Condyle Of Humerus In Children
Full text linkObjective: To compare the functional outcome of CRPP with ORIF for fracture of the lateral condyle of the humerus in children.
Methods: This randomised control study was conducted in the Orthopaedics Department, Rawalpindi Medical University, Rawalpindi, from 10th January 2021 to 10th July 2021. It included 60 patients aged 2 to 12 years who presented with type II lateral condyle of humerus fracture, according to Jakob’s classification. An equal number of participants, i.e., 30, were assigned to each group: the CRPP and ORIF groups. Randomisation was performed by the lottery method. The functional outcome was assessed at the 2nd month postoperatively by using modified Aggarwal criteria.
Results: The patient’s age range was 2 to 12 years, and male gender was dominant in both groups. Functional outcome was excellent (93.3%) in the CRPP group as compared to the ORIF group (73.3%), good (6.7%) in the CRPP group versus 10%, fair (0%) in the CRPP group versus 10% and poor (0%) in the CRPP group versus 6.7% (p=0.116).
Conclusion: CRPP could be the treatment of choice as the frequency of functional outcome of closed reduction and percutaneous pinning is statistically similar to that of ORIF.
Keywords: Humeral fracture, closed reduction, Lateral condyle fracture, Displaced, open reductio
Quality Care Through Clinical Audit: Blood Sampling Practices By Nurses In The Emergency Department Of A University Affiliated Teaching Hospital
Full text linkObjective: We aimed to conduct an audit to investigate whether the steps of phlebotomy performed by nurses in our emergency department were in line with the WHO guidelines on drawing blood. Based on our investigation, we could then make interventions to ensure that the guidelines were followed diligently. This would be followed by a repeat audit to determine if there was an improvement in adherence to the guidelines.
Methods: This clinical audit was conducted in the Emergency Department of the Holy Family Hospital, Rawalpindi. Nurses working in the department were included in the audit. Medical and nursing students, along with doctors were excluded. The initial audit was conducted from 1st to 7th July 2021. A total of 54 instances of phlebotomy were observed and analyzed. The results of this analysis were used to devise interventions for improvement.
Interventions included an interactive training session for the nursing staff, installation of visual cues in the department, ensuring better availability of equipment and formation of a team to ensure that the guidelines are being followed. A repeat audit was performed from 23rd to 30th August 2021 in which a total of 58 instances of phlebotomy were covertly observed. The chi-square test was used to compare the percentages between the initial audit and the repeated audit. A p-value <0.05 was considered significant.
Results: Steps that were least adhered to by the nursing staff were the performance of hand hygiene (16.7%), asking patients to form a fist (79.6%), putting on well-fitting sterile gloves (0.0%), disinfecting the site of phlebotomy (59.3%) and the removal of gloves (3.7%). After intervention, a significant improvement was noted in all these steps in the second audit.
Conclusion: Many of the steps recommended in WHO guidelines were frequently being missed by the nursing staff in our emergency department as observed in the first audit. However, adherence to the guidelines was better during the repeated audit after appropriate interventions. Further interventions and continuous auditing are the key to further improving adherence to the WHO guidelines
Estimation of Knowledge, Attitude and Prevalence of Female Sex Dysfunction in Elderly Pakistani Women
Full text linkObjective: The study aimed to investigate knowledge, attitude and prevalence of FSD in middle-aged and elderly ladies of our community.
Methods: A cross-sectional survey was conducted from 15 June 2022 to 15 June 2023, using a structured questionnaire after obtaining approval from the Ethical Review Board (ERB) of Rawalpindi Medical University (RMU), Rawalpindi. Mean and standard deviation were calculated for quantitative and frequency and percentages for qualitative variables. Binary logistic regression was calculated to find an association between the level of knowledge with socio-demographic variables. Data was analysed using SPSS version 26 and a p-value less than 0.05 was taken as statistically significant.
Results: A total of 150 middle-aged and elderly women were randomly included in the study.The females reporting with some medical or gynaecological problem at the teaching hospital of RMU, willing to participate and gave informed written consent where recruited. Their mean age was 54.5+ 2.5 and the overall FSD prevalence rate, estimated from the ‘Yes’ response to questions related to FSD symptoms, was 56.9%. Two-thirds of 110 (73%) had adequate knowledge about FSD. Around 60% knew that women take more time to get ready and the desire for matting and satisfaction also decreases after 40-50 years of age. Around 70% (106) reported that they felt depressed because of sexual problems. Results of binary logistic regression analysis showed that females aged 40-50 years were 2.2 times (p=0.007) more knowledgeable about FSD as compared to elderly women > 60 years. Regarding attitude, more than half of 99 (66%) initially felt embarrassed when asked about their sex problem. However, they mostly felt satisfied (98, 65.3%) when they realised they were being enquired about an important issue of elderly females.
