Journal of Islamabad Medical & Dental College
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Comparison of Preoperative Pregabalin Versus Dexamethasone for Postoperative Analgesia in Patients Undergoing Inguinal Hernia Repair
Get PDFObjective: To compare the efficacy of pregabalin versus dexamethasone for post-operative analgesia in patients undergoing inguinal hernia repair.
This randomized trial was carried out in the Department of Anaesthesia at Holy Family Hospital, Rawalpindi after the approval of the Ethical review board, from February 2019 to November 2019.
Methodology: A total of 120 patients were equally divided into two equal groups using lottery method. Group A received pregabalin and group B received dexamethasone. Patients were observed for 24 hours for post operative pain control. Visual Analogue Scale was used to grade pain at 6, 12 and 24 hours
Results: The mean age in Group-A was 43.38+15.80 years and 42.85+14.52 years in Group-B, comparison of the effect of single dose preoperative Pregabalin and IV dexamethasone on mean post-operative pain in patients undergoing hernia surgery under spinal anesthesia shows that at 6 hrs 2.83+1.10 in Group-A and 3.98+1.41 in Group-B, p value 0.0001, at 12 hrs 2.22+1.28 in Group-A and 3.33+1.49 in Group-B, p value was 0.0001 and at 24 hrs it was calculated as 1.0+0.75 in Group-A and 1.6+1.0 in Group-B, p value was 0.0005.
Conclusion: Pregabalin is superior to dexamethasone for post-operative pain control in patients undergoing hernia repair under spinal anesthesia.
Keywords: Dexamethasone, pregabalin, Inguinal hernia, post-operative pain
Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital
Get PDFObjective:
The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications.
Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26.
Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications.
Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery
Decoding Dengue: A Comprehensive Analysis of Cases at Holy Family Hospital (2019–2023) and Anticipating Pakistan's Future Dengue Dynamics under Climate Change
Get PDFObjective: Climate warming and infectious diseases are a growing concern in Pakistan's recent climate change scenario. This retrospective study considers a three-year ( 2019-2023) comprehensive analysis of dengue virus cases reported at Holy Family Hospital.
Methodology: Patient demographic features, age, location, gender, lab profiles such as Dengue Fever (DF), Dengue Shock Syndrome (DSS), and Dengue Hemorrhagic Fever (DHF), were collected and analyzed to understand the prevalence and hotspots of dengue virus.
Results: The study revealed that DF was more frequent among individuals above 50, emphasizing the age-dependent nature of dengue vulnerability. Furthermore, our findings highlighted a gender-based vulnerability, indicating that males were more prone to DF. Based on these findings, we predicted the impact of climate change (Temperature & Rainfall) on dengue transmission suitable days (DTSD).The proposed predictive model incorporates the baseline (2019-2023) and future (2025–2035, 2041–2070, and 2071–2099) periods under Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. CMIP5 models, downscaled and bias-corrected with the quantile delta mapping technique, were employed to project the potential spatiotemporal shifts and DSTD due to climate change.
Conclusion: Drawing from the insights gained in the retrospective study, our predictive analysis contributes to proactive public health measures by anticipating and preparing for the evolving dynamics of dengue in the context of a changing climate.
Keywords: Dengue, Climate, Pakista
Comparison of Open Haemoridectomy (Milligan-Morgan) and HAL-RAR in the Treatment of Grade III and IV Haemorrhoids
Get PDFBackground & Objective: Hemorrhoidectomy (HD), either open (Milligan-Morgan) or closed (Ferguson), is the conventional treatment for stages 3 and 4 of the condition. HAL-RAR therapy, a minimally invasive treatment for high-grade hemorrhoids, involves the integration of HAL (hemorrhoidal artery ligation) with a procedure known as mucopexy, which lifts the hemorrhoidal prolapses. The study objective was to compare the efficacy of open hemorrhoidectomy against haemorrhoid artery ligation with recto-anal repair (HAL-RAR).
