Journal of Rawalpindi Medical College
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Comparison of Efficacy of Azithromycin with Ciprofloxacin in the Treatment of Uncomplicated Enteric Fever in Children
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Objective: To compare the effectiveness of azithromycin to ciprofloxacin in the management of uncomplicated enteric fever in children between 6-12 years of age in the paediatrics department of Pakistan Atomic Energy Commission (PAEC) General Hospital.
Methods: It was a randomized control trial study, conducted at the Department of Pediatrics, PAEC General Hospital, Islamabad from 30-01-21 to 30-07-22. Data from 196 children with signs and symptoms of uncomplicated enteric fever was collected after obtaining verbal consent from their parents. Demographic information of the patients along with a short medical history were noted in pre-designed forms.
Results: Mean age, treatment time, body weight and defervescence time in the azithromycin group were 9.21±2.24 years, 5.87±1.78 days, 28.3±4.54 kg and 49.8±10.21 hours, respectively. Similarly, age, treatment duration, body weight and defervescence time in the ciprofloxacin group were 9.48±2.41 years, 6.41±1.14 days, 26.9±4.89 kg and 53.7±12.25 hours, respectively. The observed efficacy was 92 (93.9%) and 74 (75.5%) in the azithromycin and ciprofloxacin groups, respectively.
Conclusion: Azithromycin is an efficient outdoor patient treatment choice for children with uncomplicated typhoid fever and needs to be widely utilized in high-risk fluoroquinolone-resistant countries.
Keywords: Multi-Drug Resistance; Salmonella Typhi; Azithromycin; Ciprofloxacin
Dermoscopic And Clinical Features Of Alopecia Areata In Pakistani Patients: A Cross-Sectional Study
Full text linkObjective: To evaluate the dermoscopic and clinical findings in Pakistani patients with Alopecia Areata
Methods: The study was conducted at THQ Hospital Layyah with a sample size 800 within an age limit of 10-40. The patient's clinical history and demographic information were collected using a structured interviewing questionnaire with informed consent. Patients were examined using a Dermlite dermoscope.
Results: Of 800 patients, 52.9% were females and 47.1% were malesThe scalp was the most common site of alopecia among the studied patients, accounting for 89.9% (n=719). Dermoscopy of AA patients revealed the following: yellow dots in 79.9% (n=559), black dots in 33.1% (n=265), exclamation mark hairs in 42.5% (n=340), short villus hairs in 32.6% (n=261), broken hairs in 42.3% (n=338), pigtail hairs in 27.9% (n=223), and Pohl-Pinkus constriction in 25.9% (n=207). The Pearson chi-square test showed a significant correlation between age and the presence of black dots, yellow dots, broken hairs, exclamation mark hairs, pigtail hairs, short villus hairs, and Pohl-Pinkus constriction (p < 0.001).
Conclusion: Alopecia Areata affects both men and women equally. The majority of affected individuals are young, between the ages of 10 and 30. The scalp is the typical site of Alopecia Areata.
Key Words: Alopecia
Frequency Of Post-Partum Haemorrhage In Obese Patients
Full text linkObjective: This study will help to establish a true frequency of PPH in obesity, which will allow us to serve as a basis for future research, as well as the possibility for the requirement of intervention or at least increased vigilance in obese patients which will help to reduce morbidity, mortality, and financial costs. This study aims to determine the frequency of post-partum haemorrhage in patients who are obese.
Methods: This study is conducted in the Department of Gynaecology and Obstetrics, at PAF Hospital, Islamabad. The duration of this study was 6 months, from Dec 2022 to June 2023. It is a descriptive cross-sectional study; the sample size was 100 patients. All participants were evaluated with a thorough medical history and clinical examination on enrolment. Their BMI was calculated by using a standard measuring tape and Medica plus DT-916 weighing scale. Blood loss after delivery was measured as per operational definition.
Results: The mean age of the participants was 27 years with SD ± 8.81. 9% of the patients had post-partum haemorrhage while 91% of patients didn’t have post-partum haemorrhage (PPH).
Conclusion: Our study concludes that the frequency of post-partum haemorrhage was 9% in patients who are obese, so it is not considered a key factor for PPH.
Keywords: post-partum haemorrhage, obese, BMI., risk assessment, uterine haemorrhag
Effectiveness of 5-Fluorouracil Chemotherapy in Preventing Recurrence of Ocular Surface Squamous Neoplasia
Full text linkObjective
Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of malignancies affecting the conjunctival and corneal tissues, including conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). High recurrence rates for OSSN necessitate effective treatment strategies, particularly in low-resource settings.
