Journal of Rawalpindi Medical College
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Comparative Study Between Submucosal Diathermy And Partial Turbinectomy In Hypertrophied Inferior Turbinate Causing Nasal Obstruction
Full text linkObjective: The study aims to compare the efficacy of two different surgical techniques to reduce the inferior turbinate.
Methods: A comparative prospective study was conducted in the Otorhinolaryngology and Head and Neck Surgery department of Aziz Fatimah Hospital, Faisalabad, from 13 June 2024 to 13 December 2024, using the non-probability consecutive sampling technique. A total of 74 patients were enrolled in the study, which was divided into two groups, with Group A patients undergoing submucosal diathermy and Group B with partial turbinectomy. Patients from both groups are compared in terms of nasal outflow after 48 hours and one month. The results were then compared for both techniques.
Results: The majority of participants in both groups were female, with 24 (65%) in group A and 21 (52%) in group B. Preoperative assessment was done on both nasal sides, with the majority of participants showing no fogging on the nasal spatula test. The nasal spatula test was done 48 hours and 1 month after the surgery, with participants undergoing submucosal diathermy showing significant improvement with a chi-square value of 0.049 and a p-value < 0.05. Postoperative complications such as crusting were reported the most.
Conclusion: Submucosal diathermy has been reported to be a superior procedure to partial turbinectomy in terms of relieving the symptoms and postoperative complications.
Keywords: submucosal diathermy, partial turbinectomy, hypertrophied turbinate, nasal obstructio
Effects of Timing of Umbilical Cord Clamping on Serum Calcium Levels in Neonates- A Randomized Controlled Trial
Full text linkObjective: To assess the impact of the timing of umbilical cord clamping on serum calcium levels in neonates.
Methods: 160 neonates were selected through computer-generated randomization and allocated randomly to four groups (n=40 each). The study included full-term pregnant women with no comorbidities. Mothers with gestational diabetes, hypertension, or any other pregnancy-related complications were excluded. Neonates with congenital anomalies or birth complications were also excluded. After delivery, the neonates' umbilical cords were clamped according to their respective group timing. At six hours of life, venous blood samples were drawn from the neonates to assess serum calcium levels and other lab parameters.
Results: One hundred sixty babies (n=160) included 73 (45.63%) females and 87 (54.37%) males. The mean gestational age was 38.10 (± 0.99) weeks. A gradual increase in serum total and ionized calcium levels was observed. The serum total and ionized calcium levels were 2.12 (±0.12) mmol/L and 1.10 (±0.09) mmol/L, respectively, at 15 seconds (Group-1) of cord clamping and were 2.30 (±0.16) mmol/L and 1.22 (±0.06) mmol/L at 120 seconds (Group-4). Total serum calcium levels at 15 and 30 seconds (s) were significantly lower (p<0.001) than those at 120 s. A similar trend was seen for serum ionized calcium levels (p<0.001).
Conclusion: Delayed cord clamping significantly improves total and ionized serum calcium levels in neonates, ameliorating neonatal health and neuromuscular stability.
