Journal of Islamabad Medical & Dental College
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Diagnostic Accuracy of Doppler Ultrasound in Diagnosis of Prostatic Neoplastic Etiology Recognizing Histopathology as the Gold Standard
Full text linkObjective: To utilize histopathology as the gold standard, ascertain the diagnostic accuracy of doppler ultrasound inthe detection of prostatic neoplasm utilizing histopathology as gold standard.Methodology: Study was conducted at the Radiology Department Rawalpindi Medical University from 20thSeptember 2021 to 19th February 2022. A cross-sectional descriptive type, consisting of 157 male patients agedbetween 50 to 80 years with elevated prostatic serum antigen (PSA) and prostatomegaly on trans-abdominalultrasonography. Patients, who have previously been diagnosed with prostate cancer, took chemotherapy forprimary or secondary cancers and h/o radiation therapy were excluded. Trans-abdominal gray-scale and dopplerultrasound examinations were performed and gray-scale trans rectal ultrasound (TRUS) was performed on patientswith inconclusive trans-abdominal ultrasound. Representative photos with any focal lesions were recorded. Biopsywas performed with TRUS or transurethral resection of prostate (TURP) and follow up with biopsy report.Results: 80 (True Positive) of the 88 individuals with Doppler USG positivity for prostate cancer had the disease, whileonly 8 (False Positive) did not, according to histopathology. Among 69 patients who tested negative for Doppler USG,13 (False Negative) had prostate cancer on histology, while 56 (True Negative) did not. Sensitivity, specificity, positivepredictive value, negative predictive value, and diagnostic accuracy of conjunct Doppler USG on prostatic lesion wascalculated as 86.02 percent, 87.50 percent, 90.91 percent, 81.16 percent, and 86.62 percent, respectively, usinghistopathology as the gold standard.Conclusion: Doppler ultrasound is the non-invasive modality of preference with excellent diagnostic accuracy foridentifying prostate cancer.Keywords: Doppler Ultrasound; Prostate Cancer; Sensitivit
Patient and Family Engagement for Safe Care: From Passive Recipients to Active Partners
Full text linkComparison of Sevoflurane Versus Ketamine for Induction of Anaesthesia in Children
Full text linkBackground and Objective: Induction of general anaesthesia in paediatric patients is a challenging task. Sevoflurane and ketamine both can be used for induction. The purpose of this study was to find out ideal induction agent in paediatric cases. We compared induction time, hemodynamic variation and oxygen saturation with ketamine and sevoflurane in paediatric patients undergoing different surgeries.
Methodology: A randomized controlled trial was conducted at Department of Anaesthesia Children Hospital, PIMS, Islamabad from December 2018 to May 2019. We enrolled a total of 130 paediatric patients of either gender with age 4-12 years, who were planned for surgery under general anaesthesia. Patients were randomly allocated into two groups for anaesthesia induction. Group S patients received 8% Sevoflurane given via face mask in 100% oxygen at FGF of 6L/min and group K patients received Ketamine 1 mg/kg body weight via intravenous route. Mean time of induction, heart rate response, mean arterial pressure (MAP) response and oxygen saturation after induction was measured at one and two minutes and compared in both groups. All information was recorded via study Proforma and SPSS version 17 was used for data analysis.
Results: Mean age of group S patients was 6.8 years ± 2.9 and in group K patients was 7.3 years ± 2.5 (Ρ=0.372). There were 73.8% males and 26.2% females in group S and 61.5% males and 38.5% females in group K. Mean induction time in group S patients was 56.2 seconds ± 27.7 and in group K patients was 71.2 seconds ± 37.3 (Ρ=0.011). The induction time was significantly shorter in group S patients as compared to group K patients. At one minute, mean heart rate in group S patients was 112.4 bpm ± 18.8 and in group K patients was 121.9 bpm ± 18.7 (Ρ=0.005). At two minutes, mean heart rate in group S patients was 115.4 bpm ± 17.5 and in group K patients was 123.9 bpm ± 18.8 (Ρ=0.008). At one minute, MAP in group S patients was 60.1 mmHg ± 6.1 and in group K patients was 73.6 mmHg ± 9.2 (Ρ=0.001). At two minutes, MAP in group S patients was 60.4 mmHg ± 6.4 and in group K patients was 76.3 mmHg ± 10.8 (Ρ=0.001). At one minute, mean oxygen saturation in group S patients was 99.8% ± 0.54 and in group K patients was 99.7% ± 0.44 (Ρ=0.477). At two minutes, oxygen saturation in group S patients was 99.8% ± 0.54 and in group K patients was 99.6% ± 1.53 (Ρ=0.253).
Conclusion: Sevoflurane as an inhalational induction agent is a better choice in children due to shorter induction time and stable hemodynamic response as compared to ketamine, an intravenous induction agent.
