Journal of Islamabad Medical & Dental College
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Efficacy of Intralesion Injection of Combined 5-Flourouracil and Triamcinolone versus Triamcinalone alone in Keloids and Hypertrophic Scars: A Comparative Analysis
Get PDFObjective: The treatment of keloids and hypertrophic scars is challenging and controversial. The therapeutic agents found in the literature include silicone sheets, compression garments, corticosteroid injections, 5-fluorouracil (5-FU), bleomycin and interferon, topical imiquimod, cryotherapy, radiation, and laser or light-based therapies. Triamcinolone acetonide (TCA), a corticosteroid, considered first line treatment for the prevention and treatment of keloids and hypertrophic scars. To compare the efficacy of triamcinolone acetonide alone and triamcinolone acetonide plus 5-florouracil for treating keloids and hypertrophic scars in burn patients.
Methodology: In this study, the patients were divided into two groups A and B on the basis of treatment regimen, i.e. Group A (TCA alone) and Group B (5FU+TCA). The efficacy of both treatments was compared for improvement in Vancouver scar scale (VSS) and pruritus scale.
Results: The mean VSS score pretreatment was calculated as 10.74±2.36 in Group A and 10.27±3.14 in Group B. Post-treatment, it was reduced to 5.58±1.04 in Group-A and 3.41±2.11 in Group-B. The comparison of efficacy shows an improvement of 65.80% in Group A and 75.07% in Group B; the p value was 0.047, showing a significant difference.
Conclusion: Combination therapy of intra-lesion injection of triamcinolone acetonide and 5-florouracil has significantly higher efficacy as compared to triamcinolone acetonide alone for the treatment of keloids and hypertrophic scars, but necessary precautions have to be taken
Pattern of Adenoviral Conjunctivitis Reported to Tertiary Care Hospitals During Epidemic in Pakistan
Get PDFPurpose: To determine clinical pattern of “adenoviral conjunctivitis” during its epidemic in Pakistan.
Patients and Methods: 370 patients (550eyes) diagnosed with “adenoviral conjunctivitis” were included in this descriptive study. Diagnosis was made by the combination of characteristic clinical features and a positive conjunctival swab PCR for “adenovirus”. Clinical pattern of “adenoviral conjunctivitis” was determined by documenting various patient characteristics. Data were analyzed using SPSS 22.
Results: Median age of the study participants was 28.50 (1.00 – 67.00) years. 195 (52.70%) were males and 175 (47.30%) were females. 190 (51.35%) patients had unilateral ocular involvement, while 180 (48.65%) patients had bilateral ocular involvement. Median number of family members of patients that were infected simultaneously was 1 (0-5). Frequency of patients with “adenoviral conjunctivitis” who had concomitant corneal involvement was 30 (8.1%)
Conclusion: Epidemic of “adenoviral conjunctivitis” in Pakistan, fortunately, exhibits a milder and benign clinical pattern with higher prevalence in males and mostly involving single eye. In addition, only 8.1% patients have concomitant corneal involvement
Gallbladder Perforation as a Complication of Enteric Fever: An Intriguing Case of Acute Abdomen
No full textIf not identified and treated right once, gallbladder perforation—a uncommon but dangerousconsequence of acute cholecystitis—can result in significant morbidity and mortality. We describe theexample of a female patient, having 19 years of age, who had a history of constipation. The patient was diagnosed with typhoid fever and underwent imaging studies that revealed gallbladder wall perforation along its postero-inferior aspect with adjacent contained right subhepatic collection. The patient underwent diagnostic laparoscopy and subtotal cholecystectomy. This instance emphasizes how crucial it is to rule out gallbladder perforation while diagnosing acute abdomen in typhoid fever patients. Prompt surgical intervention and early diagnosis can avert major problems and enhance results
A Cross-Sectional Study on the Use of Computed Tomography Scan for Diagnosing Renal Masses in Pakistani Adults
Get PDFObjective: The aim of this study is to assess the validity of Computed Tomography (CT) in evaluating solid renal masses by comparing CT findings with histopathological results.
Methodology: This cross-sectional study involved 210 patients at the Department of Radiology PESSI Hospital Islamabad, spanning July 2022 to June 2023. Patients were selected based on predefined inclusion criteria, and their detailed medical histories were examined. Each patient underwent both non-contrast and contrast CT scans, and the radiological diagnoses were confirmed. The CT-based diagnoses were then compared with histopathological results, and measures such as positive predictive value (PPV), accuracy, sensitivity, specificity, and negative predictive value (NPV) of CT in diagnosing renal masses were calculated.
