Journal of Rawalpindi Medical College
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Dengue Fever With Shigellemia: A Case Report
Full text linkShigella mostly causes gastroenteritis and rarely causes sepsis. Mostly malnourished children and elderly immunocompromised population at high risk of blood stream infection. Here, we are presenting a case of a male, aged 73 years. He was a known case of diabetes, hypertension, and ischemic heart disease (history of angioplasty twice) who came into the emergency department on 16th October 2024. The presenting with of loose bloody stools for 5 days, with shortness of breath. Initially, the patient was managed on the line of viral haemorrhagic fever with secondary bacterial infection of the Gastrointestinal tract, including Shigella. The patient was improving with symptomatic treatment and on antibiotics. This case highlights the rarity of and generates awareness among health care workers and physicians to direct their approach considering patient risk factors and clinical deteriorating conditions and early diagnosis of secondary bacterial infections in viral and immunocompromised patients. This approach reduces the hospital stay and cost, risk of treatment failure and mortality rate
Renal Histomorphological Effects of Vonoprazan Vs Omeprazole: A Comparative Study in Rats
No full textObjective: This research aimed to assess and compare the nephrotoxicity of omeprazole and vonoprazan on the basis of gross and histomorphological parameters in experimental rats.
Methods: This laboratory-based randomized controlled trial included 60 male Sprague Dawley rats (250 ± 50 g), randomly allocated into three groups: control (Group A), omeprazole-treated (Group B, 20 mg/kg/day), and vonoprazan-treated (Group C, 10 mg/kg/day). Drugs were administered orally for six weeks. Following euthanasia, kidneys were excised, weighed, and prepared for microscopic analysis using hematoxylin and eosin (H&E) and Masson’s trichrome stains. Data analysis was done using SPSS 26, with statistical significance set at p < 0.05.
Results: Omeprazole-treated rats exhibited significant reductions in glomerular diameter (23.5 ± 1.9 µm vs. 37.9 ± 1.3 µm in controls, p < 0.000), kidney weight (0.92 ± 0.12 g vs. 1.39 ± 0.09 g, p < 0.000), and relative tissue body weight index (RTBWI) (0.37 ± 0.06 vs. 0.50 ± 0.04, p < 0.000). The vonoprazan-treated rats showed relatively normal renal morphology with fewer histological changes and non-significant changes in renal parameters as compared to controls.
Conclusion: Omeprazole-induced nephrotoxicity was manifested as histopathological injury and deranged renal function parameters. Vonoprazan, on the other hand, showed a comparatively safer renal profile and indicated it to be an ideal nephroprotective drug alternative to proton pump inhibitors. Further studies are required to validate such findings and elucidate the mechanisms behind them
Comparative Analysis Of Continuous And Interrupted Suturing Techniques In Urethroplasty For Hypospadias
Full text linkObjective: Hypospadias is one of the most frequent congenital anomalies in males that affects penile development and hence optimal urine and semen flow. Snodgrass Tubularized Incised Plate Urethroplasty (TIP) is a widely employed technique for hypospadias, done in a single stage. While both continuous and interrupted sutures are options for TIP procedures, the best technique for minimizing complications is still under debate.
Methods: A quasi-experimental study was carried out in the Urology department of DG Khan Medical College and Hospital from June 2022 to June 2023 that included 69 boys divided into 2 groups based on suturing technique: 37 boys underwent continuous-suture Snodgrass TIP urethroplasty and 32 boys underwent interrupted-suture Snodgrass TIP urethroplasty. The ethical protocol was followed throughout the period.
Results: The mean age was 9.12 years, and we found that there was a statistically significant association between the type of complication and the suturing technique (p=0.117). Meatal stenosis (MS), urethral stricture, and urethrocutaneous fistula (UF) did not exhibit significant differences between groups (p-values > 0.05). Compared to patients with complications (53.6%), those without complications had a significantly higher chance of having a healthy single urine stream (100%).
Conclusion: Our findings suggest that interrupted suturing in TIPU may be associated with fewer complications and a higher rate of single urine stream compared to the continuous suturing technique.
Keywords: Hypospadias, Urethra, postoperative complications, Suturing Techniques
Thrombocytopenia Rates In Newborns Diagnosed With Gram-Negative Sepsis. Insights From NICU Experimental Based Study
Full text linkObjective: To evaluate the prevalence of thrombocytopenia observed in neonates admitted to the hospital with sepsis.