Key words: Anaesthesia induction; ketamine; sevofluran
Comparison of Dexamethasone with Prednisolone in Treatment of Acute Asthma
Full text linkOBJECTIVE:
The objective of this study was to compare the efficacy of single dose oral dexamethasone with single dose oral prednisolone in the treatment of acute asthma exacerbation
MATERIALS AND METHODS
This study was conducted in the in the Department of Paediatrics,Hameed Latif Teaching Hospital Lahore from March 2023 to November 2023. Through a randomized controlled trial Study Design, a total of 160 children under 12 years of age were randomly allocated in two groups, children in group A were subjected to oral dexamethasone and in group B oral prednisolone was given. All children were followed up till 10th day after discharge to determine the efficacy of treatment in terms of relapse
RESULTS
The mean age of the infants in group A was 7.53 + 2.23 years while in group B it was 8.1 + 2.3 years (p value 0.107). Off the whole sample, we had 65% (n=52) males in group A and 55% (n=44) in group B, female gender was found in 35% (n=28) in group A while 45% in group B (n=36) with p value of 0.197. Efficacy in terms of relapse for group A was 85% while that of group B was 70%, (p value of 0.023).
CONCLUSION
The dexamethasone is more effective than prednisolone in the treatment of acute asthma exacerbation below 12 years of age, however, more randomized controlled trials especially in various combinations with bronchodilators in the management of acute asthma are required.
KEY WORDS
Acute Asthma, dexamethasone, steroid, prednisolone, , relaps
Parent’s Satisfaction Level without Antibiotic Prescription in Children with Clinical Diagnosis of Viral URTI
Full text linkABSTRACT
Objective: Objective of this study is to assess parent satisfaction levels when healthcare providers do not prescribe antibiotics for children with clinical diagnoses of viral upper respiratory tract infection (URTI).
Methodology:
200 children having ages between 6 months to 12 years, clinically diagnosed, as viral upper respiratory tract infections (based on clinical sign and symptoms) without respiratory distress signs were included. Structured questionnaire included items related to parent’s demographic information, their understanding of URTIs, their expectations regarding antibiotic prescriptions and their satisfaction levels with the healthcare provider's decision. A medical officer conducted face-to-face interviews of parents or guardian after their child's diagnosis and consultation with a Consultant Pediatrician, in a friendly atmosphere.
Results: The average age of the children included in the study was 5.12 ± 2.93 years. There were 124 males (62.0%) and 76 females (38.0%). 18 participants (9.0%) reported being highly unsatisfied with the healthcare provider's decision not to prescribe antibiotics for their children's viral URTI. 152 (76.0%), expressed being unsatisfied, while 30 participants (15.0%) were satisfied. The majority of participants, 192 (96.0%), believed that antibiotics could help in the treatment of viral URTIs. Only a small percentage, 8 (4.0%), held the correct belief that antibiotics do not help in viral URTI.
Conclusion: Majority of parents expressed dissatisfaction with the healthcare provider's decision not to prescribe antibiotics for their children's viral URTIs.
Key words: Viral Upper respiratory tract infection, Antibiotics, Parental satisfactio
Clinical Significance of Microvascular Obstruction Following Primary Percutaneous Coronary Intervention
Full text linkObjective: To evaluate the clinical significance of Microvascular obstruction following primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and to assess its impact on myocardial recovery and long-term outcomes.
Methodology: This retrospective study was conducted at Department of Cardiology, Hayatabad Medical Complex, Peshawar, from September 2023 to September 2024. A total of 250 STEMI patients undergoing primary PCI were enrolled. Data on demographics, clinical presentation, angiographic characteristics, and procedural details were collected. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging (CMR) 48 hours post-PCI. Statistical analysis included chi-square tests, t-tests, and logistic regression models.
Results: Among 250 patients, 150 (60%) were males and 100 (40%) were females, with a median age of 58 years (range 25-85). MVO was detected in 35% of patients. Myocardial Blush Grade (MBG) was Grade 3 in 30%, Grade 2 in 50%, and Grade 1 in 20% of patients. Infarct size ≤30% was seen in 50% of patients, 30-50% in 40%, and >50% in 10%. Adjunctive therapies significantly reduced MVO incidence (p=0.02). Logistic regression identified age ≥60 (OR=2.1, p=0.015), infarct size >30% (OR=3.2, p=0.008), and MBG 1 (OR=3.4, p=0.003) as significant predictors of MVO.
Conclusion: MVO significantly impacts myocardial recovery post-PCI, increasing infarct size and reducing left ventricular function. Early detection and adjunctive therapies improve outcome. Future research should explore long-term prognostic implications.
Keywords: Microvascular obstruction, primary PCI, STEMI, myocardial blush grade, cardiac MRI.