Results: The mean age of the study participants was 48.00±810 years. Male to female ratio was 2:1. The majority of the study participants were belonging from the urban area and were under graduate. The results of the study further revealed the frequency of renal masses which was more in male (71.90%, n=151) as compared to female (28.09%, n=59). The study found that the right kidney was affected in 58.09% (n=122) of cases, the left kidney in 36.19% (n=76), and both kidneys in 5.71% (n=12). In our study, we observed variations in density among patients, with 39.06% exhibiting mixed density, followed by 23.80% with hypo-dense, 20.95% with hyper-dense, and 16.19% with iso-dense lesions. When it comes to enhancement, we found that 40.01% had a moderate degree, 24.76% had mild enhancement, 21.90% had intense enhancement, and 13.33% showed no enhancement.
Conclusion: In this study, we found a strong correlation between histopathological diagnosis and computed tomography (CT) in identifying solid renal masses, with notably high validity test results. Given these robust validity parameters, we can confidently conclude that CT scans serve as an effective and reliable diagnostic modality for identifying and diagnosing renal masses
Applanation Ultrasound versus Optical Biometry in the measurement of Axial Length in a Normal Eye
Get PDFObjectives
Accurate measurement of the axial length (AL) of the eye is important to make sure that the patient is emmetropic postoperatively. Multiple studies conducted around the globe compare AL using optical and ultrasound biometry. However, results are still inconclusive, as some studies stated that there is no difference in both modalities, whereas other studies considered optical biometry to be more superior. We aim to compare AL measurements using applanation ultrasound and optical biometry AL Scan, in Islamabad, in order to find out which modality is more superior.
Methods
This was a prospective cross-sectional study that was conducted at the department of Ophthalmology, PAF Hospital, E9 Islamabad. The study was conducted over a period of eight months, from April to November 2023. Participants were enrolled using non-probability, consecutive sampling. The axial length of each eye was measured by both optical and ultrasound biometer.
Results
There were 80 eyes of 40 participants including both males (77.5%) and females (22.5%) aged between 16-58 years. The axial length using the optical biometer showed a greater value ranging from 22.01 to 30.18mm with a mean value of 23.89 ± 1.31mm whereas the axial length measured using applanation ultrasound was 21.62 to 30.00mm with a mean of 23.53 ± 1.29mm. The mean difference between both was 0.36 ± 0.21mm which was statistically significant (P <0.005).
Conclusion
There is a statistically significant difference between the mean readings of the AL measured by the IOL master and ultrasound biometer, so both the devices cannot be used interchangeably
Expanded Dengue Syndrome with Pulmonary Manifestations: A Case Report
Get PDFDengue fever is a vector-borne disease that is spread by mosquito called Aedes-egypti. It belongs to Flavivirus family, of which 4 serotypes have been identified. Its incubation period ranges from 7 to 10 days. Currently, dengue fever causes more illness and death than any other arbovirus disease of humans Dengue viruses are distributed world wide in tropical regions. It is currently endemic in 128 countries, mostly developing countries, putting an estimated 3.97 billion people at risk each year. Changing and increasing incidences are associated with rapid urban population growth, overcrowding, and lax mosquito control measures
Assessment of Helicobacter pylori Antibodies and Stool Antigens in Pediatric Patients with Epigastric Pain: Diagnostic Insights and Clinical Implications
Get PDFObjective: To assess the H. pylori antibodies and stool antigens in paediatric patients with epigastric pain as well as the clinical implications of diagnosing H. pylori infection using these non-invasive methods.
Methods: A cross-sectional, observational study was conducted over a period of 12 months, from May 2023 to October 2023, at the Paediatric Department of Abbas Institute of Medical Sciences (AIMS), Muzaffarabad, AJK. Patients aged 5 to 12 years old, both genders, who presented with a history of epigastric pain for at least more than 30 days were included. A 5 ml venous blood sample was obtained for serological testing, and enzyme immunoassay (EIA) was used to detect immunoglobulin G (IgG) antibodies against H. pylori. Stool samples were collected for the stool antigen test (SAT), and tests were done using a commercially available monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) kit. A self-made study proforma was used for the data collection, and analysis of the data was done by SPSS version 26.
Results: Out of total study sample of 61, girls were in the majority (62.3% and boys were 37.7%, with an overall mean age of 8.60+3.35 years. Of the participants, 63.9% (39) tested positive for H. pylori antibodies, while 36.1% (22) tests were negative. For H. pylori antigens, 90.2% (55) of the children tested positive, whereas 9.8% (6) tested negative. Furthermore, the differences in H. pylori antibody and H. pylori antigen positivity based on gender and residential status, consumption of junk food, and sources of water were not statistically significant (p=0.>0.05).
