Journal of Islamabad Medical & Dental College
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Unmasking Acne: Azithromycin Edges Out Doxycycline in Randomized Trial at Tertiary Care Centre
Get PDFBackground: Acne vulgaris, a prevalent global condition, often necessitates antibiotic therapy. Doxycycline has been a mainstay treatment; however, recent research suggests azithromycin might be superior. Conflicting data and a lack of local studies regarding their comparative efficacy warrant further investigation.
Objectives: This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in treating acne vulgaris at a tertiary care hospital in Islamabad.
Methods: A randomized controlled trial was conducted. Patients aged 14-30 years (n=190) were enrolled and randomly assigned to either azithromycin or doxycycline treatment groups. Baseline and post-treatment (12 weeks) Global Acne Grading System (GAGS) scores were assessed. Percent reductions in GAGS score were categorized into four groups (<25%, 25-50%, 51-75%, and >75%) for intergroup comparison. Written informed consent was obtained from all participants.
Results: The mean patient age was 21.30±4.93 years, with a female predominance (male:female ratio 1:1.2). Most patients had Fitz-Patrick Skin Type-V (64.7%) compared to Type-IV (35.3%). Baseline GAGS scores were comparable between groups (p=0.612). Notably, post-treatment GAGS scores were significantly lower in the azithromycin group (p<0.001), demonstrated by a greater mean change (19.33±3.03 vs. 17.70±2.99; p<0.001) and percent reduction (81.87±8.74 vs. 75.97±11.12%; p<0.001) compared to doxycycline. Additionally, 75.3% of patients achieved an excellent reduction in GAGS score, with a significantly higher proportion observed in the azithromycin group (87.4% vs. 63.2%; p<0.001). Similar significant differences were observed across subgroups based on age, gender, and skin type.
Conclusion: This study suggests that azithromycin demonstrates superior efficacy to doxycycline for acne vulgaris management, regardless of patient demographics or skin type. Its established better safety profile further supports its potential as a preferred therapeutic option in future dermatological practice.
Keywords: Acne Vulgaris, Azithromycin, Doxycycline, Percent Reduction in GAGS Scor
The Evaluation of the protective roles of canagliflozin and zinc sulphate on body weight and hepatic histology in diabetic dyslipidemia
No full textThe significant increase in diabetes prevalence in the past decade has placed a considerable strain on the global healthcare system, especially in developing nations such as Pakistan. Although current therapy options effectively manage blood glucose levels, their accompanying adverse effects can hinder patient adherence. This study investigates the therapeutic properties of Canagliflozin, a SGLT-2 inhibitor, recognized for its tolerance and supplementary advantages on body weight and blood pressure, when used in combination with Zinc Sulphate. Zinc is acknowledged for its function in the regulation of hyperglycemia and dyslipidemia. The study involved the use of a type-2 diabetic rat model, induced by a high-fat diet and streptozotocin to examine the separate and combined impacts of Canagliflozin and Zinc Sulphate on the liver's histology. A total of forty-eight male Sprague-Dawley rats were separated into six groups and the treatments were delivered for eight weeks. Body weights were observed and histological evaluations of the liver were performed with the NASH-CRN scoring system. The findings exhibited a notable decrease in body weight among the diabetic-induced groups in comparison to the normal control. The combined utilization of Canagliflozin and Zinc Sulphate showed a heightened efficacy in managing diabetes related weight loss and steatosis of liver in the rat model having type-2 diabetes. This indicates a possible combined treatment strategy that should be further investigated to enhance the management of hepatic steatosis in individuals with diabetes. The study also proposes the potential for using a reduced dosage of Canagliflozin in combination with Zinc, so limiting adverse effects
A Survey of Acute Transfusion Reactions in Thalassemic Patients in Pakistan: A Single Centre Experience
Get PDFBackground: Blood transfusion reactions are characterized as adverse reactions linked to whole blood or any of its constituent parts, encompassing a spectrum of severity levels, from minor to potentially life-threatening. The administration of blood products is a common practice to enhance the hemodynamic status and overall clinical well-being of patients. However, it's important to note that transfusing blood components comes with potential complications, both infectious and non-infectious in nature.
Objective: The current study aim to evaluate the type and frequency of transfusion reactions in thalassemic patients at Hamza Foundation Welfare Hospital and Blood Services, Peshawar.
Method: The current study was a descriptive cross-sectional study. The data was collected from 152 participants through a self-generated questionnaire during the 4 months (from April to July 2022) study period.
Results: The overall frequency of febrile non-hemolytic reactions (FNHTR), allergic transfusion reactions (ATR), and acute hemolytic transfusion reactions (AHTR) was 84%. Among the 152 participants, 91 (59.8%) were males, and 61 (40.2%) were females. Of the total males, 83 (55.6%) experienced transfusion reactions, while 46 (30%) of the females had transfusion reactions. Specifically, 56 males and 36 females experienced FNHTRs, 22 males and 4 females experienced ATRs, and 5 males and 6 females experienced AHTRs. Fever was observed predominant symptom 69.7% and 52.6% among FNHTR and AHTR, anxiety was predominantly observed in 34.8% in ATRs.
