Journal of Islamabad Medical & Dental College
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Role of MDCT in Patients with Abdominal Trauma
Get PDFObjectives: To assess the role of abdominal imaging for precise identification of the injuries for early surgical exploration by using Multidetector Computed Tomography (MDCT) and to assess those patients that can be managed conservatively.
Study Design: Prospective cross-sectional observational study.
Place and Duration of the Study: Pakistan Air Force Hospital Islamabad, November, 2022-November, 2023.
Methodology: The study was carried out on 120 cases of abdominal trauma. MDCT scan with contrast was performed after the initial resuscitation and stability of the patients in the emergency room being done by the respective medical and paramedical staff.
Results: In clinically stable patients, the use of multi-detector CT as initial triage of abdominal trauma resulted in a reduction in the number of laparotomies by 91% and an increase in number of conservatively managed with a better outcome of around 95% and 92% respectively.
Conclusion: The current study assessed and showed the better role of MDCT in evaluation of the blunt trauma patients in early detection and timely surgical exploration. MDCT imaging test helps the clinicians in making an early and right choice of intervention. The high-resolution MPR, MIP, and 3-D volume reconstruction images assisted in displaying complex injuries, increasing diagnostic capacity, accuracy, associated vascular and bony pathologies, and reduced reporting time
Paper Mills and Intellectual Prostitution in Pakistani Research: A Challenge to Scientific Integrity
Get PDFIn recent years, the phenomenon of ‘paper mills’ has gained significant attention within the academic and scientific communities globally. A paper mill refers to an organization or individual producing research papers, often fabricated or plagiarized, for authors in exchange for financial incentives. This troubling practice has infiltrated various regions, including Pakistan, leading to a surge in research publications that lack genuine scientific merit. The underlying issue, particularly in Pakistan, is the growing tendency among academics to prioritize career advancement/promotions over contributing to knowledge or solving real-world problems.
According to a report published in the leading journal ‘Nature’, thousands of publications in academic journals have been linked to paper mills in China, Iran, Saudi Arabia, and Russia. According to some estimates, the percentage of academic articles produced by paper mills is between 2 to 20%. In 2023 alone, 10,000 research articles were retracted as a result of fake research and unfortunately, Pakistan was included among the list of countries with highest number of retractions. There are serious repercussions for the authors, the journals, and eventually the country as a whole
Safety and Efficacy of Early Cholecystectomy in Acute Biliary Pancreatitis
Get PDFObjective: This study was done to assess the safety and efficacy of early Cholecystectomy in mild to moderate Acute Biliary pancreatitis in own surgical setup.
Methodology: This descriptive study was done in surgical unit 1, Fauji Foundation Hospital Rawalpindi from 1st January 2019 to 31st December 2022. Total 70 patients diagnosed as having mild or moderate acute biliary pancreatitis were included in study. Patients having severe acute biliary pancreatis, multi-organ dysfunction syndrome and pre-existing severe medical co-morbidity were excluded from study. After informed consent early cholecystectomy either laparoscopic or open was performed by senior consultant surgeon within 2-4 days of admission. Post-operatively patient subjective feeling of pain, intravenous analgesia and hospital stay were recorded. Post-operative complications were documented. Data were analyzed on SPSS version 26.
Results: The age range was from 28 to 72 years with a mean of 45.2 ± 11.86 years. Majority of patients were of mild severity 44(62.9%), while 26(37.1%) cases were of moderate severity. Laparoscopic cholecystectomy was performed 28(40%) cases and open cholecystectomy was done in 38(54.28%) cases. Post-operative pain numerical scale mean was 4.31 ± 1.55. The duration of requirement of post-operative intravenous analgesia was mean 37.02 ± 18.12 hrs. Mean hospital stay of patients was 5.95 ± 1.39 days. Among post-operative complications, the most frequent was post prandial dyspepsia 10(14.3%) cases followed by surgical site infection 6(8.6%) cases, recurrent pancreatitis 4(5.7%) cases, pseudocyst formation 2(2.9%) cases, lobar pneumonia 1(1.4%) case and recurrent biliary sepsis in 1(1.4%) case.
