Journal of Rawalpindi Medical College
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Frequency Of Feto-Maternal Outcomes In Prelabour Rupture Of Membranes
Full text linkObjective :
To determine the frequency of fetomaternal outcomes in patients with prelabour rupture of membranes presenting to tertiary care hospitals.
Methods:
A descriptive study was conducted at the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital, Rawalpindi from 25th March 2023 to 25th January 2024
A total of 245 patients with prelabour rupture of membranes (PROM) were included in the study, fulfilling the inclusion criteria. All patients were managed as per standard protocol and followed until delivery. Data regarding fetomaternal outcomes was noted.
Results:
This study found that the mean age of the patients was 29.89 ± 5.83 years. Among 245 patients of PROM, in 160 cases maternal and in 90 instances fetal complications were observed. As per maternal outcomes, 93 (58%) underwent cesarean section, puerperal sepsis was observed in 31 (19%) and 36 (23%) wound site infections occurred. On the neonatal side, 29(32%) had low APGAR scores while 26 among 90 (29%) had low birth weight. NICU admission was necessary in 21 (23%) babies while fetal distress was recorded in 14 (16%) newborns.
Conclusion:
Our study has concluded that a considerable proportion of patients with PROM experienced fetomaternal complications. Among maternal complications, it is observed that a significant number of pregnant women with PROM required cesarean sections. This warrants a careful and timely management of such cases to ensure good fetal outcomes.
Keywords:
Fetal membranes, Premature rupture, Fetal distress, Puerperal infection, Cesarean sectio
Comparison of Cell Counter Indices (Mentzer vs. RDWI) in Differentiating Iron Deficiency Anaemia from Beta-Thalassemia Trait in a Tertiary Care Hospital in Pakistan
No full textObjective: This study aims to assess the diagnostic value of the Mentzer Index and Red Cell Distribution Width Index (RDWI) in differentiating between Iron Deficiency Anaemia (IDA) and Beta-Thalassemia Trait (β-TT) in adult patients of a tertiary care hospital in Pakistan.
Methodology: This cross-sectional study was carried out in the outpatient department of Medicine, Combined Military Hospital Rawalpindi from Jul 2024 to December 2024. The data were collected from 170 patients with microcytic anaemia aged >18 years with a confirmed diagnosis of IDA and β-TT. Haematological parameters, including haemoglobin, red blood cell (RBC) count, mean corpuscular volume (MCV), RDW, Mentzer Index, and RDWI, were calculated. Data was analysed using SPSS-25. The chi-square test was used to assess between variables. Sensitivity, specificity and diagnostic accuracy were calculated.
Results: The study population included 90 patients (52.9%) with IDA and 80 patients (47.1%) with β-TT. Our results demonstrated statistically significant differences between the IDA and β-TT groups for key diagnostic parameters. The results indicated that both indices have almost equal sensitivity (92%) while RDWI demonstrated higher specificity (89% vs. 80%). RDWI had a slightly higher diagnostic accuracy of 90% and the Mentzer Index 86%.
Conclusion: The Mentzer Index and RDWI are valuable screening tools for differentiating IDA from β-TT, especially in settings where advanced diagnostic methods are not available. Although significant differences between haematological parameters were seen in this study, further research with larger sample sizes is recommended to improve the diagnostic accuracy of these indices
Predictive Role Of C-Reactive Protein (CRP) In Determining The Severity Of Acute Cholecystitis Presenting In The Emergency Department Of A Tertiary Care Hospital
No full textObjective: This research aims to explore the predictive role of CRP in determining the severity and grading of acute cholecystitis, particularly in our local population presenting to the emergency department.
Methods: A Cross-sectional (validation) study was conducted at the Department of Surgery, Holy Family Hospital, Rawalpindi, on 288 patients aged 18 to 70 years who had clinical symptoms suggestive of acute cholecystitis. Baseline CRP levels from blood samples taken at the time of admission were determined. Additional CRP measurements were taken at predefined intervals, such as 24 hours and 48 hours after admission. All patients were subjected to follow-up imaging findings via Histopathology as a gold standard technique. The hospital lab was used for the results of the investigation, i.e CRP.