Methods: A comparative randomized controlled trial was conducted at general surgery department of Pakistan Aeronautical Complex Hospital Kamra and Pakistan Air Force Hospital Islamabad between June 2021 and December 2022. Total 30 patients diagnosed with hemorrhoids of grades III–IV were assigned randomly to either HAL-RAR (n=15) or hemorrhoidectomy (n=15). Every procedure was a day surgery performed under spinal anesthesia. After 15 days, 30 days, and 6 months patients were re-evaluated. Patients rated their own pain on a visual analog scale. All the data was analyzed by SPSS v 26.
Results: Mean age of the participants was 51.3±6.67 years. HAL-RAR group addressed a greater number of prolapsed hemorrhoidal cushions compared to the hemorrhoidectomy group (2.9 vs 2.02, p = 0.001), and the operation took longer in HAL-RAR group (40 min vs 24 min, p = 0.001). HAL-RAR group had less discomfort in the first 30 days after surgery (p = 0.001). In addition, higher number of patients in HAL-RAR group reported experiencing relief from pain (VAS = 0) after day 7. By day 15, HAL-RAR group had substantially better symptom resolution than the hemorrhoidectomy group. Resolution of bleeding, prolapse, itching, and soiling occurred sooner in HAL-RAR group than in hemorrhoidectomy group during the 30-day follow-up.
Conclusion: The symptoms of haemorrhoids are resolved with less discomfort with HAL-RAR than after hemorrhoidectomy, and recovery time is shorter
TUMOR BOARD - Historical Perspective and Functionality at Dr. Akbar Niazi Teaching Hospital, Islamabad
Get PDFSystemic Lupus Erythematosus Presenting As Mixed Sensori-motor Axonal Polyneuropathy
Get PDFSystemic Lupus Erythematosus (SLE) is an autoimmune disease that has multisystem manifestations. However, axonal polyneuropathy is rare in SLE. We report the case of a 41-years old lady who presented with gradual onset, progressively worsening bilateral lower limb weakness for 1 month along with tingling, prickling and burning sensation. There was history of dry eyes, oral ulcers, dry mouth, dental caries, lethargy and fatigue. On examination, poor oral hygiene, coarse dry tongue, oral ulcers, dental caries and conjunctival pallor were noted. Neurological examination of lower limbs revealed flaccid LMNL paralysis with paresthesia of both feet extending up to the mid-shin level. She had normochromic normocytic anemia with hemoglobin 10.8 g/dl and raised ESR 40 mm/hour. NCS revealed mixed sensori-motor axonal polyneuropathy. ANA, anti-DsDNA (138 IU/ml), Anti-Sm (>200 U/ml) and anti-Ro/SSA antibodies (146 U/ml) were positive with low serum C3 (29.3 mg/dl) and low serum C4 (07 mg/dl). She was diagnosed as SLE and started on plasmapheresis, steroids, hydroxycholoroquine and azathioprine with marked improvement at follow-up
Efficacy of Reticulocyte Hemoglobin Content and Immature Reticulocyte Fraction in Early Diagnosis of Latent Iron Deficiency in Blood Donors
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Objective: To assess the utilization of Reticulocyte Hemoglobin content and Immature Reticulocyte Fraction in detecting of Latent Iron deficiency in Blood donors.
Methodology: A prospective Cross sectional study was conducted at Pakistan Atomic Energy Commission Hospital in collaboration with Pakistan Institute of Medical sciences, Islamabad Pakistan. The study was conducted over a period of 6months from July 2023 to December 2023. A total of 191 donors were included in study and evaluated by using Mindray BC-6200 hematology analyzer. Serum Ferritin was correlated with Reticulocyte parameters. The agreement between Ferritin and Mindray BC-6200 was assessed by applying P- test.
Results: The mean age of donor group was 36.35 years with predominatly male donors (82%). About 65% were repeated donors. The sensitivity of RHE in correlation with serum ferritin was 87.5% and Specificity of this test was 93.7% and the sensitivity of IRF in correlation with serum ferritin was 68.7% and Specificity of this test was 86.75%.The P-value is significant in both parameters <0.01.
Conclusion: RHE can be used as a first line test in detecting Latent Iron deficiency in donors and can replace serum Ferritin, IRF is less sensitive and specific as compared to RHE.