Conclusion: Among the transfusion reaction types, FNHTRs emerged as the most common, followed by ATRs and AHTRs.
Key words: Febrile Non-Hemolytic Reaction, Allergic Transfusion Reaction, Hemolytic Transfusion Reaction
Early Postoperative Pain in Mesh Fixation Versus without Fixation in Open Lichtenstein Mesh Hernioplasty
Get PDFBackground & Objective: Inguinal hernia is a frequently encountered issue in surgical practice. Surgical techniques for hernia repair have significantly advanced and improved. The study objective was to compare early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty regarding early postoperative pain.
Methods: A randomized control trial was done at the Department of Surgery of the Federal Government Services Hospital, Islamabad from April to December 2023. Total 60 patients meeting the inclusion criteria and were presented with inguinal hernia. Randomly patients were divided into two groups, each consisting of 30 patients and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of mesh. Patients from both groups were observed for 24-hours and early postoperative pain was recorded using visual analog scale (VAS). The data underwent analysis utilizing SPSS v 25.
Results: The mean age of the patients was 46.0±9.2 years. Among 60 patients, 36 (60%) men and 24 (40%) women. The average BMI was 26.34±4.27 kg/m2. No significant difference was observed in postoperative pain between two groups (p ≥ 0.05). A t-test was utilized to compare the VAS score between two groups and it was observed the results insignificant except in patients with BMI less than 25 (p ≤ 0.05).
Conclusion: There is no difference in occurrence of postoperative pain in fixed versus non-fixed mesh
Laparoscopic Appendectomy: A Safe and Feasible Procedure in Emergency Department of a Public Sector Hospital
Get PDFOBJECTIVES:
To evaluate LA (laparoscopic appendectomy) in terms of operative time, post-operative recovery and rate of post-operative complications in Department of Surgery, Benazir Bhutto Hospital, Rawalpindi
METHODOLOGY:
A prospective Descriptive study. This study was carried out at Benazir Bhutto Hospital, Rawalpindi. The data was collected prospectively for a duration of five years, from March 2019 to March 2024. Data was collected prospectively for patients operated for acute appendicitis by laparoscopic appendectomy with the help of questionnaires. Data of patients undergoing laparoscopic appendectomies over five years was collected by consective non-probabilty sampling technique.
RESULTS:
108 patients underwent laparoscopic appendectomy from March 2019 to March 2024 with follow-up of up to 01 month. 50(46.2%) men and 58(53.7%) women were included in the study. The mean age was 28±7.8 years. The mean operative time was 45±24.3 mins. 3.3% of operations required conversion to laparotomy. The mean length of stay was 1.5±3 days. Post-operative pain on the visual analog scale averaged around 6 on day one and reduced thereafter. The mean resumption of physical activity was 6 hrs. post-operatively. There was no death in the 30-day postoperative period. No complication occurred except for port site skin infection in 3 patients, intrabdominal abscess in 1, and fever in 9 patients.
CONCLUSION:
Our study advocates that laparoscopic appendectomy is a safe minimal invasive procedure with minimal complications
Evaluation of Accuracy of Phenotypic Methods in the Detection of Methicillin Resistant Staphylococcus aureus
Get PDFAbstract:
Methicillin resistant Staphylococcus aureus (MRSA) is a variant of Staphylococcus aureus; responsible for a significant share of the infectious load.
Objective: The current study was conducted to evaluate the accuracy of already in vogue phenotypic methods of identification of MRSA keeping in view the gold standard method of mec-A gene detection using Polymerase chain reaction (PCR) and to compare the sensitivity and specificity of different phenotypic methods (Cefoxitin Disc Diffusion, Oxacillin Disc Diffusion, Oxacillin Screen Agar, and MIC of Oxacillin by Agar Dilution Method) with the genotypic method (PCR).
Method: A descriptive cross-sectional study was carried out at Microbiology Lab, Pakistan Railway Hospital, Rawalpindi from October 2021 to September 2022, after attaining the formal approval from Institutional Ethical Review Committee (Riphah/IIMC/IRC/21/73), using non-probability sampling technique. A total of 222 samples of Staphylococcus aureus were isolated from all the clinical specimens received at Microbiology lab at Pakistan Railway Hospital. Among those isolates, 150(67.5%) were Methicillin sensitive Staphylococcus aureus (MSSA) and 72(32.4%) were Methicillin Resistant Staphylococcus aureus (MRSA). The results of Phenotypic methods were compared with the results of PCR by using Chi-square formula. The sensitivity and specificity of Cefoxitin Disc Diffusion method was 62.5% and 96.6%, Oxacillin Disc Diffusion method was 65.3% and 93.3%, Oxacillin Screen Agar technique was 81.9% and 96% while that of Oxacillin MIC by Agar Dilution was 91.6% and 89.3% respectively. Oxacillin screen agar demonstrates the better phenotypic technique for detection of MRSA in routine practice
Utilizing Integrated Lung and Inferior Vena Cava Ultrasound for Dry Weight Assessment - Insights from a Single-Center Experience
Get PDFABSTRACT
Precise dry weight evaluation holds significant importance for individuals with end-stage renal disease (ESRD) undergoing hemodialysis. Fluid overload is associated with an increased likelihood of mortality and morbidity. Ultrasonography aids in assessing dry weight and modifying dialysis prescription.