Methodology
This prospective case series, conducted from March 2023 to March 2024 at the Department of Orbit and Oculoplastics, Alshifa Trust Eye Hospital, Rawalpindi, included 34 eyes from 34 patients with biopsy-confirmed OSSN. Patients underwent surgical excision with a 4 mm clear margin, followed by applying 1% 5-fluorouracil (5-FU) for 90 seconds and cryotherapy using a double freeze-thaw cycle. Post-surgical patients received topical 5-FU in cycles: one week on and three weeks off, for three to five months. Outcomes were documented through clinical examination and anterior segment optical coherence tomography (OCT). Primary outcomes were recurrence of clinical lesions. The secondary outcome was detecting the presence of HIV in patients by using an HIV antibody titres assay.
Results
The mean age of patients was 53.3 years. 73.5% were males, and 26.5% were females. The majority (76.5%) were diagnosed with full-thickness dysplasia. Treatment was predominantly post-excision. Chemoreduction prior to surgery was done in 4 patients. Most had 3 cycles of 5-FU (52.9%). During follow-up, not a single recurrent lesion occurred. Logistic regression indicated a positive, though non-significant, association between the number of 5-FU cycles and reduced recurrence (β = 0.2598, p = 0.321).
Conclusion
This study demonstrates that using 5-FU with cryotherapy significantly reduces OSSN recurrence in low-resource settings. Further research with larger cohorts is recommended to confirm these findings and refine treatment protocols.
Keywords
5-Fluorouracil, Cryotherapy, chemotherapy protocols, Squamous Cell neoplasm, Conjunctival disease
Efficacy Of Clarithromycin Versus Oral Steroids In Reducing The Grading Of Nasal Polyps In Pre-Operative Patients Of Functional Endoscopic Sinus Surgery
No full textObjective: To compare the use of oral steroids and clarithromycin in the reduction of Nasal polyp score in pre-operative patients of FESS.
Methods: After the ethical approval from the institutional review board, this comparative study was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery, Rawalpindi Teaching Hospital, Rawalpindi Medical University, Rawalpindi from December 2023 to May 2024. Through non-probability consecutive sampling, 60 patients aged between 18-60 years, with Bilateral Nasal polyps and clinically Grade 4, were included in the study.
Results: In terms of endoscopic scores, before treatment (Table 2), Group A had a mean score of 3.1 ± 0.6, while Group B had a higher baseline score of 3.6 ± 0.7, with a statistically significant difference between the two groups (p = 0.009). After treatment, the mean endoscopic score in Group A decreased to 2.3 ± 0.70, while in Group B, it decreased more substantially to 1.5 ± 0.56. This difference in post-treatment scores was highly significant (p < 0.0001) (Figure 1). The mean reduction in the endoscopic score was 0.8 ± 0.40 in Group A and 2.03 ± 0.9 in Group B, indicating a significantly greater decrease in Group B (p < 0.0001)
Conclusion: Clarithromycin has more anti-polyp effect in terms of size reduction than oral steroids, which provides a strong recommendation towards the management of FESS patients through pre-operative use of the drug
From Instructor to Mentor: Reframing the Roles of Medical Educators in Light of the Dreyfus Model
No full textThere have been significant changes to the flow of educating and learning in undergraduate medical education (UGME), but one feature has remained constant: the terminology used to describe the educators. Facilitator is perhaps the most misused and overused term throughout all years of UGME, irrespective of the learners’ level or the academic activities of the teacher. This practice flattens the learners’ complexity, and the evolution of the system needs to be considered together with the multifaceted nature of teacher roles. In 1980, the Dreyfus model of skill acquisition was proposed, outlining five stages of development: from novice to expert, which are defined by growing degrees of autonomy: Novice, Advanced beginner, Competent, Proficient, and Expert.[1] This model is increasingly gaining acceptance in medical education as a framework to better understand and optimise learner progression. [2] The cognitive and psychomotor skills exhibited by the students about the competencies set for them in UGME suggest dynamic shifts which call for equally responsive teaching approaches. Therefore, it is proposed that the roles of medical educators at different levels change gradually, and this change should be accompanied by a change in terms:
Instructor (1st Year – Novice Stage)
In the beginning stages, where there is little experience, students need to acquire knowledge in a very systematic way, one where rules predominate. Here, teachers act as instructors by giving direct instruction and providing the students with basic information. Their responsibility is instructional and teaching centred, with steps accompanying the novice, learners who depend on set patterns and repetition will always remain, rules and repetition. [3]