Conclusion: The findings, with 63.9% testing positive for H. pylori antibodies and 90.2% for H. pylori antigens, underscore a notable prevalence of H. pylori infection among children with recurrent abdominal pain
Cross-Sectional Study for the Detection of Glioblastoma on Spectroscopy with Histopathology as Gold Standard
No full textObjectives: Glioblastoma (GBM) is one of the most aggressive brain tumors. Patients with GBM typically experience an irreversible return of the disease despite receiving multimodal treatment including surgery, radiation, and chemotherapy. GBMs typically exhibit poor vascularization and fast cell growth, which frequently results in tumor regions with insufficient oxygen supply. This study's goal is to ascertain, using histopathology as the gold standard, the diagnostic accuracy of magnetic resonance spectroscopy (MRS) in the diagnosis of glioblastoma.
Methods: 83 participants were engaged in this six-month cross-sectional descriptive study that was carried out at the Department of Radiology, Shifa International Hospital in Islamabad. For each of these individuals, a single voxel approach was used for MR spectroscopy. To locate the lesion, post-contrast conventional MR imaging was first performed. A voxel was then placed on the region of interest. The pathology department at Shifa International Hospital in Islamabad received specimens from patients undergoing intracranial biopsies for histopathological investigation. The results of the MRS were then compared with the histopathology report.
Results: The patients' average age was 52.2±12.6 years. 34 females (51%), and 49 males (59%) were present. The average length of the illness was 2.0±1.7 years, and the average lesion size was 54.3±26.9 mm. The results of MR spectroscopy diagnostic accuracy in the diagnosis of glioblastoma were 91.5%, with sensitivity being 90.7%, specificity being 94.4%, positive predictive value being 98.3%, negative predictive value being 73.9%.
Conclusion: To sum up, this study showed that magnetic resonance spectroscopy is a valuable tool for glioblastoma diagnosis
Prevalence of Vitamin D Deficiency in Patients with Autoimmune Thyroid Disorders at Tertiary Care Hospital, Karachi
Get PDFBackground & Objective: Vitamin D deficiency is commonly observed in patients with autoimmune thyroid disorders, potentially influencing disease severity and management. This study aimed to ascertain the magnitude of vitamin D deficiency in those with autoimmune thyroid disorders (AITDs).
Methodology:
A cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan from February 2024 to June 2024. Patients who attended the outpatient department and were diagnosed with AITDs, such as autoimmune hypothyroidism and Grave's disease, based on positive anti-thyroid antibodies were included in the study. The 25-hydroxy vitamin D levels in these patients were then measured.
Results:
The study had 60 participants, with a mean age of 35.23 ± 9.934 years. The majority of participants had low vitamin D levels (28.3% had insufficient and 48.3% had deficient levels). Additionally, it was discovered that vitamin D status and AITDs were related, where a majority of individuals had low vitamin D levels (P-value = 0.014). Further, it was revealed that anti-TPO antibodies followed by the presence of anti-TG antibodies were more indicative of low vitamin D levels.
Conclusion:
The individuals with AITDs, specifically hypothyroidism had a noticeably higher prevalence of vitamin D deficiency followed by insufficiency
Frequency of Positive Anti-CCP Antibodies in Rheumatoid Arthritis Patients with Negative Rheumatoid Factor
Get PDFBackground: Rheumatoid arthritis (RA) is a polyarticular autoimmune disease that affects about 1% of the adult population. The disease is characterized by synoviocyte hyperplasia, mainly synovial fibroblasts, resulting in bone and joint destruction. Recent studies have shown that cytokines and other systemic inflammation mediators have a key role in the development ofrheumatoid arthritis. Recently, Anti-Citrullinated Protein Antibodies (anti-CCP) have come into use for the diagnosis of rheumatoid arthritis (RA). It has been reported that anti-CCP has quite a high specificity for RA (98%), together with sensitivity similar to that for rheumatoid factor (RF). The study aimed to determine the frequency of positive anti-CCP antibodies in rheumatoid arthritis patients with negative rheumatoid factor.
Methods: 91 patients (both male and females) aged 40-70years with negative RF were clinically diagnosed with rheumatoid arthritis. Patients with positive rheumatoid factor and joint injuries were disclaimed. The consultant pathologist used a second-generation enzyme-linked immunosorbent assay (ELISA) to assess the serum levels of anti-CCP antibodies, >20IU/ ml is considered positive p-value of 0.05 were considered statistically significant.
Results: In the study, the age range was 40 to 70 years, averaging 53.44 ± 7.16 years. 59 (64.84%) of the patients were between the ages of 40 and 55. Of 91 patients, 56 (61.54%) were women, and 35 (38.46%) were men with aratio of 1.6:1 man to women. In patients with negative rheumatoid factors, 27 (40.66%) patients were found to have the levels of positive anti-CCP antibodies.
Conclusion: Patients with negative rheumatoid factor showed the high frequency of positive anti-CCP