Journal of Rawalpindi Medical College
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Gender Disparity In COVID-19: Clinicopathological Outcomes Among a Subset Of Karachi Population
No full textObjective: In COVID-19, sex differences are increasing globally, and gender-specific mortality risk for men compared to women has been observed by researchers. This study aimed to explore clinic-pathological characteristics and the sex-related factors that might be the cause of gender disparity in COVID-19 cases.
Methods: A retrospective, observational cohort study was conducted at Ziauddin Hospital, Clifton, Karachi, from April to July 2020. Data were collected from the medical records of the admitted patients aged 18 and above, who tested positive for COVID-19 through the laboratory and had confirmed signs of pneumonia.
Results: Patients (244) were selected, including 167 (68.4%) males (mean ages 56.72±13.31) and 77 (31.6%) females (mean ages 56.36±17.15). The majority of the patients (87, 35.7%) had significant COVID-19 symptoms between 5 and 10 days. Only 4.4% of pregnant females had COVID-19 symptoms. Comorbidities included hypertension [44(18%)], diabetes mellitus [27(11.1%)], both HTN and DM60 [(24.6%)], whereas, 67(27.5%) patients had no known co-morbid. Complications were significantly more pronounced in males (p<0.001). Combined hypertension and diabetes observed a two-fold increase [36(14.8%)] in males than females [24(9.8%)]. Among these severely ill patients, 49 (20%) expired, which included 36 (14.3%) males and 13(5.2%) females, with statistically significant (p<0.05) results.
Conclusion: Our study found that men remained symptomatic for a longer duration (10-14 days) than women. Similarly, the severity of the disease, the complications, and the death rates were much higher in comorbid men than women. Females are genetically different and less exposed to environmental insults therefore we recommend that sex and gender-sensitive medicine (SGSM) may be added as a part of medical education
Cross-Sectional Observational Study To Correlate Body Composition With Age And Gender In Healthy Attendees Of Cancer Patients
Full text linkObjective: To investigate the correlation of body composition with age and gender in healthy cancer patients’ attendants in a tertiary care hospital.
Methodology: This is a cross-sectional comparative study conducted over one year at the oncology department of a tertiary care teaching hospital in collaboration with the Physiology Department of the affiliated medical college at Rawalpindi. A total sample of 100 participants (50% females and 50% males) was taken by convenient sampling in this cross-sectional comparative study.
Results: Females had significantly higher levels of per cent body fat and total body fat, while males had statistically significant levels of total body water, fat-free mass and skeletal muscle mass. Fat mass increased significantly with age.
Conclusion: Females have higher levels of per cent body fat and total body fat, while males have higher levels of skeletal muscle mass. Fat mass increases with advancing age
Studying Angiographic Disease Pattern In Patients With Left Bundle Branch Block Undergoing Coronary Angiography
Full text linkObjective: To observe the relationship between left bundle branch block (LBBB) and coronary artery disease (CAD) severity using the SYNTAX score and to evaluate the impact of CAD severity on left ventricular ejection fraction (LVEF) in patients undergoing coronary angiography.
Methods: A prospective, comparative, cross-sectional study was conducted at the Rawalpindi Institute of Cardiology. Patients with symptomatic LBBB, defined by European Society of Cardiology criteria, who underwent coronary angiography were included. Echocardiography was used to assess LVEF, dividing patients into two groups: Group A (LVEF <45%) and Group B (LVEF ≥45%). CAD severity was evaluated using the SYNTAX score, categorising patients into low (0–22), intermediate (23–32), and high (>32) groups. Statistical analysis was performed using SPSS version 24, with a p-value of <0.05 considered significant.
Results: A total of 140 patients were included (57% male, mean age 57.14 ± 10.42 years). Hypertension (60%) and multi-risk factors (50%) were predominant. Angiography revealed left anterior descending artery (LAD) involvement in 60% of patients. Group A exhibited significantly higher intermediate and high SYNTAX scores than Group B (p<0.001). Male patients and those with multiple risk factors were more likely to show abnormal angiographic findings (p<0.05). LAD involvement was notably higher in patients with high SYNTAX scores (p=0.002).
Conclusion: Patients with LBBB show a strong correlation with severe CAD and reduced LVEF, highlighting the need for routine coronary angiography in high-risk cases. The study emphasizes the importance of addressing cardiovascular risks aggressively in this population to improve clinical outcomes
Efficacy Of Montelukast As A Therapeutic Option In Bronchiolitis
Full text linkOBJECTIVE: To determine the efficacy of Montelukast as a therapeutic option in treating bronchiolitis and establish a relationship between Montelukast and clinical outcomes in our children with acute bronchiolitis.
PATIENTS AND METHODS: A descriptive cross-sectional study was conducted at Combined Military Hospital, Abbottabad, from September 2024 to November 2024.
Infants with bronchiolitis between the ages of 1 and 2 years were included in the study. Group A consisted of those with a history of prior montelukast use for more than two weeks before acute bronchiolitis, and Group B consisted of those who did not. Data was collected using a pre-designed form filled by paediatric residents. Relevant demographic and clinical data regarding various risk factors were recorded.