Keywords: Umbilical Cord, Neonates, Pregnancy, Calciu
Frequency Of Patient Satisfaction And Its Association With Socio-Demographic Characteristics: A Cross-Sectional Study Of Public And Private Family Medicine Clinics In Karachi, Pakistan
Full text linkObjective: To determine patient satisfaction with family medicine clinics at selected public and private tertiary care hospitals in Karachi, Pakistan. The study also determined sociodemographic factors associated with patient satisfaction at family medicine clinics. Methods: A cross-sectional survey was conducted at a public and private tertiary care hospital. PSQ-18 was used to measure patient satisfaction. Patients visiting the facility were selected using convenient sampling. Data was analyzed using SPSS vs. 24. Results: 89.3% (n =299) of all the study participants were satisfied with the services provided at family medicine clinics. The frequency of patient satisfaction was significantly higher at public clinics i.e. 90.9% (n=150) as compared to patients visiting private clinics i.e. 87.6% (n=149) (p-value <0.001). Married patients were more likely to be satisfied with services as compared to unmarried (adj. OR: 3.2, 95% CI; 1.5-6.7, p-value 0.002). Patients from middle socioeconomic status (adj. OR: 0.19, 95/5 CI: 0.10-0.35, p-value <0.001) and high socioeconomic status (adj. OR: 0.23, 95/5 CI: 0.10-0.51, p-value <0.001) were less likely to be satisfied with the services. No significant association was observed for age, sex, education and employment status.Conclusion: Sociodemographic factors seem to have a substantial effect on perceived satisfaction with family medicine clinics. Large-scale studies are required to determine the role of patients` sociodemographic characteristics on patients` satisfaction with healthcare services. This will help in designing and implementing specific interventions to address specific expectations from the family medicine services to achieve patient satisfaction
Validity Of Urine Dipstick Parameters In Identifying Urinary Tract Infections
Full text linkObjectives: To evaluate the diagnostic accuracy of urine dipstick parameters using semi-quantitative urine culture as the reference standard in the assessment of UTI.
Methods: A cross-sectional validation study was conducted over 12 months in the Department of General Medicine in a public sector tertiary care hospital in Islamabad. A total of 303 cases suspected of having UTI were included. Combur10 Roche dipstick was used as a diagnostic test dipstick for the detection of urine leucocyte esterase and Urine nitrite. Cystine-lactose electrolyte deficient agar (CLED) media was used for quantitative culture of urinary microorganisms, the results of which were considered the gold standard.
Results: 149 were females with a mean age of 50±20 years, while 154 participants were males with a mean age of 49±24 years. 42.6% (N=129) of the population studied had a positive result for urine culture with the most commonly isolated organism being klebsiella species (8.3%). The most specific parameter was the combination of nitrite positive and leucocyte esterase positive with a specificity of 98.9% (95% CI= 96.5-99.8%). The least specific results were those that were either nitrite positive or leucocyte esterase positive, with a specificity of 75.9% (95% CI= 69.2-81.8). Overall sensitivity of dipstick analysis was relatively poor.
Conclusion: The combination of both the dipstick parameters, nitrite and leucocyte esterase showed better accuracy in terms of specificity and therefore ruling in the presence of UTI. The sensitivity, however, was generally poor, and it can be inferred that the dipstick is not a useful investigation in successfully ruling out the presence of UTI, urine culture must therefore be performed in highly suspicious cases.
Keywords: Klebsiella, Pseudomonas, Urinary Tract Infections, bacteriuria, Escherichia col
Biochemical Markers, Medications, and COVID-19 Complications in Vaccinated Versus Unvaccinated Pakistani Patients
Full text linkObjective
This study aimed to explore the association between COVID-19 vaccination and prolonged post-COVID symptoms (long COVID) in adults reporting this condition.
Material and Methods
This is a cross-sectional design of the study design. With the consent, the data were collected through questionnaire questionnaires from patients (N=308) who visited OPD or were admitted to the hospital with COVID-19 infection. The patient demographic details, vaccination status, type of complications, and haematological and pathological blood tests including complete blood count (CBC), D-dimer, white blood cells (WBC), and platelet count along with medication details the patient used. Patients used either Group I medicines (Panadol and Azomax) or Group 2 (Azomax, Surbex-Z, Loprine, Multivitamin, Ivermectin, and anti-allergy). Using. The data was analyzed using characteristics and inferential statistics such as chi-square and Fischer’s exact tests.
Results
A significant association is observed between the duration of infections and the type of medication used (group 1 & group 2). For infection duration of more than a week with group 1 medications 65.9% (p<0.001) and for two weeks or more with group II medications 87.9% (p<0.001). Data analysis showed no correlation between vaccination status and POST-Covid-19 complications. A significant association was observed when WBC count was compared with neuro-psychological and cardiovascular complications at the 0.05 significance level (p-values <0.001 & 0.008). No significant association was observed between neutrophil count and the type of vaccination used.