Coach (2nd Year - Advanced Beginner Stage)
When students are given the patterns and begin the earlier forms of clinical exposure, the controllers take charge in the form of educators. Teaching patients to define, refine, and build clinical skills as well as deepen early-stage clinical reasoning for confident judgment is the objective of coaching or guidance along with correction. [4]
Facilitator (3rd Year – Competent Stage)
After spending adequate time through rotations, students progress in taking responsibility with little guidance. Constructivist educators become facilitators, guiding the learners in self-directed and evaluative practices pertaining to reflection along with supporting context-based application of knowledge. [5]
Supervisor (4th Year – Proficient Stage)
Independent functioning plus comprehensive understanding of concepts arises at this stage of knowledge paired with expression. Instructors step in as supervisors overseeing the constructive clinical activity of the students, while offering comments and guiding their free acting in/on safe space boundaries. [6]
Mentor (Final Year – Expert Stage)
During the last stage of the education cycle, the students are exposed to real-life examples and a professional identity as a physician. The teachers’ role from this point will now shift to mentors to assist their students through the multifaceted professional, ethical and emotional world of medicine. Helps transition the student from ‘competent’ to ‘independent, lifelong learner and responsible clinician’ [7]
That the relationship changes so that students can shift instructional strategies within competency-based medical education is strong evidence towards the claim concerning its success. Adapting the phrases is much more than a mere matter of words. It recognises the changing functions and obligations of the educators throughout the spectrum of education. It is important not just for the staff but also for the students, bringing order to the whole system while improving faculty training, assessment techniques, and structuring the curriculum.
For these reasons, revising the rigid allocation of facilitator for all levels of teaching is critical, and in its place, introducing a facilitator-mentor taxonomy incorporating five levels: Instructor, Coach, Facilitator, Supervisor, Mentor. Such a change is necessary with documented pedagogical frameworks accompanying teaching for the sophisticated dynamics of teaching in contemporary medical training
Informed Consent In Tertiary Care Hospitals Of Pakistan; The Moral Magic Of Consent
Full text linkObjective: This study aimed to assess whether standard international guidelines obtain informed consent and to identify potential contributing factors.
Methodology: This Questionnaire descriptive cross-sectional study was conducted at public sector hospitals of Karachi (October 2021-Aug. 2022) after ethical approval. A 12-point questionnaire was developed based on three categories, first to assess awareness & significance of IC, second regarding elements of IC & third for administrative part of IC. Indoor adult patients ≥18 years of age, who have undergone any surgical or medical procedures were included. The critically ill, unconscious and those unable to give consent were excluded. Data was analyzed by SPSS version 23.
Results: A total of 587 subjects were included, with a mean age of 43. There were 340(57.9%) males & 247(42.1%) females. 51.7% of respondents had an education level of <10 years. 51.1% & 48.9 % of subjects underwent medical related & surgical related procedures respectively. 426(72.6%) patients were aware of IC and 318(54.2%) responded affirmative to significance of IC. 407(69.3%) subjects were informed about treatment options prior to procedure, 349(59.5%) were informed about complications, while risks & benefits of procedure were discussed with 294(50.1%). 281(47.9%) of the patients were satisfied with the information about the procedure, and 288(49.1%) subjects understood the information. Of the respondents, 356(60.6%) stated that the language used wasn’t appropriate for comprehension, 200(34.1%) identified language as a barrier, 185(31.5%) pointed to cultural factors, and 202(34.4%) believed that both language and culture were barriers to IC. 368(62.7%) of the subjects signed the IC, while the IC was signed by a family member in 219(37.3%). Only a minority of patients, 199(33.9%), felt that the consent process was free and fair, while 388(66.1%) believed their decision was influenced. Among them, 233(39.7%) felt influenced by the doctor, and 155(26.4%) attributed the influence to a family member.