Results: CRP levels sensitivity was (93.30%), specificity (85.32%), PPV (91.26%), NPV (88.57%), and diagnostic accuracy (90.28%) in predicting the severity of the acute cholecystitis, taking histopathology as the gold standard.
Conclusion: According to the study's findings, CRP has a good predictive value for assessing the severity and grading of acute cholecystitis and can be used as a diagnostic criterion for the conditio
Motivational Influences on Volunteer Activities and Field Satisfaction: Insights from Medical Students in Peshawar
No full textObjective: This study aimed to assess the level of satisfaction with the medical field among medical students in Peshawar.
Methods: A cross-sectional analytical study was conducted on 329 medical students from 1st May 2024 to 15th July 2024, in the Northwest School of Medicine, across seven private medical colleges in Peshawar. Data was collected through a structured questionnaire covering demographics, volunteer experience, motivations, and satisfaction levels. Statistical analysis, including Pearson Chi-Square tests, was performed using SPSS version 26 to examine associations between volunteer status and field satisfaction and stress levels.
Results: Out of all the participants, 183 (55.6%) had volunteer experience, showing significantly higher field satisfaction p < 0.001) than non-volunteers. Additionally, volunteers reported lower stress levels (p = 0.028), with motivations including helping others, skill development, and social connections. Time constraints were a significant barrier for non-volunteers, while the lack of institutional support also limited volunteer involvement.
Conclusion: Volunteer activities have a positive influence on field satisfaction and reduce stress levels in medical students, suggesting that their integration into medical education may enhance students' overall well-being. Addressing logistical barriers and expanding volunteer support in academic institutions could further benefit students and the communities they serve.
Keywords: Motivation, Social Support, Adaptation, Psychological Community-Institutional Relations
To Compare Thread Technique Versus Aspiration Plus Steroid Injection Of Wrist Ganglion In Terms Of Frequency Of Recurrence
Full text linkObjective: To compare the recurrence of wrist ganglion following thread technique versus aspiration plus steroid injection.
Methods: This was a Randomized controlled trial conducted in the Department of Surgery. HIT Hospital, Taxila from June 2020 to December 2020. Sixty patients were randomized into two equal groups A and B after clinical diagnosis of wrist ganglion. Informed written consent was obtained after informing all pros and cons of the procedure. The thread technique was done in group A while in group B methyl prednisolone acetate 40 mg/ml was injected after aspiration. The patients were followed 2 weeks, 6 weeks, 3 months, and 6 months. The clinical examination was done to see the possible recurrence.
Results: The mean age of the participants was 29.30 ± 6.0 years. The mean duration of ganglia was 19.33 ± 8.35 months. The location of ganglia was 37 (61.7%) dorsal and 23 (38.3%) volar. The male-to-female ratio was 22 (36.7%): 38 (63.3%). Collectively, the frequency of recurrence was 6 (10%), 10 (16.7%), 12 (20%) and 16 (26.7%) at 2 weeks, 6 weeks, 3 months, and 8 months respectively. There was no difference between groups A and B in terms of age, gender, location, and duration of disease (p values 0.401, 0.592, 0.791, 0.783 respectively). The frequency of recurrence was significantly different among groups at 6 months i.e. 12 (40.0%) in group A versus 4 (13.3%) in group B (p-value 0.020).
Conclusion: The thread technique of wrist ganglia is superior to steroid injection in terms of recurrence. The RCTs with a larger sample size and prolonged follow-up would provide more insight into this subject
The “D” Word And Covid-19; Outcome Of Indoor Diabetics With Covid-19 In Tertiary Care Hospital.
Full text linkOBJECTIVE: COVID-19 has been a global challenge. Diabetes is a frequent co-morbid in Covid cases having a complex bidirectional relationship. This study aims to determine the outcome of COVID-19 cases with diabetes vs. non-diabetics.