Conclusion:
Biochemical and haematological diagnostic markers, such as blood CBC, platelet count, and neutrophil count, exhibit a correlation with the type of medication used in managing COVID-19 complications, highlighting differences between vaccinated and unvaccinated patients.
Keywords:
Blood CBC, Neutrophil count, Platelet count, COVID-19, Hypertensio
Comparison of Diagnostic Yield between Pleural Fluid Cell Block and Pleural Biopsy by Pleuroscopy at the Pulmonology Department, Mayo Hospital, Lahore
No full textObjective: To compare diagnostic yield between pleural fluid cell block and pleural biopsy by Pleuroscopy.
Methods: This prospective study was conducted at the Pulmonology Department, Mayo Hospital Lahore. Patients with exudative pleural effusion from December 2020 to December 2022 who underwent Pleuroscopy at the Pulmonology Department were included in the study. Pleuroscopy was performed under local anaesthesia; pleural fluid was collected for a cell block, and then multiple pleural biopsies were taken.
Results: Thirty patients with exudative pleural effusion were enrolled in the study. Final diagnosis was 16 adenocarcinoma, 2 small cell carcinoma, 1 squamous cell carcinoma, 5 malignant pleural mesothelioma (MPM), 3 no malignancy, 2 metastatic carcinoma, 1 caseating granuloma. Diagnostic yield by pleural biopsy in comparison to cell block was found to be significantly higher [90% (27/30) vs. 70% (21/30); p = 0.008]. Nine patients with negative cell block had positive results on pleural biopsy (1 diffuse large B cell lymphoma,1 metastatic small cell carcinoma,1 mesothelioma,4 adenocarcinoma,1 metastasis malignancy). Three patients had inconclusive evidence for malignancy on both pleuroscopy and cell block.
Conclusion: Cellblock can be used as an initial, less invasive diagnostic test for the workup of suspected pleural effusion. It can be easily performed on pleural fluid during thoracentesis, and treatment can be initiated in case of positive cell block reports without the need for pleuroscopy in every patient with suspected malignant pleural effusion. However, Pleuroscopy can be subsequently performed in patients with a negative cell block
Hemodynamic Effects Of Intravenous Magnesium Sulfate In Direct Laryngoscopy And Intubation In Elective Surgery
Full text linkObjective:
To determine the efficacy of 20 mg/kg of IV MgSO4 in blunting laryngoscopic stress response.
Methodology:
A single-blind randomized control trial was carried out Department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad. 122 patients were included and divided into two groups with the help of computer-generated random numbers. Group A patients received 20 mg/kg of MgSO4 while group B patients received a similar volume of Normal saline. Baseline hemodynamics were recorded. General anaesthesia was induced in both groups using Midazolam, Propofol and Atracurium given IV. Following intubation hemodynamics were noted.
Results:
Baseline parameters and hemodynamics following intubation were similar in both groups apart from DBP in the immediate post-intubation period which was lower in group A.
Conclusion:
IV MgSO4 at a dose of 20 mg/kg is ineffective in blunting laryngoscopic stress response. Therefore, higher doses should be utilized to reach this therapeutic effect.
Role of Vitamin D supplementation on the size of Uterine Leiomyomas in Women with Vitamin D Deficiency
No full textObjective: To determine the role of vitamin D supplementation on size of uterine leiomyomas in vitamin D deficient woman.
Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Rawalpindi, from July 2019 to January 2020. This was a quasi-experimental study. A probability consecutive sampling method was used. Sixty-five women with a diagnosis of 1 to 2 uterine leiomyomas measuring 4– 8 cm in diameter, vitamin D insufficiency and experiencing heavy vaginal bleeding were included. The 25-hydroxyvitamin D levels in the blood were checked. Vitamin D was then administered in five dosages over a period of ten weeks, with each patient receiving a total dose of 50,000 IU of vitamin D after every fourteen days. After 6 months, an ultrasound was done to determine the size of the fibroid. The mean size of leiomyomas was compared before and after vitamin D for six months using a paired t-test.