 
Infective Causes of Fever and Thrombocytopenia among Indoor Patients in a Tertiary Care Hospital in Islamabad
Full text linkObjective. To identify infective causes of thrombocytopenia among indoor patients in a tertiary care hospital in Islamabad.Methodology: All patients with documented fever of more than 3 days and platelets of less than 140,000/ml were included in the study. In total 147 patients of fever due to infective causes with thrombocytopenia were included, whereas patients with non-infective causes of thrombocytopenia were excluded. The patients were advised Blood CP, MP smear, ICT MP, Blood C/S, Dengue NS1, Dengue serology, Serology for leptospirosis and X-Ray chest. Statistical analysis was done using SPSS.Results: Among 147 cases, 35% of patients were males and 45% were females. Mean age was 39.65+16 years. The maximum number of patients had a platelet count between 20,000-50,000. The largest number of patients presented with petechiae followed by those with gingival bleeds and epistaxis. The diseases diagnosed in order of frequency were Dengue, Enteric fever, Malaria, Sepsis with DIC, Brucella, Leptospirosis, Hepatitis A, Disseminated TB and HIV.Conclusion: Infective causes of, which are fairly reversible with control of infection, should be kept in mind before embarking upon definitive and prolonged treatments of thrombocytopeniaKey words: Epistaxis, Gingival bleed, Petechiae, Thrombocytopenia
Efficacy of Xylocaine and Nitrate Combination in Preventing Radial Artery Spasm and Pain during Transradial Coronary Interventions
Full text linkObjective: To compare the efficacy of Xylocaine combined with nitrate versus nitrate and placebo in preventing radial artery spasm (RAS) and reducing pain during transradial coronary interventions.Methodology: This study was conducted at Hayatabad Medical Complex, Peshawar, from July to December 2024. A total of 60 patients undergoing transradial coronary procedures were included. Patients were assigned to one of two treatment groups based on clinical considerations: 30 received Xylocaine and nitrate, while 30 received nitrate and placebo. Both patients and interventional cardiologists were blinded to treatment allocation. Radial artery spasm was assessed using a radial spasm score, and pain was measured using the Visual Analog Scale (VAS). Statistical analysis was performed using t-tests and chi-square tests, with significance set at p < 0.05.Results: The Xylocaine and nitrate group had a significantly lower RAS rate (13.3%) compared to the nitrate and placebo group (36.7%) (p = 0.04). Pain scores were also significantly lower in the Xylocaine and nitrate group (2.3 ± 1.2) than in the placebo group (4.1 ± 1.6) (p = 0.01). Procedural duration and nitrate doses were similar between groups.Conclusion: The combination of Xylocaine and nitrate significantly reduces radial artery spasm and procedural pain compared to nitrate and placebo. This double-blind quasi-experimental study supports its clinical utility in improving patient outcomes during transradial coronary interventions.Keywords: Coronary Interventions, Nitrate, Pain Reduction, Radial Artery Spasm, Xylocain
Traumatic Orbital Apex Syndrome: A Rare Entity
Full text linkBACKGROUND:
Orbital Apex Syndrome (OAS) is an extremely rare significant ocular complication affecting the multiple cranial nerves following craniomaxillofacial trauma. The syndrome's clinical features predominantly involve a combination of ophthalmoplegia, proptosis, ptosis, hypoesthesia of the forehead, and vision loss.
Case Presentation:
We present the case of a young adult male who experienced traumatic OAS with facial bone fractures following a high energy injury from an RTA. The patient exhibited ptosis, complete ophthalmoplegia in the left eye and visual acuity impairment. Diagnostic imaging revealed the left supraorbital rim, which was comminuted and depressed. Additionally, there were fractures of the orbital roof, medial orbital wall, floor and also right ZMC fracture. Traumatic OAS was caused by direct compression due to a displaced fracture segment from the superior orbit. The patient was treated with a combination of emergent pharmacological and early surgical intervention and close monitoring thereafter. While there was some improvement in extraocular muscle movements, the visual impairment persisted.
Conclusion:
The overall recovery of vision after OAS is generally poor, although steroid therapy or surgical decompression did appear to improve the remaining visual parameters especially if the patient presents to the E.R immediately after the injury. Additional standardized patient data is required to clarify the effectiveness of these therapies. 
Socio-Demographic Determinants of Urinary Tract Infection and it’s Association with Preterm Birth
Full text linkObjective: To determine socio-demographic and other predictors of urinary tract infection in pregnancy and their association with preterm labour and delivery.
Methodology: It was the cross-sectional study done in Gynae department of Rawal Institute of Health Sciences from 1st September 2023 till 30th September 2024. In this study 450 patients, fulfilling inclusion criteria, were included. All patients presenting from 24 till 36+6 weeks in labor or threatened preterm labor, with confirmed UTI as isolated risk factor, were enrolled. Each confirmed case of UTI was treated in accordance with established medical guideline. Patients were followed till delivery. Data was evaluated using SPSS VS 25 and p value <0.05 was taken as statistically significant.
Results: Total of 385 patients diagnosed with UTI, 300 cases ended up having preterm delivery. Majority cases were between 26-33 years of age 160(42%), uneducated 215(56%), resident of rural area 320 (83%), belonged to lower middle class 173(45%) and no- booked 288 (75%). Regarding obstetrics history majority 175 (45%), were P4 and above. Predominant pathogen of UTI was Ecoli in 78%. It is evident that females with associated risk factors of UTI such as parity 4 and above, uneducated, rural resident belonging to lower middle class, non-booked cases, recurrent UTI and anemic had preterm delivery with statistically significant p value <0.05.
Conclusion: Considering the strong link between urinary tract infection and preterm labor, early detection and management in high-risk population with UTI risk factors is vital to improve maternal and neonatal outcomes.
Keywords: Preterm birth, Socioeconomic Factors, Urinary tract infectio