Methods: A total of 103 patients, including both males and females with ages below 28 days, who were admitted to the NICU (neonatal intensive care unit) with gram-negative sepsis were enrolled in this study. Blood samples were collected from each patient for sepsis and platelet analysis on the 1st and 3rd day of patients’ admission and sent to the Ghurki Hospital laboratory for analysis. Thrombocytopenia was defined as platelet counts <150,000/mm3. Thrombocytopenia was classified as mild, moderate, and severe. The type of organism and mortality rate related to thrombocytopenia were also recorded.
Results: Of 103 neonates, 64 (62.13%) were males while 39 (37.86%) were females. 88 (85.43%) had thrombocytopenia (p <0.001) whereas 15 (14.56%) had normal platelet count. E. coli was found to be the most common organism responsible for gram-negative sepsis. On day one, 61 (59.22%) patients had normal platelet count whereas 12 (11.65%), 14 (13.59%), & 16 (15.53%) neonates had mild, moderate & severe thrombocytopenia respectively. In contrast, on the third day, 18 (17.47%) neonates had normal platelet count, 6 (5.82%) had mild, 33 (32.03%) had moderate, and 46 (44.66%) had severe thrombocytopenia. 12/103 (11.65%) patients died, out of which 11 (10.68%) had thrombocytopenia.
Conclusion: Thrombocytopenia is a significant marker of gram-negative sepsis in neonates.
Keywords: Neonate, Neonatal Intensive Care Unit, Thrombocytopenia, Sepsis
Navigating The Landscape Of Innovation & Entrepreneurship In Pakistan: A Review
Full text linkThis article's abstract explores the concepts of innovation and entrepreneurship and how they work together to promote economic progress. Despite its challenges, Pakistan may prosper in these fields thanks to its large and growing market, skilled labour force, and supportive political environment. However, for innovation and entrepreneurship to live up to their potential, several problems need to be resolved, including bureaucracy and corruption, poor intellectual property protection, inadequate research and development, and limited access to capital.
In the medical device industry, innovation and entrepreneurship may drive progress as new technologies and opportunities for expansion and improvement can be developed. Getting finance, negotiating legal and regulatory environments, managing new trends and technologies, The potential for coordinated effort and organisation, and laying the basis for a flourishing enterprising biological system in Pakistan are points shrouded in this article. The article makes various significant proposals for Pakistani entrepreneurs who must work on their odds of coming out on top, including making a strong marketable strategy, finding finance sources, interfacing with others and cooperating, using innovation, and being versatile. Pakistan can lead the way nearby for advancement and business, setting the way for monetary development and improvement, with continuous endeavours and participation.
Keywords: Innovation, Entrepreneurship, Economic growth, venture, Value, Workforce, Research and development, Medical device, Networking, Technology, Adaptability, Success
Pain Experience And Analgesic Consumption In Orthodontic Patients After Fixed Appliance Adjustments
Full text linkObjective: To investigate the frequency of pain and analgesic intake among orthodontic patients on the first day of fixed appliance adjustments.
Methods: This retrospective observational study included 313 orthodontic patients from the Rawal Institute of Health Sciences, Islamabad, conducted between 3rd January 2024, and 30th August 2024. Patients aged 13 years and above undergoing fixed orthodontic treatment for at least three months were included in this study. Patients already taking analgesics for any reason were excluded from the study. Data on pain experiences (mild, moderate, severe) and analgesic intake (type, dosage, frequency) within the first 24 hours of bracket placement were collected from the history. Statistical analysis included descriptive statistics and chi-square tests to assess the association between pain and analgesic use, with significance set at p ≤ 0.05.
Results: Of the 313 patients, 255 (81.5%) were females and 58 (18.5%) were males. Pain was reported as follows: 75 (24%) patients experienced no pain, 133 (42.5%) reported mild pain, and 105 (33.5%) reported moderate pain. No patients reported severe pain. Regarding analgesic intake, 120 (38.3%) did not take any analgesics, while 105 (33.5%) used acetaminophen, 45 (14.4%) used ibuprofen, and 43 (13.7%) used naproxen. A significant association was found between pain levels and analgesic intake (p = .000).
Conclusion: The study highlights that while many patients experience mild to moderate pain, a significant portion do not utilize analgesics. Acetaminophen was the most common analgesic used, particularly among females. These findings underscore the importance of tailored pain management strategies in orthodontic care to enhance patient comfort and safety. Further research is needed to develop standardized protocols for analgesic use in orthodontic treatment.