Conclusion: Early cholecystectomy is a safe surgical procedure in mild to moderate biliary pancreatitis. It shortens the course of illness, prevents complications and reduces hospital stay.
KEYWORDS: Cholelithiasis, Acute biliary pancreatitis, cholecystectomy, safety, Efficacy
Gender Based Variation in the Prevalence of Cerebral Palsy in Pakistan
Get PDFCerebral palsy (CP) is a neurological disorder that affects motor movement, posture, and tone as a result of a persistent encephalopathy acquired during fetal, infancy, or early childhood development. This review aimed to gather the pooled prevalence to assess the gender-based variation of CP in different cities of Pakistan. A comprehensive literature review was conducted in July. 2023 to Nov. 2023, and search terms ‘Cerebral Palsy’ or ‘CP’, ‘gender’ or ‘sex’, ‘Prevalence’, and ‘Pakistan’ were utilized. Published literature from different databases including Google Scholar, PakMediNet, PubMed, and ScienceDirect were employed to retrieve articles. From a total of 6,560 articles published during 2000-2022, 8 were selected. Titles and abstracts of all studies were reviewed, and full texts of relevant studies were obtained from cohort, chain referral, cross-sectional, descriptive retro-prospective, and survey studies. The majority of studies reported a greater male-to-female ratio of CP and a few reasons for this disparity are discussed
Sex Determination through Pelvic Bone Using Anteroposterior Radiographs
Get PDFBackground: Forensic anthropology uses digital radiography to identify victims' gender, despite the population-specific nature of determining gender from bones, offering a cost-effective and straightforward method. The objective of the study was to evaluate the accuracy of the digital radiography technology for sex recognition of the selected participant group in Hyderabad, Sindh
Time and location: Cross-sectional study conducted by department of Forensic medicine Liaquat University of medical and Health Sciences Jamshoro and Isra University Hyderabad at the outpatient of Liaquat University hospital, Hyderabad from February to May 2023.
Methods: The study included male and female patients aged 18-50 years and was authorized by the Research and Ethics Committee LUMHS. Study participants were divided into two groups; male and female. Differences in pelvis bone fragments parameters like iliac height, inter-acetabular distance, pelvic inlet (breadth), acetabulum diameter, pubic length, Ischial length and ischio-pubic index on digital x-ray radiographs of both groups were examined and compared.
Results: A statistically significant difference (p<0.05) in bony prominence parameters including inter-acetabular distance, acetabular diameter, breadth of the pelvic inlet, pubic length, ischial length and ischio-pubic index was observed between group A and group B. The study revealed that the accuracy in recognizing male individuals through ileum height (68.8%), inter-acetabular distance (64.7%), and the pelvic inlet breadth (61.0 %)
Conclusion:
The iliac height, inter-acetabular distance, pelvic inlet (breadth), inter-acetabular diameter, pubic length, Ischial length and ischio-pubic index on radiographs (x-rays) of pelvic bones are a reliable bone fragments parameters in sex determination with high precision
Role of zinc supplementation in the treatment of children with culture-proven febrile urinary tract infection
Get PDFObjectives: To compare the efficacy of zinc plus antibiotics versus antibiotics alone in the treatment of culture-proven febrile urinary tract infection in children
Patients and methods: This randomized control trial was conducted at FFH, Rawalpindi. Children with culture proven UTI requiring IV antibiotics were enrolled in the study (n=70) divided in two groups. Group A was given zinc in addition to the antibiotic while group B received antibiotic only. The results of two groups were then compared or the difference in the clinical response.
Results: In our study total 70 patients were enrolled, 35 patients in each group. Mean age was 7.69±2.5 years in group A and 8.3±2.2 years in group B. There were 62.9% males group A and 60% in group B, females were 37.1% in group A and 40% in group B. Mean duration of illness was 6.9±2.4 days in group A and 8±4.1 days in group B. Efficacy was 82.9% in group A and 57.1% in group B, p-value 0.019.
Conclusion:
There was early clinical recovery and significant reduction in the time of hospital stay in patients given zinc along with the antibiotic treatment.