Conclusions: A significant burden of FSD exists in the middle-aged and elderly women of our community and they had adequate knowledge about the problem. The study indicates that our middle-aged and elderly ladies need more attention and education so that they can get appropriate treatment for FSD, which would not only improve their quality of family life but also prevent them from going into depression
Understanding Student Engagement And Satisfaction With Chatgpt In Dental Education: A Qualitative Exploration
Full text linkObjective: The study aimed to explore the engagement and satisfaction levels of dental students in Pakistan using ChatGPT as a supplementary learning tool.
Method: Thematic analysis was conducted on qualitative data from semi-structured interviews with dental students. A purposive sampling strategy was employed to select participants, and data were collected through in-depth interviews until saturation. The data were analysed using the Bran and Clarke framework to identify key themes and sub-themes related to students' perceptions and experiences with ChatGPT.
Results: The thematic analysis revealed several key themes and sub-themes related to students' engagement levels and satisfaction with ChatGPT. Themes included perceived utility, ease of access, interactive learning experience, relevance to learning needs, user interface experience, confidence in responses, personalisation of learning, challenges with ChatGPT (language barriers, technical issues, lack of human interaction, content limitations), and suggestions for improvement (language support, technical assistance, enhanced content generation, integration with classroom instruction).
Conclusion: The findings highlighted the perceived utility and relevance of ChatGPT to students' learning needs. However, challenges such as language barriers, technical issues, and content limitations indicate areas for improvement. By addressing these challenges and incorporating suggestions for enhancement, ChatGPT has the potential to play a valuable role in dental education, complementing traditional teaching methods and preparing students for the future of dentistry
The Frequency Of Maternal Near Misses At Benazir Bhutto Hospital- Using The WHO Standard Tool, A Cross-Sectional Study
Full text linkObjective: To analyse maternal near-miss frequency and causes on WHO-based tools at a government hospital.
Methods: This cross-sectional study was conducted at the Obstetric and Gynaecology Department of Benazir Bhutto Hospital Rawalpindi from January to December 2019. All maternal near-miss cases admitted to the hospital were included in the study. Patients were identified according to the WHO maternal near-miss tool. The number of maternal near-miss cases per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Causes of maternal near-miss were also documented.
Results: During the study period, 8909 deliveries were recorded. Among these, life-threatening conditions developed in 122 (1.36%) patients out of which near-miss patients were 84 (0.94%). The incidence ratio of near-miss cases was 9.43 / 1000 live births. The major causes of maternal near-miss (MNM) were postpartum haemorrhage n=25 ( 29.7 %), followed by hypertensive disorders n=23 (27.3%). At the same time, sepsis and hypertension were the main reasons for maternal death. Anaemia was an important contributing factor for both maternal outcomes.
Conclusion: This study shows that haemorrhage and Hypertension are the main causes of maternal near-miss.
Keywords: cross-sectional study, morbidity, post partum haemorrhage
Can We Reduce Postoperative Airway Symptoms Related To Endotracheal Intubation In Elective General Anesthesia?
Full text linkObjective: To assess whether applying betamethasone-gel to an endotracheal tube is more effective than using an unlubricated endotracheal tube in minimizing the occurrence of postoperative sore throat, hoarseness, and cough.
Methods: 144 patients of the American Society of anaesthesiologists-physical status (ASA-PS) I and II, aged 18–65 years of either gender planned for elective surgery under general anaesthesia with endotracheal intubation were included. Patients undergoing ENT /oral cavity / oropharyngeal surgeries and upper respiratory tract infections were excluded. Patients were divided into two groups. In group X, patients were intubated with an endotracheal tube lubricated with 0.05% betamethasone-gel. In group Y patients were intubated with the unlubricated endotracheal tube. All patients were evaluated for the frequency of POST, HOV and PEC at 24 h after extubation.
Results: Post-operative sore throat was present in 25 (34.7%) patients in group X and 29 (40.3%) patients in group Y. Post-extubation cough was present in 06 (8.3%) patients in group X and 9 (12.5%) patients in group Y. Hoarseness of voice was present in 04 (5.6%) patients in group X and 6 (8.3%) patients in group Y. A comparison of both groups showed a p-value of 0.0001 which is statistically significant.
Conclusion: Using betamethasone-gel to lubricate the endotracheal tube markedly diminishes the frequency and intensity of postoperative airway symptoms.
Keywords: Endotracheal intubation, betamethasone, sore throat, cough, hoarseness, anesthesia
Efficacy Of Triamcinolone Injection In Management Of Oral Lichen Planus
Full text linkObjective: To study the efficacy of triamcinolone injection in the treatment of oral lichen planus patients presented to the department of oral and maxillofacial surgery at KRL General Hospital Islamabad.