Key words: blood donors, latent iron deficiency, reticulocyte haemoglobin expression (RHE), immature reticulocyte fraction (IRF), serum ferriti
Re-Emergence of SARS-CoV-2: Frequent Mutations, Amplified Transmissibility and Immune Elusion
Get PDFOvulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome at Fertility Clinic of a Tertiary Care Hospital, Rawalpindi
Get PDFBackground: More than 80% of premenopausal females presenting with Polycystic Ovarian Syndrome (PCOS) have above average BMI. Obesity enhances the magnitude of hormonal and metabolic disturbances leading to anovulation. Objective: To validate the influence of obesity on response of ovulation induction by Clomiphene citrate in PCOS related subfertility. Methodology; Study Design & Setting: Comparative Analytical study at Fertility Clinic of Department of Obstet & Gynae, Benazir Bhutto Hospital, Rawalpindi. Study Duration: Twelve months (Dec 2020-Dec 2021) Method: Rotterdam criteria was used to diagnose PCOS. WHO criteria of BMI=23 kg/m² cutoffs for Asian population was used to divide women in two groups; non-obese (Group-A < 23 kg/m²) and obese/overweight (Group-B ≥ 23 kg/m²). In both groups ovulation was induced with Clomiphene Citrate and response was assessed via ultrasound follicular tracking, Day 21 serum progesterone and serum B-HCG levels two weeks after the HCG injection. Results: Total participants were 200 (100 in each group). Mean age (years) in Group-A vs Group-B was 25.38 vs, 27.62 and mean BMI (kg/m²) was 20.82 vs 28.34 respectively. The frequent symptoms in Group-A Vs Group-B were Oligomenorrhoea (87% vs 97%) and amenorrhoea (13% vs 03%). P-value (0.009) was significant. Difference in Ultrasound features of PCOS and LH:FSH ratio in both groups were insignificant (P-value=0.214 and 0.316 respectively). The difference in almost all parameters of OI between the two groups was statistically significant. In Group-A vs Group-B; the presence of dominant follicle after Clomiphene citrate was 52% vs 34% (p value=0.01); Day 21 serum progesterone >30ng/ml was 21% vs 09% (p value=0.01); a positive serum β-HCG level >50 mIU/L 02 weeks after HCG administration was 12% vs 04% (p value=0.09). Conclusion: Obesity control and lifestyle modification are imperative for significant improvement in fertility outcomes for PCOS related subfertility
Types and Frequency of Complications in Laparoscopic Cholecystectomy in Acute Cholecystitis in Tertiary Care Setup
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Laparoscopic cholecystectomy is the procedure usually performed in our setups for both acute & chronic Cholecystitis and simple gall stone disease.
Objective
Find the outcomes of laparoscopic cholecystectomy in acute cholecystitis in our hospital setup.
Methods
This prospective cross sectional study was conducted in Hazrat Bari Sarkar Hospital Islamabad on 10th Nov 2022 to 30 June 2023. The patients from above 10 year age with both genders were included by convenient sampling. All Diagnosed cases of gall stone disease with acute cholecystitis, acute on chronic cholecystitis, abscess, and empyema or mucocele gall bladder were included in this study. SPSS 22 was used for data analysis that was recorded on a performa.
Results
This study included 77 laparoscopic cholecystectomies done for Acute Cholecystitis. 53 female & 24 male patients with female to male ratio of 2.2:1 undergoing laparoscopic cholecystectomies were included in the study. The mean age of patients was 47.6 years + 11.6 SD. The mean operative time was around 90min + 13.5 SD and the mean hospital stay was 2.23 days + 0.77 SD with a range of 1-4 days.
Conversion rate to open cholecystectomy was noted in 8 cases. The operative complications were bleeding in 2 cases, minor bile duct injury in 2 cases, surgical site infection 15 cases, retained stone in 2 cases.
Conclusion
Laparoscopic cholecystectomy for acute cholecystitis has better results in patient outcomes as regards post-operative recovery & length of hospital stay & safety.