Keywords: Zinc, urinary tract infection, febrile UT
Medical Journalism and Role of Accreditation in Enhancing Quality of Medical Journals in Pakistan
Get PDFTreatment Non-Compliance due to Glyceryl Trinitrate Side Effects in Anal Fissure
Get PDFObjective: Anal fissures generally respond very well to the glyceryl trinitrate (GTN) ointment. However, it is associated with side effects like headache and hypotension. The objective was to evaluate the noncompliance of patients with topical glyceryl trinitrate due to its side effect in the management of anal fissure.
Methodology: After taking ethical approval, a prospective case series was conducted at IIMCT-Pakistan Railway Hospital over a period from 1st March, 2023 to 31st August 2023. A sample size of 112 was calculated using WHO calculator 1.1 and these many patients were subsequently studied for side-effects of GTN and their compliance to the therapeutic regime.
Results: Of 122 patients studied: 62 (55.4%) were males, mean age was 35.35±10.22 years and mean daily doses of GTN was 2.31±0.56. Sixty-five (53%) of the patients using topical GTN reported side effects. Headache and postural hypotension were the most commonly reported side effects: 29.5% and 21.4% reported these side effects, respectively. Non-compliance was noted in only 14 patients (12.5%). Headache contributed 78.6% whereas postural hypotension & palpations contributed 21.4% towards the non-compliant cases. Thus, these two side effects were the only ones contributing towards non-compliance and had statistically highly significant association with non-compliance at a p value of 0.001. 94% of the compliant patient completely healed completely whereas only 2% of non-compliant patients achieved healing till 3-month follow-up: these results were significant at p<0.001.
Conclusion: Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing
Emphysematous Spinous Osteomyelitis and Acute Pyelonephritis in Diabetic Patient.
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Spontaneous emphysematous osteomyelitis with concurrent pyelonephritis is exceedingly rare and fatal entity that needs prompt diagnosis. Imaging play a crucial role in its diagnosis. We present a case of 52 years old woman known case of diabetes and hypertension presenting to ER with high grade fever and right flank pain. CT scan abdomen and pelvis revealed intraosseous gas extending in epidural space and in retro peritoneum, suggesting emphysematous osteomyelitis, which was later confirmed by E coli in blood culture. Right kidney was also swollen and enlarged with surrounding perinephric stranding. Our case also highlights the importance of radiological imaging in Emergency settings particularly in patients with comorbid. Being familiar with this rare entity thus can help in early diagnosis and initiation of treatment
Esophagogastroduodenoscopy at a Tertiary Care Hospital: Common Indications, Endoscopic Findings and Interventional Approach
Get PDFObjective: Esophagogastroduodenoscopy (EGD) is frequently performed as a screening, diagnostic and therapeutic procedure in patients presenting to gastroenterology department. No data documentation of EGD with demographics, indications, findings and intervention performed is available for our tertiary care setup in recent years. The aim of this study is to assess the common indications, esophagogastroduodenoscopy (EGD) findings and therapeutic procedures performed in patients undergoing EGD for various gastrointestinal (GI) symptoms.
Methodology: A cross sectional study was conducted on 127 patients in department of Gastroenterology, Pakistan Institute of Medical Sciences Hospital. Duration of study was six months. Collected data included name, age, gender, indications for EGD, mode of presentation, EGD findings and therapeutic procedures that were performed. Statistical package for social sciences version 23 was used to analyze the data.
Results: Mean age was 47.85 ± 6.74 years with male to female ratio of 1.04. Most common indications for EGD included upper GI bleed 25.19% and dyspepsia 22.83%. The three most common EGD findings were esophageal varices (34.64%), portal gastropathy (24.4%) and mild gastritis (14.96%). Variceal banding was the most common procedure performed.
Conclusion: In our tertiary care hospital, upper GI bleed is the most common indication for EGD. Esophageal varices is the most common EGD finding encountered and variceal banding is the commonest procedure performed.
Key words: Esophagogastroduodenoscopy; EGD; Upper gastrointestinal endoscopy; Upper gastrointestinal bleed; Varices; Gastritis; Gastropathy; variceal bandin