Conclusion: There is significant room for improvement in achieving legally and ethically valid informed consent (IC). Literacy, language barriers, and cultural beliefs are major factors influencing patient’s understanding of IC. Higher levels of education were associated with better comprehension of IC. The majority of patients reported that the consent process was neither free nor fair, with language and cultural barriers being significant obstacles. Enhancing the communication skills of healthcare professionals and incorporating formal training on obtaining IC at all levels, from undergraduate education to consultant training, is suggested
Diagnostic Accuracy Of Different Clinicopathological Parameters In The Differentiation Of Septic Versus Aseptic Mono-Arthritis In The Paediatric Age Group
Full text linkObjective: Determining the diagnostic accuracy of various clinicopathological parameters in differentiating Septic Arthritis versus Aseptic Inflammatory Arthritis in the paediatric age group.
Methods: A cross-sectional study took place at the Department of Orthopedics, Nawaz Sharif Medical College, University of Gujrat, Gujrat, from February 2023 to July 2024. 150 children aged 10-160 months, of either gender, presented for the first episode of acute monoarthritis lasting for less than a week were included and categorized into two groups. Group A included children with confirmed diagnosis of SA and Group B included children diagnosed with aseptic inflammatory arthritis. Body temperature and serum inflammatory markers were measured. Receiver operating characteristic curves were made to discover the optimum diagnostic cut-off values of the parameters. The areas under the curves were then estimated to juxtapose the overall predictive accuracy for SA.
Results: 49.33% of patients had SA and 50.67% had Aseptic Inflammatory Arthritis. All clinicopathological parameters including body temperature, TLC, ANC, NP, ESR, and CRP exhibited significantly higher values in Group A than in Group B (p<0.01). TLC had a considerable discriminatory power in distinguishing SA from aseptic inflammatory arthritis followed by ESR, CRP, NP, body temperature and ANC.
Conclusion: In conclusion, these clinicopathological parameters can be used for the prompt diagnosis of SA to start the treatment and prevent the progression of the disease
Complications Of Cataract Surgery In Rural Eye Camps And Their Burden On Tertiary Health Care Facility
Full text linkObjective: To Document and Elaborate Complications of cataract surgery in rural eye camps and their burden on tertiary health care facility.
MATERIAL AND METHODS: For this noncomparative, descriptive cross-sectional study, data was collected Retrospectively. All patients who presented in the ophthalmology outpatient department(opd), Bahawal Victoria Hospital Bahawalpur and fulfilled the inclusion criteria were included in the study. The strategy of non-probability purposive sampling was adopted.
RESULTS: Data from a total of 200 patients were included in the study who presented in eye opd with severe ocular morbidity after camp eye surgery. Of the total, 91(45.5%) were male and 109 (54.5%) were female patients. Of all the complications; significant refractive errors, (refractive errors that compel the patients to attend eye opd) were in greatest numbers, 56 (28%). Next were the patients with Corneal oedema 50 (25%). 42 (21%) patients present with posterior segment diseases and Endophthalmitis occurred in 39(19.5%). Posterior Capsule rupture was present in 33(16.5%) and IOL dislocation /Lens fragments, each, were present in 27(13.5%). 25(12.5%) patients were Aphakic while 15(7.5%) patients present with Retinal detachment.
CONCLUSION: There is a need for an improvement in the quality of surgery with a more balanced distribution of services and highly skilled surgeons should operate in eye camps. The standard surgical protocol should be followed for camp surgery. Unethical practices should be strictly discouraged at all levels.
Key Words: Cataract surgery, Healthcare facility, Endophthalmitis, Corneal oedema, Refractive errors, Postoperative Complications
Evaluating the Anti-Arthritic Potential of Nerolidol Using In-Vitro and In-Vivo Models
No full textObjective: The current study's objective was to assess nerolidol's anti-arthritic effects by using both in vitro and in vivo animal models.
Methods: In vitro methods included the denaturation of the egg albumin protein, bovine serum, as well as the human red blood cell membrane stabilisation assay at concentrations of 50, 100, 200, 400, 800, 1600, 3200, and 6400 μg/ml. The in vivo method involved the induction of non-immunological arthritis by formaldehyde at doses of 200, 400, and 800 mg/kg.
Results: Nerolidol inhibited the denaturation of protein and neutralised the human red blood cell membrane in a concentration-dependent manner, with maximum consequence attained at 6400ug/ml ( ). Likewise, formaldehyde induced model reduced the paw volume and an extreme reduction was obtained at 800mg/kg (p ).
Conclusion: These findings form a base to conclude that nerolidol supports the folklore claim of providing fortification against arthritis.
Keywords: Arthritis, Nerolidol, in vitro, in vivo, protein denaturatio