Journal of Islamabad Medical & Dental College
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Association of High Sensitivity C-reactive Protein with Type II Diabetic Retinopathy
Get PDFObjective: The objective of this study is to find out the association of diabetic retinopathy with serum homocysteine and high sensitivity (hs) CRP levels.
Methods: The research was conducted out at the Army Medical College's Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Rawalpindi, in partnership with the Armed Forces Institute of Ophthalmology, Rawalpindi for a tenure of 12 months. Ninety subjects, were included in the study, thirty in each group: controls, diabetic subjects, and the patients suffering from diabetic retinopathy (DR).
Results: Healthy controls, diabetic subjects, and patients with DR were found to have mean Fasting Blood Glucose (FBG) values of 5.51 0.34 (mmol/l), 8.11 0.67 (mmol/l), and 8.73 0.90 (mmol/l), respectively (p=0.001). The mean HbA1c level in normal subjects was noted as 5.08 ± 0.27 in healthy controls as compared to 7.70 + 0.89 (mmol/l)) in diabetic subjects and 9.02 + 1.76 (mmol/l) in patients with DR (p=0.001 by ANOVA).
In normal subjects, the mean hs CRP levels were noted to be 3.74 + 1.97 (mg/l) in healthy controls as compared to 15.32 + 2.93 (mg/l) in diabetic subjects and 26.71 + 4.88 (mg/l) in patients with diabetic retinopathy (p=0.001 by ANOVA).
Conclusion: During the study, it was found that elevated levels of these inflammatory biomarkers can accurately predict the onset of diabetic retinopathy and that hs CRP levels are strongly related with the development of diabetic retinopathy. Monitoring these inflammatory signs in the serum can therefore help prevent diabetic microangiopathic consequences, including DR
A Comparison of Hysterosalpingographic Results in Individuals Experiencing Primary and Secondary Infertility: A Prospective Approach
Get PDFIntroduction: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used in process of different investigations. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. This study aims to compare the HSG results in a study population having primary and secondary infertility.
Materials and Methods: We conceded a one-year prospective study at Islamabad Diagnostic Center in Islamabad, Pakistan after getting institutional review board approval. The study duration was from July 1, 2022 to June 30, 2023. Sample size was calculated using online software “Raosoft” which estimated it to 242. All the patients who gave informed consent and having primary and secondary infertility were enrolled. Demographics of the patients including age, duration of infertility, and the presence of tubal and uterine abnormalities, were collected by reviewing clinical notes and X-ray findings.
Results: Among 242 enrolled patients with infertility, the ratio of primary infertility was 70.27% (n=170) and that of secondary infertility was 29.75% (n=72). In both the groups, fallopian tube blockage was observed as a major abnormality that affected 20.00% (n=34/170) of patients with primary infertility and 30.55% (n=22/72) of patients with secondary infertility. Unilateral tube blockage was observed in 26.47% (n=9/34) whereas, bilateral blockage was observed in 29.41% (n=10/34) patients with primary infertility. 23.52% (n=8/34) of patients got affected with Bilateral hydrosalpinx, whereas unilateral loculated spill was perceived in 8.82% (n=3/34) of. In patients with uterine congenital abnormalities, 5.88% (n=2/34) had a bicornuate uterus, 2.94% (n=1/34) had a unicornuate uterus, and 2.94% (n=1/34) had uterine didelphys.
Conclusion: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. In this study, fallopian tube abnormalities were most predominant among barren women. So, taking deterrent actions and efficiently management of pelvic infections are indispensable in plummeting the manifestation of infertility resultant of the tubal issues.
Keywords: Hysterosalpingography, Infertility, Subfertility, Tubal blockage
 
Assessment of Clinical Outcomes in Patients with Oral Lichen Planus and Oral Lichenoid Lesions Following Treatment with Topical Corticosteroids
Get PDFObjective: To assess the clinical outcomes in patients with oral lichen planus and oral lichenoid lesions (OLP & OLL) following treatment with topical corticosteroids.
Methodology: A total of 175 patients diagnosed with OLP and OLL were recruited from the outpatient department. This cross-sectional study was conducted at Institute of Dentistry (IOD) & CMH, Lahore from July 2023 to December 2023. Inclusion criteria included patients aged 18 years and above with clinically and histopathologically confirmed OLP or OLL lesions. All enrolled patients received topical corticosteroid therapy according to a standardized protocol. Patients were instructed on proper application techniques and advised to adhere to the prescribed treatment regimen. Clinical evaluation of the oral mucosal lesions was performed at baseline and at regular follow-up. Outcome measures included changes in lesion size, severity of symptoms (pain, burning sensation), and overall improvement in clinical appearance.