Keywords: Analgesics, Orthodontic appliances, Pain, Patient comfort
Exploring the Landscape of HPV Vaccine Acceptability in Pakistan: A Systematic Review
Full text linkThe FDA-approved vaccination against the Human Papillomavirus (HPV) was introduced in 2006, and since then, many countries have successfully implemented various HPV immunization programs. However, Pakistan, with approximately 73.8 million women at risk of cervical cancer, significantly lags behind, and currently, the HPV vaccination is not included in any immunization programs. This could be attributable to a dearth of awareness and knowledge amongst the masses regarding the HPV vaccine. The primary aim of this review was to evaluate public awareness and acceptance of the HPV vaccine in Pakistan. A literature search was conducted using electronic databases, including PubMed, Google Scholar, and ScienceDirect. Of the 222 studies in total, 15 were finalized, which met the review’s criteria and objectives. The review assessed the population’s awareness of the HPV vaccine's availability, their current vaccination status against HPV, and their willingness to get vaccinated against HPV. The analysis revealed that the current immunization status remains alarmingly low, which could be in line with low awareness regarding the availability of the HPV vaccine in Pakistan. There is a pressing need to introduce the HPV vaccination into the national immunization schedules and simultaneously strengthen regulatory frameworks surrounding the HPV vaccination in Pakistan.
Key words: Human Papillomavirus; HPV vaccine; Immunization programs; EPI; Pakista
Impact of Pregnancy Induced Hypertension on Birth Weight of Newborn at Term
No full textBackground: To determine the birth weight of newborns at term born to mothers with pregnancy induced hypertension.
Methods: In this cross sectional study birth weight of 124 newborns, of mothers with pregnancy induced hypertension were recorded within one hour of delivery
Results: In 124 mothers, who fulfilled the inclusion criteria, the incidence of Pregnancy Induced Hypertension was 24.2 %. None of the patients had pre-eclampsia or eclampsia. The average birth weight among the total cases was 3.044 kg. The incidence of low birth weight babies among the pregnancy induced hypertensive pregnancies was 3.33%. The incidence of normal weight babies, among the pregnancies affected with Pregnancy Induced Hypertension was 96.66%.
Conclusion: Pregnancy Induced Hypertension has no significant effect on birth weight of new bor
Impact Of Modifiable Risk Factors On Outcome In Patients With Perforated Peptic Ulcers: A Local Experience
No full textObjective: This study aims to determine the impact of modifiable factors in perforated peptic ulceration on reducing mortality at our local setting of Benazir Bhutto Hospital, Rawalpindi, over two years.
Methods: All the patients who were admitted and managed for perforated duodenal ulcer at the emergency department of the Surgical Unit 1 at Benazir Bhutto Hospital, Rawalpindi, from 01-11-2021 to 31-10-2023 were included in the study. The possible causes, co-morbidities, and complications were noted, and data were recorded on a specified proforma.
Results: Among thirty-two patients of perforated duodenal ulcers, 63% were smokers, a history of NSAIDs use was present in 37.5% patients, and co-morbidities were present in 25.00% patients. All patients underwent exploratory laparotomy and repair of perforation. The average hospital stay was 5 days, with a range of 1-15 days. The mortality rate in our study was 28.12%.
Conclusion: Perforation is still a prevalent complication of peptic ulcer disease. Smoking, increased NSAIDs use, and stressful life play an important role in such cases. Mortality rate is very high in perforated duodenal ulcer cases despite increased understanding of post-operative care
Association Of Maternal Stressors During Pregnancy With Postpartum Depression (PPD), A Cross-Sectional Analytical Study : Maternal Stressors during Pregnancy
Full text linkObjective: Postpartum depression can negatively impact both the mother's health and the child's development if treatment is not received. This study's goals are to discover different prenatal stressors and ascertain if the mother's stress during pregnancy is linked to postpartum depression.
Materials & Methods: Using a consecutive sampling technique, an analytical cross-sectional study was conducted at postnatal wards, EPI centers and Gynae OPD of women aged 20 to 45 during the postpartum period (one week to six months). The study excluded female participants having a history of chronic illness, psychiatric medication, or a diagnosis of psychiatric disorder. The Edinburgh Post-Depression Scale and self-structured pre-partum stressors were included in an interview-based questionnaire.Results: Of the 313 mothers, 63.3% experienced mild stress, 32.6% experienced moderate anxiety, and 3.8% experienced severe stress. Inflation (82%), husband issues (64%), abuse at the hands of the husband (55%), and housekeeping during pregnancy (52%), were the most frequent sources of stress. Postpartum depression was seven times more likely to occur in those with high stress levels.Conclusion: Prepartum stress was modest for the majority of participants. The main causes of stress were things like inflation, followed by problems with the spouse, abuse at the hands of the husband, concerns about the children's schooling, and the amount of chores that came with being pregnant. Postpartum depression was more common in those with high stress levels