Method: This study was conducted in the Department of Oral & Maxillofacial Surgery, Kahuta Research Laboratories Islamabad. 100 patients who fulfilled the inclusion-exclusion criteria were selected. All the enrolled patients were treated with intralesional TA injection once a week for 4 weeks. A 0.5ml TA (40mg/ml) dose was used. The subepithelial tissue just beneath the lesion and next to the normal mucosa was the exact location of the injection. The treatment was stopped earlier when all three of the symptoms of burning, pain and patch colour were removed. The patients were examined clinically on the 7th, 14th, and 21st day of treatment and based on the examination, the decision of the next dose was decided. The final examination of the patient was on the 28th day of treatment. To assess the oral pain and burning, we used the Visual Analogue Scale (VAS) having 10 grades (0-10).
Results: The mean age of the patients in the study was 35.47±13.459 ranging from 18 to 65 years. In frequency of gender of the patients, there were 57(57%) male and 43(43.0%) female patients. In frequency of distribution of patients, 38(38.0%) patients had unilateral while the remaining 62(62.0%) had bilateral disorders. In frequency of efficacy, 87(87.0%) patients found with improved symptoms and 13(13.0%) were not improved/inefficient.
Conclusion: This study concluded as much of previous literature concluded that the efficacy and safety of intralesional TA injection were found efficient after observation at 28th weeks of treatment.
Keywords: Triamcinolone injection, Oral lichen planus, Efficacy, Reticular, Plaque
Comparison Of Knowledge and Attitude Towards Chat GPT In First and Final-Year Dental Students
Full text linkObjective: This study aimed to examine the knowledge and attitude towards Chat-GPT among first and final-year dental students.
Methods: This was a cross-sectional comparative study conducted at the Rawal Institute of Health Sciences RIHS Islamabad. The duration of the study was 3 months after approval by the Ethical Committee from June 2023 to August 2023. An electronic questionnaire was designed to assess the knowledge and attitude of first-year (G1) and final-year (G2) dental students studying at RIHS. The respondents had to agree or disagree with each statement of the questionnaire. The frequency and percentage for each response were calculated. All the items of the knowledge and attitude questionnaire were assessed for the difference in response between G1 and G2 groups with the help of the Chi-square test.
Results: The knowledge assessment section showed that both first-year and final-year student groups (G1, G2) had inadequate knowledge and discouraging attitudes toward Chat-GPT. 90.6% and 86.7% of G1 and G2 students knew about what Chat-GPT is and this was the only response that showed good knowledge in both groups. 71.1% of first-year students agreed to use Chat- GPT in education as compared to 60% of final-year students. The response of any group could not exceed 70% for any of the attitude questions. The difference in knowledge and attitude response was statistically insignificant between the G1 and G2 groups showing no relationship between the responses of the two groups.
Conclusion: These results highlight that there is a strong need to improve knowledge and a positive attitude towards the use of AI tools like Chat-GPT in dental students.
Keywords: Artificial Intelligence, Chat-GPT, Dental education, Dental students, Knowledge, Attitude
Hematoma Block Verses General Anesthesia For Close Reduction And Percutaneous Pinning Of Distal Radius Fractures In Elderly Patients
Full text linkObjective: The objective of our study is to compare two techniques used for analgesia, hematoma block and general anaesthesia, in patients presented with a fracture of the distal radius in the trauma centre of Aziz Bhatti Shaheed Hospital Gujrat.
Methods: Our study was conducted at the Trauma Centre of Aziz Bhatti Shaheed Hospital Gujrat from January 2021 to April 2023. All the patients having distal radius fractures who met the inclusion criteria were included in our study. The patients were placed into two groups, A and B. All the patients were treated by close reduction and percutaneous pinning. The analgesia method used in group A was Hematoma block while in group B was general anesthesia. Data was analyzed using SPSS.
Results: 156 patients met the inclusion criteria. The mean age was 61.3 ± 6.6 years. These patients were placed in two groups, A and B, of 78 patients each. There was significantly less pain intensity at 2 and 6 hours after the procedure in the hematoma block group (P < 0.001). Duration for manipulation did not differ significantly between the two groups. Duration for surgery was significantly shorter for the hematoma block group (P 0.02). In 100 per cent of cases, anatomical reduction was achieved in both groups.
Conclusion: Hematoma block used as analgesia for the management of fractures of the distal radius in elderly patients is a more effective and safe method than general anaesthesia in emergency trauma centres.
Keywords: Hematoma block, distal radius fracture, elderly