Results: The mean age of the patients was 52.4 years (SD: 10.3). In terms of gender distribution, among the included patients 25 patients (28.57%) were male and 25 patients (71.42%) were female. Among the symptoms observed, Pain was reported by 95 patients (54.28%), Burning Sensation by 110 patients (62.85%), Discomfort by 75 patients (42.85%), and Other symptoms by 20 patients (11.42%). In the clinical outcomes observed with topical corticosteroids, reduction in lesion size was noted in 140 patients, accounting for 80.0%, complete resolution of lesions occurred in 60 patients, representing 34.3%, and reduction in symptoms was reported by 155 patients, constituting 88.6%. Oral candidiasis was noted in 7 patients (4.0%), Mucosal atrophy occurred in 13 patients (7.42%), whereas the majority.
Conclusion: In conclusion, our study underscores the efficacy of topical corticosteroid therapy in managing oral lichen planus (OLP) and oral lichenoid lesions (OLL). With 80.0% of patients experiencing a reduction in lesion size, 34.3% achieving complete resolution of lesions, and 88.6% reporting a reduction in symptoms, our findings highlight the significant therapeutic benefits of topical corticosteroids
Effect of Warm Saline Irrigation Versus Negative Gas Suction on Reduction of Postoperative Pain in Patients of Laparoscopic Cholecystectomy
Get PDFABSTRACT
OBJECTIVE: To compare warm saline irrigation and negative gas suction in terms of frequency of severe postoperative pain in patients of laparoscopic cholecystectomy.
PATIENTS AND METHODS: A comparative clinical trial was conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of six months. After ethical approval from the hospital ethics committee, all patients who had laparoscopic cholecystectomy for gallstones were enrolled in the study. Patients were randomly divided into two equal groups by lottery methods. One group had warm saline irrigation of the operative field while the other group had negative gas suction at the end of the procedure. The pain score was recorded postoperatively by visual analog score. SPSS version 21 was used for descriptive analysis of the variables.
RESULTS: A total of 102 patients were included according to the study's inclusion criteria. All the patients were observed for 24 hours for severe postoperative pain. The mean age (years) of the patients was 40.40+11.55 years. There were 28 (27.5%) male and 74 (72.5%) female patients in the study. The frequency of severe postoperative pain in patients of laparoscopic cholecystectomy among warm saline irrigation and negative gas suction was 33 (64.7%) and 14 (24.5%) respectively which was statistically significant (p-value ˂0.001).
CONCLUSION: Patients in the negative gas suction group have better modalities in reducing severe postoperative pain after laparoscopic cholecystectomy. This helps in early pain relief that reduces the agony of the patients and shortens the post-operative hospital stay.
KEYWORDS: Cholelithiasis, Laparoscopic Cholecystectomy, Postoperative Pai
A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial
Get PDFObjective: Proximal tibia fractures can be treated with open reduction and internal fixation (ORIF), hybrid fixation, or external fixation; however, it is still unknown which method is better than the others. The purpose of the study was to compare the clinical and functional outcomes handled by Ilizarov and ORIF in order to determine the gold standard treatment choice for proximal tibia fractures. This study aimed to compare the functional outcomes of open reduction internal fixation and Ilizarov external fixation in the treatment of complicated proximal tibial fractures.
Methodology: An RCT was carried out in the Orthopaedic Department at PIMS Islamabad. It was carried out during a 12-month period after the synopsis was approved.This study included 104 patients with Schatzker's grade IV–VI fractures who presented to the orthopaedic department at PIMS, Islamabad. Using the lottery approach, the patients were split into two treatment groups at random. Group B uses the Ilizarov External Fixation procedure, while Group A uses the Open Reduction and Internal Fixation (ORIF) technique. Every three weeks, post-operative follow-ups were conducted. Up until the fracture healed, post-operative radiographs were taken every three weeks. Every patient had a 24-week clinical follow-up. At the follow-up appointment, each patient's outcomes were documented in accordance with the operational definition. SPSS was used to enter and process all of the data.
Using SPSS v25.0, all of the data were input and processed. The surgery time, VAS score, and length of hospital stay were compared between the two groups using an independent sample t-test. The functional outcome at six months was compared between the two groups using the Chi-square test. A significant p-value was defined as ≤0.05.
Results: There were 31 (59.6%) men and 21 (40.4%) women in group A, and 36 (69.2%) men and 16 (30.8%) women in group B.In group A, the mean age was 44.87±14.15 years, while in group B, it was 44.25±15.68 years. In terms of functional outcome, 22 (42.3%) of the ORIF technique group had excellent outcomes, while 10 (19.2%), 16 (30.8%), and 4 (7.7%) had good, fair, and poor outcomes, respectively. In contrast, 35 (67.3%) of the Ilizarov technique group had excellent outcomes, while 10 (19.2%), 5 (9.6%), and 2 (3.8%) had good, fair, and poor outcomes, respectively. These results have a statistically significant p-value of 0.024.