RESULTS: A total of 230 children with bronchiolitis. The mean age of participants was 15.97 ±3.431 months. 74 (32.2%) patients had a history of prior montelukast ingestion, and 142 (61.7%) were categorised as low risk as per the clinical severity scale (CSS). Pearson Chi-square test revealed that CSS, oxygen saturations and need for Continuous Positive Airway Pressure (CPAP) differed significantly between group A and group B. P- value was 0.040, 0.050 and 0.020, respectively.
CONCLUSION: Most children had low CSS scores at this age. Those with a prior history of montelukast ingestion were less likely to desaturate, require CPAP or have a higher CSS score.
KEY WORDS: Bronchiolitis, infant, montelukast, oxygen saturation, nasal continuous positive airway pressure, length of stay
Correlation Between Epicardial Fat Thickness Measured By Echocardiography And Coronary Artery Disease Severity Using The Gensini Score
Full text linkObjective: To investigate the relationship between epicardial fat thickness (EFT) and the severity of coronary artery disease (CAD) and determine an EFT cutoff value for CAD prediction.
Materials and Methods: A correlational study was conducted at the Rawalpindi Institute of Cardiology with 113 patients undergoing coronary angiography. EFT was measured using echocardiography, and CAD severity was assessed using the Gensini Score. Pearson’s correlation and receiver operating characteristic (ROC) analysis were used for statistical evaluation.
Results: A significant positive correlation was observed between EFT and Gensini Score (r = 0.749, p < 0.01). The EFT cut-off for predicting CAD was 4.50 mm, with a sensitivity of 89.8% and an area under the curve (AUC) of 0.920. Waist-to-hip ratio also correlated significantly with CAD severity, while BMI showed a weaker correlation.
Conclusion: EFT is a reliable and non-invasive marker for CAD severity, with significant implications for risk assessment and management.
MeSH Keywords: Epicardial Fat, Coronary Artery Disease, Gensini scor
Efficacy Of Rivaroxaban Versus Warfarin For The Treatment Of Deep Vein Thrombosis At Tertiary Care Hospital, Islamabad
No full textObjective: The occurrence of venous thromboembolism outside the pulmonary arteries or lower extremity conventional deep vein is referred to as deep vein thrombosis (DVT). The optimal anticoagulation treatment for deep vein thrombosis remained debatable. Therefore, the purpose of the current study was to compare Rivaroxaban versus Warfarin in treating deep vein thromboembolism at the Tertiary Care Hospital, Islamabad.
Methods: A randomised controlled trial investigated 170 deep vein thrombosis (DVT) patients in the Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, from July 2023 to January 2024. Patients were categorised into two groups: Group R (Rivaroxaban) (N=85) and Group W (Warfarin) (N=85). Demographic data, such as age, gender, comorbidities, clinical outcomes, and efficacy recorded for both groups. Major bleeding included any fatal bleeding, bleeding in critical organs, or bleeding causing a haemoglobin drop ≥2 g/dL or requiring ≥2 units of blood transfusion. Minor bleeding is defined as overt bleeding, including events like mild epistaxis or bruising not requiring medical intervention. SPSS version 16 was used for statistical analysis.
Results: The overall mean age of group R and W was 47.78±17.91 years and 46.45±18.01 years, respectively. Out of 170 patients, there were 83 (48.8%) males and 87 (51.2%) females. Gender based distribution of patients in both groups was as follows: Group R, N=85 (Male 42 (49.4%) and female 43 (50.6%) and Group W (Male 41 (48.2%) and female 44 (51.8%). Rivaroxaban (Group-R) showed higher efficacy, 72 (84.7%), than Warfarin (Group-W), 62 (72.9%).
Conclusion: The present study observed that treatment with Rivaroxaban is preferred over Warfarin due to reduced risk of DVT, major bleeding, and minor bleeding
Establishing Validity And Reliability Of Newly Developed Professionalism Assessment Tool
No full textObjective: This study aims to establish construct validity and reliability of a newly developed tool for assessment of professionalism in undergraduate medical students.
Method: The study was carried out after establishing feasibility and obtaining ethical approval from Aga Khan University and Rawalpindi Medical University. Data was collected from 3rd-year and 4th-year undergraduate medical students at the end of 2-week rotations. The tool was initially administered to year 4 MBBS students (pilot test); the data obtained was analysed by principal component factor analysis and reliability analysis to estimate the construct validity and reliability. A total of 391 Year 3 medical students were assessed using the 16-item PAT. The principal component analysis (PCA) and reliability analysis were conducted, thus further establishing the validity and reliability of the tool.