OBJECTIVE:
To assess the following in ESRD Patients by ultrasonography:
Dry weight and effectiveness of fluid removal
Adjust the dialysis prescription
METHODOLOGY:
A prospective cross-sectional study was carried out in the Pediatric Hemodialysis unit at The Children's Hospital Lahore, over 6 months from July to December 2022. The study included 30 children aged 5-16 years undergoing maintenance hemodialysis and exhibiting signs of overload. Ultrasound was performed for B-lines and IVC diameter before and after dialysis. Dialysis prescriptions were modified and patients were monitored through sequential scans. Data was analyzed using SPSS version 20.
RESULTS: A total of 30 patients were enrolled with 53.3% being males. The average pre-dialysis weight was 25.39 kg, systolic blood pressure was 150.67 mmHg and diastolic blood pressure was 92.6 mmHg. Pre-dialysis pleural and pericardial effusions were observed in 86.7% patients, while B-lines were present in 63.3%. Majority of children (83%) were on twice-weekly dialysis and remaining were prescribed thrice weekly dialysis. A significant reduction in weight, blood pressure, pleural and pericardial effusion, B-lines, and IVC diameter was found after dialysis. Dialysis prescription was adjusted following the first session, with 80% subjects receiving thrice-weekly sessions, 16.7% daily, and 3.3% twice-weekly dialysis.
CONCLUSION: Monitoring the appropriate fluid removal and adjustments to the dialysis prescription in hemodialysis patients can be accomplished using ultrasonography.
Keywords: Dry weight, Ultrasound, B-lines, IVC, Dialysis frequency
Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children
Get PDFBackground: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population.
Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children.
Study Design: Prospective comparative study.
Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024.
Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations.
Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287).
Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics
Primary Percutaneous Coronary Intervention in Multivessel Disease: Complete versus Culprit-only Revascularization
Get PDFObjective: To compare the clinical outcomes of complete revascularization and culprit-only revascularization in patients with multivessel coronary artery disease (CAD) who presented with ST-segment elevation myocardial infarction (STEMI) at Hayatabad Medical Complex, Peshawar.
Methodology: A prospective, randomized controlled trial was conducted, enrolling 400 patients with multivessel CAD. Patients were randomly assigned to either the complete revascularization group (n=200) or the culprit-only revascularization group (n=200). The primary outcomes assessed included cardiovascular death, reinfarction, and the need for repeat revascularization over a six-month follow-up period. Statistical analysis was performed using chi-square tests and Kaplan-Meier survival analysis.
Results: Complete revascularization significantly reduced the rates of major adverse cardiovascular events compared to culprit-only revascularization. Cardiovascular death was lower in the complete revascularization group (4% vs 9%, p = 0.02), as was reinfarction (5% vs 11%, p = 0.01), and repeat revascularization (7% vs 15%, p = 0.004). Kaplan-Meier analysis showed a significant improvement in event-free survival in the complete revascularization group.
Conclusion: Complete revascularization significantly improves clinical outcomes in patients with multivessel CAD presenting with STEMI, reducing cardiovascular death, reinfarction, and repeat revascularization. This study supports complete revascularization as a preferred treatment strategy in such patients to improve long-term outcomes.
Keywords: coronary artery disease, STEMI, complete revascularization, culprit-only PCI, cardiovascular outcome
Hypertonic Dextrose Prolotherapy for Knee Osteoarthritis: A Comprehensive Review of Mechanism, Techniques, Limitations, and Side Effects.
Get PDFThis review delves into the potential of hypertonic dextrose prolotherapy (HDP) as a treatment for knee osteoarthritis (KOA), a prevalent condition, that significantly impacts individuals' quality of life, particularly affecting older adults. HDP involves injecting a hypertonic dextrose solution into or around the affected joint, inducing inflammation and subsequent tissue healing. This review examines various aspects of HDP, including its mechanism of action, comparative effectiveness with other therapies, dosage, and safety considerations as well as HDP's cost-effectiveness, safety profile, and efficacy in providing pain relief and improving function. Comparative studies indicate its superior effectiveness compared to other therapies such as saline, exercise, and steroids, with persistent benefits observed over extended follow-up periods. However, careful consideration of contraindications and potential side effects is crucial. Further research is warranted to conclusively establish its safety and long-term efficacy. In summary, HDP offers a promising avenue for managing KOA, potentially improving outcomes and enhancing the quality of life for affected individuals.