Conclusion: Compared to open reduction and internal fixation, Ilizarov external fixation is a more reliable method for fixing complicated proximal tibial fractures. For patients with complicated proximal tibial fractures, the Ilizarov external fixation approach yields superior functional outcomes than the open reduction internal fixation technique.
KEY WORDS: Proximal Tibia Fracture, Open Reduction , Internal Fixation, Ilizarov External Fixation
Clinicopathological Features and Prognosis of Primary Breast Sarcoma: A Single Centre Retrospective Study
Get PDFObjective: This study aims to describe clinicopathological characteristics and outcomes of primary breast sarcoma (PBS) and the relevance of clinical and pathological characteristics with the outcomes.
Methodology:
Study Design: Retrospective longitudinal study
Place and duration of study: Department of Medical Oncology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore from January 1995 to August 2021.
Patients aged 18 years and older were included in the study. Individuals with primary or secondary angiosarcoma or cystosarcoma phyllodes were not included. The hospital information system was used for collecting data, and data was collected for 27 patients meeting inclusion study criteria.
Results: Twenty-seven patients were treated with surgery, seven out of 27 patients (25.90%) received adjuvant chemotherapy and 2 patients (7.40%) received chemotherapy on a palliative intent. The remaining (66.70%, n=18) did not receive chemotherapy. Twenty-four out of 27 patients (88.90%) received radiation therapy; intent was adjuvant in the entire cohort. Median PFS was 18 months with 74.01% of patients having no progression at their last follow-up. The median OS was 23 months. Adjuvant radiotherapy was associated with a significant overall survival benefit (P-value: 0.05). Adjuvant chemotherapy was not associated with a significant survival benefit (P-value: 0.5). Age, tumor size, and disease status (localized disease) conferred a non-significant trend towards a better outcome.
Conclusion: Adjuvant radiotherapy is the only factor that affects the outcomes of this disease. Further multicentred and preferably prospective studies with a larger number of patients are required to define disease characteristics and patient outcomes of primary breast sarcoma in Pakistan.
Keywords: clinical characteristics, outcomes, prognosis, primary breast sarcoma (PBS
Challenge of Multidrug-resistant Strains of Enterobacteriaceae Isolated from Clinical Samples
Get PDFBackground: The rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems worldwide. Antibiotic resistance of clinically important bacteria, the types and levels of resistance and multidrug resistance (MDR) among pathogens is extremely important. With the rise of infections caused by ESBL-producing Enterobacteriaceae (ESBL-E) and with their co-resistance to many other antibiotic classes, carbapenems have been considered to be the last and life-saving agents against these life-threatening infections. The current study was carried out to determine the frequency, disease burden and therapeutic challenge of infections caused by multidrug resistant strains of Enterobacteriaceae with particular reference to Extended-Spectrum Beta-lactamase-producing Enterobacteriaceae (ESBL-E), Carbapenem-resistant Enterobacteriaceae (CRE) and the emerging infections caused by Extended-Spectrum Beta-lactamase-producing Carbapenem-resistant Enterobacteriaceae (ESBL-CRE)
Methodology: This cross-sectional study was carried out in the Microbiology Department of Islamabad Diagnostic Centre over a period of two years, from January 2018 to December 2020. Enterobacteriaceae isolated on culture from clinical samples were identified using appropriate characterization tests including the selective use of API 20E. Antimicrobial susceptibility testing (AST) and ESBL detection was performed on Vitek 2 compact system by Minimum Inhibitory Concentration (MIC) methodology. Isolates that were resistant to more than one carbapenem were identified as Carbapenem-Resistant Enterobacteriaceae ( CRE).
Results: Out of 7270 specimens that yielded the growth of Enterobacteriaceae, 2943 (40.5%) were ESBL positive (ESBL-E) and 487 (6.7%) were carbapenem resistant (CRE). Further analysis of CRE revealed 247/487 as non-ESBL-CRE and 240/487 as ESBL-producing CRE (ESBL-CRE). Maximum number of CRE isolates - both non-ESBL and ESBL CRE - were from urine specimens. Klebsiella species followed by Eschcerichia coli and Enterobacter were the dominant ESBL-CRE isolates. Admission to a health care facility was the major risk factor followed by advancing age.
Conclusion: Besides ESBL-E, Carbapenum-resistant Enterobacteriaceae (CRE), particularly those co-producing Extended-Spectrum Beta-lactamase (ESBL-CRE), (wherein resistance mechanisms to both carbapenems as well as to beta-lactam antibiotics are concomitantly expressed in the same organism), have emerged as the major pathogens of concern. The later appears to have introduced a new dimension in the resistance profile of infections caused by multidrug-resistant enterobacteriaceae.