Results: Mean age of the patients was 35.85±6.140 year. Mean age at menarche of the patients was 11.62±1.206 year. Mean marital life of the patients was 9.47±6.046 year. Mean Hb levels of the patients were 11.406±1.1875 mg/dl. Mean size of leiomyoma before treatment was 54.170±4.5493 mm, while mean size of leiomyoma after treatment was 44.991±2.7046 mm, with a p-value of 0.001.
Conclusion: Vitamin D supplementation has been demonstrated to considerably reduce the growth of uterine fibroids. It would seem that females with vitamin D insufficiency can effectively treat their uterine fibroids by taking vitamin D supplements
Efficacy of Bovine Colostrum in The Treatment of Acute Diarrhea in Infants and Children
No full textObjective: The objective of this study was to determine the efficacy of bovine colostrum for the treatment of acute diarrhoea among infants and children admitted to a tertiary care hospital in Islamabad, Pakistan.
Methods: This interventional study was conducted at a tertiary care hospital, Islamabad. Infants and children admitted to the hospital with acute diarrhoea were selected through consecutive sampling. Group A received bovine colostrum along with the standard treatment, whereas group B received standard treatment alone. Number of days to achieve defecation frequency of <3 Times per day, normal stool consistency, and duration of hospital stay were the main outcomes of interest. SPSS version 21 was used for statistical analysis.
Result: Mean recovery time in Group A was 1.4865+ 0.506 days and in Group B was 1.2174 + days. The mean number of days remaining for patients admitted in Group A was 3.8919 + 1.629 days, while in Group B it was 3.8261+ 1.64 days. The efficacy was 33.59 in group A, while 25.52 in group B. This difference was not statistically significant (p=0.738).
Conclusion: There was no difference between the group taking standard treatment and the one taking standard treatment plus bovine colostrum in terms of recovery time and efficacy but the difference was significant in terms of the number of days patients remained admitted where bovine colostrum group had increased no of days of admission so conclusion is there is not much role of bovine colostrum in treatment of acute diarrhea when combined with standard care
Role of Continuous Versus Alternate Regime of Thromboprophylaxis in Obstetric Outcome in Bad Obstetric History (BOH)
No full textObjective: To compare the frequency of live births in patients with BOH taking LMWH daily versus alternate days.
Methods: This was a randomised controlled trial, conducted at the Department of Obstetrics and Gynaecology, at POF Hospital, Wah, from 1st of January to 31st of December 2024. This study included 122 women aged 30-45 years with a history of adverse obstetric outcomes. Participants were randomly assigned to receive 40 mg low molecular weight heparin (LMWH) either daily (Group A Control) or on alternate days (Group B Experimental) starting in first trimester at enrolment visit when fetal cardiac activity becomes positive, with follow-ups assessing compliance, symptoms, and fetal well-being through history and ultrasound. Live birth was the primary outcome. Data analysis was performed using SPSS v. 22, with p-values <0.05 considered statistically significant.
Results: The mean age was 34.90 ± 2.56 years, and the mean gestational age at enrolment was 9.95 ± 1.14 weeks. Among them, 46.7% underwent Spontaneous vaginal delivery, 39.3% Cesarean section, and 13.9% Evacuation and curettage, with 76.2% resulting in live births and 27.9% of newborns requiring Neonatal intensive care admission. No significant differences were observed between groups in terms of age, gestational age, mode of delivery, live birth frequency (p = 0.832), or Intrauterine death rates (p = 0.543). However, Neonatal intensive care unit admissions were significantly higher in the control group (p = 0.043).
Conclusion: The study found no significant difference between the two groups in terms of live births. However, neonatal intensive care unit admissions were significantly higher in the women receiving a daily low molecular weight heparin dose