METHODS: This observational study was conducted at RIHS Islamabad (June–Dec. 2020) after ethical approval. Adult indoor confirmed (PCR positive) COVID cases of both genders were included by consecutive sampling. Patients <18 years of age, having gestational diabetes, drug-induced diabetes and Cushing’s syndrome were excluded. The study included 75 Covid cases with diabetes (group A) and 75 Covid non-diabetics (group B). Diabetes was labelled based on glycated haemoglobin and blood sugars. Patients were managed as per recommendations and followed till discharge or expiry. Details are documented on a specially designed proforma. Data was analyzed by SPSS V-22 with significant p<0.05. The chi-square test was applied to study the association of diabetes in Covid cases with expiry, duration of hospital stay, disease severity and need for mechanical ventilation.
RESULTS: Among 150 cases of Covid; there were 54(36%) females and 96(64%) males. The mean age was 58+13 years (range 27-92 years). The mean age of those cases who expired was 60.77+12.78 years vs. 56.73+13.40 years in those who were discharged (p>0.05). Obesity was observed in 41(27.3%), hypertension in (35.3%), ischemic heart disease in 26(17.3%), asthma in 11(7.3%), COPD in 7(4.7%), chronic kidney disease in 7(4.7%), hypothyroidism in 5(3.3%), These co-morbid conditions had no association with mortality. 9(6%) cases had mild Covid, 97(64.7%) moderate and 44(29.3%) had severe Covid. Higher frequency of moderate 41(54.7%) and severe 29(65.9%) Covid was found in diabetics. Death was observed in 14(14.4%) moderate and 34(77.3%) severe Covid (p<0.0001). The mean duration of hospital stay was 13+7.7 days (1-45 days) having no association with mortality. The need for invasive ventilation and duration of admission were comparable between the two groups. Total 102(68%) cases were discharged and 48(32%) expired. 30(62.5%) of deceased were diabetics vs. 18(37.5%) non-diabetics (p=0.036).
CONCLUSION: Diabetes is commonly observed comorbidity in COVID-19 cases and is significantly associated with disease severity and mortality. Patients with both diabetes and COVID-19 require close monitoring and careful management. Additionally, older age and obesity are important risk factors that further contribute to the severity of the disease and the risk of mortality in diabetic patients with COVID-19
Unveiling Potential: Using A Mixed-Methods Approach To Explore The Influence Of Mini-CEX-Associated Feedback On Students’ OSCE Performance
Full text linkObjectives:
Objective Structured Clinical Examination (OSCE) and Mini-Clinical Evaluation Exercise (Mini-CEX) on a continuum allow for appropriate assessment of clinical skills. At Shifa College of Medicine (SCM) both assessment strategies are implemented. Mini-CEX-associated feedback is intended to help learners perform well during summative OSCE. This study was conducted to determine the interplay between mini-CEX and end-of-clerkship OSCE performance of fourth-year undergraduate medical students and to understand their perspectives regarding the effectiveness of feedback provided following mini-CEX encounters.
Methods:
This cross-sectional study employed a Mixed-Methods approach. One Hundred fourth-year students, rotating through different clinical clerkships, were invited to participate. Survey responses and students’ OSCE and mini-CEX were quantitatively analyzed using descriptive statistics and Pearson’s coefficient. Thematic analysis of the comments on the survey and focus group discussions provided an in-depth understanding of the process.
Results:
Survey analysis showed that respondents agreed with current practices of mini-CEX assessments and associated feedback and considered them suitable for appropriate learning and assessment. Statistical analysis revealed a significant positive correlation between two sets of scores.
(r = 0.692).
Thematic analysis of Focus group discussions provided insight into the process and external factors, i.e., resources, exam setting, duration, scheduling, scoring schemes, and preceptors, and their influence on the quality of the assessment activity, associated feedback, and its effectiveness on our learners’ performances.