Key words: Carbapenem Resistant Enterobacteriaceae, Extended-Spectrum Beta-Lactamase, ESBL-producing Carbapenem-resistant Enterobacteriaceae, Escherichia coli, Klebsiella, Multi-drug Resistant Enterobacteriaceae.  
Evaluation of Zinc Sulfate and Canagliflozin as Therapeutic Agents in a Type-2 Diabetes Rat Model
Get PDFIntroduction: Diabetes mellitus (DM) poses a growing global health concern due to increasing prevalence, leading to substantial economic burdens. While current therapeutic options control hyperglycemia, their side effects can reduce patient compliance. Canagliflozin, an SGLT-2 inhibitor and zinc supplementation have individually demonstrated potential in managing diabetes mellitus. Aims & Objectives: This study aimed to assess the synergistic effects of Zinc Sulphate and Canagliflozin in a combination therapy on a type-2 diabetic model of rats.
Material & Methods: The study utilized a rat model, inducing type-2 diabetes through a high-fat diet and streptozotocin injection. Rats were divided into six groups: normal control, disease control, zinc-treated, canagliflozin-treated and two groups receiving combination therapy with different doses. Parameters such as fasting blood glucose and serum insulin were measured over an 8-week period.
Results: Blood glucose and serum insulin levels were significantly altered in diabetic groups but showed improvement with zinc and canagliflozin treatment. HOMA-IR and HOMA-B changes in diabetic rats were mitigated with both agents individually and exhibited further improvement in combination therapy groups.
Conclusion: The combination of zinc and canagliflozin demonstrated superior efficacy in improving blood glucose, insulin levels and Insulin resistance compared to individual treatments. This suggests a potential synergistic effect of the two agents in managing type-2 diabetes. Further studies are warranted to explore the underlying mechanisms and potential clinical applications of this combination therapy.
Key words: Zinc sulphate, Insulin, Canagliflozin, Diabetes
Cross-Sectional Study of Ultrasonographic Assessment of Renal Volume and Its Correlation with Basal Metabolic Index
Get PDFObjective: Renal volume measurements are useful for differentiating between upper and lower urinary tract infections and for monitoring unilateral kidney disease by comparison with the other. The goal of the current study is to evaluate the relationship between renal volumes and BMI in the local population. Normal renal volume varies with BMI. Clinicians could use this to distinguish between volume variations caused by healthy processes and variations caused by diseased processes. This study aims to find the relationship between BMI and renal volumes in patients in a private tertiary care hospital who have no prior history of renal disease.
Methods: This six-month cross-sectional study, conducted at the Department of Diagnostic Radiology, Shifa International Hospital in Islamabad, involved 310 participants in total. In this study, participants between the ages of 18 and 70 who had no prior history of renal disease were chosen. Using ultrasonography, the volumes of both kidneys were measured and correlated with BMI.
Results: The mean value of the right renal volume was 88.7 cm3 with 15.7 SD, while the left renal volume had a mean value of 95.3 cm3 with 16.5 SD. The calculated correlation coefficients between the right renal volume and BMI were 0.947 (P=0.001) and the left renal volume and BMI was 0.911 (P=0.001), suggesting a strong and statistically significant positive correlation between the renal volumes obtained by ultrasonography and BMI.
Conclusion: This study found a strong statistically significant positive correlation between BMI and renal volumes as determined by ultrasonography.
 
Frequency of Hypocalcemic Seizures in Children with Afebrile Seizure: From 2 months - 2 years in a Tertiary Care Hospital
Get PDFObjective: To determine the frequency of hypocalcemic seizures in children with afebrile seizure from age 2 months - 2 years.
Methodology: This Descriptive Cross-Sectional study was conducted in Pediatric Department of Ayub Teaching Hospital Abbottabad for a period of six months (15th April, 2019 to 15th October, 2019). Total 130 cases fulfilling the inclusion criteria were enrolled in the study after approval from ethical committee of hospital and informed consent from the parents of children. A detailed history and examination were done and blood samples for serum calcium level were sent to the hospital laboratory along with other routine investigation to rule out the cause. All data was analyzed using SPSS version 21.
Results: Out of 130 cases 48(36.9%) children had hypocalcemia while 82(63.1%) were normocalcemic. 79 (60.8%) were males and 51 (39.2%) were females. The mean age of children was 13.03 ± 6.81 months. The average calcium level was 8.23±1.51mg/dl.
Conclusion: It has been concluded that afebrile seizures occur frequently in children with hypocalcemia. Thus, we got the local evidence regarding this association and recommend to screen all new afebrile seizure cases for hypocalcemia.
Key words: Hypocalcemic fits, children, afebrile seizures, hypocalcemi