Result: Four factors were obtained on exploratory PCA. Nine items loaded on Factor 1 and merged the items on the proposed P-SS2 and P-SS3 subscales of “Ethics and personal characteristics” into one (SS1). SS2 was validated as all three items loaded on this subscale were related to “Effective communication and doctor-patient relationship.” SS3 and SS4 separated the four items included in the P-SS4 of ‘Supports Community Needs and Others’ into SS3 of “Respects and Supports Others” and into SS4 with items related to “collegiality: Responsive to Community Needs and Other Health Professionals.” The 16-item PAT had an overall reliability (Cronbach’s alpha) of 0.856. The Reliability of the new Subscales obtained after PCA for SS1 was 0.767, for SS2 was 0.726, for SS3 was 0.568 and for SS4 was 0.380.
Conclusion: The final tool developed for assessment of professionalism had 16 items on a 7-point Likert-like scale, across 4 Subscales. It can be used as a reliable and valid tool for assessment and feedback of professionalism for undergraduate medical students
Comparative Analysis Of Donor Site Morbidity and Rates Of Seroma Formation In Extended Versus Muscle-Only Latissimus Dorsi Flaps
No full textObjective: To compare the incidence of seroma formation and donor site morbidity between Extended Latissimus Dorsi (ELD) flaps and muscle-only Latissimus Dorsi (MLD) flaps in reconstructive surgery.
Methods: A comparative cross-sectional study was conducted at the Department of Plastic Surgery, Shifa International Hospital, Islamabad. A total of 60 patients undergoing breast reconstruction, upper and lower limb reconstruction after tumor resections or trauma and functional muscle transfers in brachial plexus injuries with either ELD (n=30) or muscle-only LD (n=30) flaps were included. Data on demographics, comorbidities and postoperative complications such as seroma formation, wound infection, skin necrosis, dehiscence, and pain (VAS) were collected over a 3-month follow-up period. Statistical analysis was performed using SPSS version 26.0, with significance set at p<0.05.
Results: Seroma formation was significantly higher in the ELD group (43.33%) compared to the MLD group (10%) (p<0.001), with a greater mean seroma volume (97.7 ± 38.5 ml vs. 25.2 ± 12.1 ml). Pain scores on Day 1 and at 1 month were also significantly higher in the ELD group (p<0.01). Other complications—wound infection, skin necrosis, and dehiscence—were more frequent in the ELD group but not statistically significant. Seroma recurrence was also more prevalent in the ELD group.
Conclusion: The ELD flap has been associated with significantly higher donor site morbidity, particularly seroma formation and postoperative pain, when compared to the muscle-only LD flap. These results indicate that ELD flaps can yield increased tissue volume with increased risk of complications and warrant careful consideration to improve operative technique
Microbial incidence in acute pharyngitis using throat swab analysis
Full text linkBackground & Objective: The inflammatory response of mucous membrane in the oropharynx is acute pharyngitis, often due to infection by various microorganisms, including fungi, virus, and bacteria. The study objective was to identify the spectrum of microorganisms responsible for acute pharyngitis through analysis of throat swab specimens.
Methods: A cross-section observational analysis was conducted at the ENT Department of Akbar Niazi Teaching Hospital, Islamabad, between February and July 2023. The study comprised a total of 100 patients diagnosed with acute pharyngitis. Throat swabs were aseptically collected from all patients and sent for culture. The microorganisms were identified using biochemical procedures, and their susceptibility to antimicrobic agents was determined using conventional techniques. SPSS v 25 was used for data analysis.
Results: Microorganisms were identified in 30 out of 100 specimens, with no growth observed in the remaining 70 specimens. The most commonly identified organism was Streptococcus pyogenes, found in 90% (n=27) of cases, subsequently Staphylococcus aureus at 60% (n=18) and Candida albicans at 13% (n=4). In 43.3% of cases, a solitary pathogen, Streptococcus pyogenes in 12 cases (92.3%) and Staphylococcus aureus in 1 (7.7%) were identified. The remaining 56.7% of culture reports indicated mixed infections.
Conclusion: It was found that Streptococcus pyogenes and Staphylococcus aureus were the primary causes of single infection, whereas Candida albicans, in conjunction with bacteria, was isolated in cases of mixed infections
A Comprehensive Study of Sternal Foramen in a Pakistani Cohort: Prevalence and Morphometric Analysis
Full text linkObjectives:This study aims to find the prevalence and morphometry of sternal foramen in the Pakistani population to prevent any potential cardiac complications and radiological or medicolegal misinterpretations.
Materials & Methods:This study was conducted on 178 dry human sternum bones of unknown sex and age available at the bone bank of King Edward Medical University Lahore, Pakistan. All the bones were grossly inspected for the presence of foramen. To describe the exact location of foramen its distance from the right and left sternal border was measured. For the size of the foramen, its vertical and transverse diameter was taken.
Results:The prevalence of foramen was found to be 7.3%. The foramina were round (53.8%) in shape, median (53.8%) in position and were located on body (61.5%). The average transverse diameter was found to be 3.08mm and the average vertical diameter was 2.83mm.Conclusion:This study provides valuable insights for cardiac surgeons, acupuncture specialists, forensic experts, and radiologists, helping them avoid potential complications that may arise from the lack of awareness of the sternal foramen.
Key Words: Sternal Foramen, Medico-legal Significance, Acupuncture, Bone marrow biopsie