Conclusion:
From this study, we gathered that mini-CEX has been an invaluable learning opportunity for our students. Its associated feedback positively impacted their academic performance. Moreover, it was concluded that the overall impact can be improved by training the faculty and students alike to provide and optimally utilize feedback
Effects Of Simvastatin On Histomorphological And Biochemical Parameters Of The Thyroid In Rats
Full text linkObjective: This study intended to explore the effect of simvastatin on the thyroid gland's biochemical function and histological structure in a rat specimen.
Methodology: An experimental study using a controlled laboratory model from January 2022 to January 2023. This study was conducted at Army Medical College, Armed Forces Institute of Pathology Rawalpindi in collaboration with the National Institute of Health Islamabad, Rawalpindi over one year. Forty male Sprague-Dawley rats weighing approximately 250 grams and between the ages of 3-4 weeks were randomly assigned into identical groups: a control group (A) and an experimental group (B), which received simvastatin for 12 weeks. After the test, rats were euthanized, and their thyroid glands were harvested for analysis. The glands were examined histologically to assess for structural changes, inclusive of size of diameter of thyroid follicles. In addition, serum levels of thyroxine (T4) and thyroid-stimulating hormone (TSH) were assayed. Data have been analyzed using SPSS software version 23. Statistical significance was expressed using Chi-square checks for qualitative records and independent sample t-test for quantitative comparisons, with P < 0.05 considered significant.
Results: Simvastatin treatment resulted in noteworthy differences in the biochemical profile, with a noticeable decrease in serum T3 level (p=0.001) s and a rise in thyroid-stimulating hormone (TSH) (p=0.001) levels compared to the control group. Supplementary noticeable histological changes in the thyroid glands of the rats were detected and characterized by decreased diameter of thyroid follicles (p=0.001).
Conclusions: The results of this study specify that Simvastatin induces considerable alterations in endocrine profile and variations in thyroid gland histology in rats. These results propose that the drug could influence thyroid health, with probable implications for long-term statin use in clinical situations.
Keywords: Hypothyroidism, Hyperthyroidism, Thyroid Diseases, Apoptosis, Endocrine Gland, Metabolis
Revolutionizing Aging: The Dawn of Longevity Medicine and Lifespan Extension
Full text linkAgeing, conventionally measured as an inevitable biological process, is one of the major areas of leading-edge scientific research. Nowadays, the field of senolytics, telomere extension and other cellular rejuvenation techniques intended at tackling ageing at its foundation have been studied by scientists as potential new options for extending human life and refining health in later years.1
Senolytics, Aging Reversal and Signaling the End of Senescence
The class of drugs known as senolytics, which kill senescent cells, have seen great promise in preclinical and very early human trials. Senescent cells, also termed zombie cells, accumulate with a normal ageing process and contribute to inflammation, tissue malfunction, and age-related disease. Senolytics, the drugs that selectively remove these cells, improve health, reduce frailty and it might even extend life.2 Such drugs as dasatinib and quercetin have been effective in animal models and ongoing human trials in checking their lifelong impact on ageing-related disorders like osteoarthritis and cardiovascular failure. A strategy of senolytics has proven to be promising against age-related decline due to its ability to target specific pathways that allow senescent cells to persist and evade regular cell death. Senolytics can accomplish this by acting in BCL-2, PI3K/AKT, and p53/p21 pathways, restoring tissue homeostasis and decreasing chronic inflammation.3 Dasatinib, a renowned tyrosine kinase inhibitor initially developed for leukaemia, and Quercetin, an exceptional natural flavonoid with brilliant senolytic properties, are two of the most prominent senolytics. Often, these both work well synergistically to enhance each other’s effects. An alternative flavonoid, fisetin, also has great potential for extending lifespan in experimental mice. Additionally, Navitoclax was identified for its ability to induce apoptosis of senescent cells through a selection of BCL-2 family members.4
Telomere Extension: The Key to Cellular Immortality
Telomeres are sequences of DNA located at the end of chromosomes that degrade with each cell division, leading to cell dysfunction. Telomerase, an enzyme that replaces telomeres, has been shown to extend the cellular lifespan and possibly reverse the ageing process in various studies.5 Current studies include gene therapy to increase telomerase activity, which has been successful in animal models. The main challenges are the potential for uncontrolled cell growth and cancer. Telomere extension offers a great prospect to enhance the quality of human life and increase the lifespan primarily through two ways. First, there is telomerase activation, a process that reverses the shortening of telomeres. Telomerase is a ribonucleoprotein that adds tandem repeats to the ends of telomeres.6 It is mostly inactive in somatic cells, but this is very important in stem cells, germline cells and cancer cells. Gene therapy or the use of tiny molecules such as TA-65 could perhaps be used to deliver telomerase to ageing cells and resuscitate it, or reactivate it and increase its activity. Other research has shown that specific nutrients and hormones can increase telomerase activity, so there may be other avenues to be explored to regrow cellular health as well.7
On the other hand, an interesting mechanism called Alternative Lengthening of Telomeres (ALT) is working independently from telomerase mainly in cancer cells. ALT allows cells to extend their telomeres by copying telomeric DNA from one chromosome to another by using DNA repair mechanisms, such as homologous recombination. Blocking ALT could be an important cancer research target since ALT inhibiting could do much to stop the infinite proliferation of cancer cells.8
Beyond Senolytics and Telomeres: Additional Promising Interventions
Other therapies are gaining popularity in longevity therapy, besides senolytics and telomere extension. Metabolic pathways have been shown to regulate lifespan when metformin and rapamycin are mimicking calorie restriction. In addition, there are great breakthroughs from regenerative medicine in the renewing of ageing organs and tissues, including stem cell therapy and tissue engineering.9
The Ethical and Social Consequences of Prolonged Lifespan
While these scientific advances are interesting, they involve equally or even more serious ethical and societal dismays. What will be the implications of being able to confidently dramatically postpone or even, in some cases, reverse ageing on the global dynamics of population, economic systems and health systems? To prevent a future in which only the wealthy can afford extended lifespans, anti-ageing medications must be available as well.10, 11
The Future of Longevity Medicine
Anti-ageing research has moved beyond the realm of science fiction. With continuous advances in biotechnology, the idea of reducing, halting, or even reversing parts of ageing is becoming more real. However, converting these discoveries into safe and effective medicines for general usage is still a considerable issue. As research advances, the focus must stay on guaranteeing not only a longer but a healthier life.12
The promise of healthy longevity is closer than ever, but it will necessitate careful consideration of scientific, ethical, and cultural issues. The next few decades could redefine what it means to be old, turning ageing from an unavoidable decline into a controlled, treatable condition
A Correlation Between Retinal Nerve Fibre Layer Thickness And Axial Length In Non-Glaucomatous Myopes
Full text linkObjective: To assess the correlation between retinal nerve fibre layer thickness and axial length in non-glaucomatous myopes.
Methodology: This cross-sectional Study was conducted from May to October 2023 in the Department of Ophthalmology of Fauji Foundation Hospital, Rawalpindi. Eighty-five (85) patients with myopia 1D to −10D who visited the ophthalmology outpatient department underwent ocular examinations for the measurement of refraction, axial length, and OCT RNFL thickness. After pupillary dilatation, the thickness of the retinal nerve fibre layer surrounding the middle of the optic disc was assessed using optical coherence tomography (OCT). An automated computer program produced the analysis report of mean retinal nerve fibre layer thickness, which was then compared to the age-matched normative database that was integrated into 3D OCT.
Results:
The mean age was 18.88 + 5.4 years. The male: female ratio was almost the same. 47 (55.3%) were female and 38 (44.7%) were male. Most of the patients had moderate myopia, i.e. 48 (12.9%). The mean axial length was 25.89 + 1.42. The mean retinal nerve fibre layer (RNFL) thickness was 138.65 + 18.68. Pearson’s coefficient of correlation was -0.586.
Conclusion: As axial length increases in myopic patients, the RNFL thickness decreases