Journal of Islamabad Medical & Dental College
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Factors Associated with Nurses’ Attitude towards Patient Safety Culture in an International Accredited Tertiary Care Hospital, Islamabad
Get PDFBackground: Patient safety has emerged as a prime agenda over the past few decades to deliver safe care in increasingly complex service delivery. This study was set out to measure the factors associated with the safety attitudes of nurses.
Methodology: This descriptive cross-sectional research was conducted from May 2017 to June 2018 in Shifa International Hospital, Islamabad. Nurses were invited to participate in the study. The safety attitude questionnaire was used for data collection. Data were analyzed using SPSS v23.0.
Results: The response rate was 86%. Job satisfaction was high at 78.37±23.63 while stress recognition was low at 53.18±27.68. Nurses liked their job being a nurse 79.92±28.01 and workplace conditions 80.33±26.44. Whereas, hostile situations 48.92±34.95, the negative effect of fatigue 48.50±35.32, being held back to report patient problems 47.58±34.76 and discuss errors 45.42±34.79 were also highlighted. Safety attitudes were statistically significant high among intensive care nurses (P-Value < 0.05). Safety scores of nurses with longer job duration were high than those with lesser job duration. Teamwork was favorably correlated with safety climate, job satisfaction, perception of management, and working conditions (R > .466, P-Value < .01).
Conclusion: There was a positive attitude of nurses toward patients’ safety with some areas of improvement.
Keywords: Attitude, Nurse, Patient safety, Practic
Peripheral Arteriovenous Malformations and their Response to Treatment Modalities: Experience at Tertiary Care Hospitals
Get PDFBackground: Arteriovenous malformations result in abnormal communication between veins and arteries. Treatment of AVMs can be surgical or non-surgical. This study aimed to assess the response of Peripheral Arteriovenous Malformations (AVMs) to various treatment modalities.
Methodology: This cross-sectional study was performed at Combined Military Hospital Lahore, Rawalpindi, and Midcity Hospital, Lahore Pakistan, from January 2016 to June 2020. Patients were divided into two groups based on gender. Their demographic data, clinical presentation, and treatments provided were assessed and comparison was done using Chi-Square Test.
Results: Of the 43 patients, 74.4% (n=32) were females with a male-to-female ratio of 1:3. Mean age was 27± 6 years (males) and 17± 4 years (females). Low-flow AVMs were more prevalent in females (81%, n=27). In males, 50% (n=5) AVMs were on the trunk whereas in females 93.9% (n=31) AVMs were on limbs. Doppler-guided foam sclerotherapy (DGFS) as the sole treatment was used in 95.3% (n=41) patients while 32.5% (n=14) patients underwent DGFS followed by surgical excision. In 4.6% (n=2) cases, angioembolization followed by surgical excision was done. One patient was treated with sirolimus. Recurrence was found in 20.9% (n=9) cases, of which 66.6% (n=6) had high-flow AVMs.
Conclusion: Male patients presented late and with mostly high-flow head and neck AVMs. Sclerotherapy alone or surgical excision with preoperative sclerotherapy or embolotherapy is an efficacious curative treatment for AVMs while sirolimus can be offered as a palliative option.
Key words: Arteriovenous Malformations, Enbucrilate, Sclerotherapy, Vascular Malformation
Relationship between Inflammatory Markers and Disease Outcome in COVID-19
Get PDFBackground: Coronavirus disease-2019 (COVID-19) has been labelled as a global pandemic and a cause of documented high mortality rates among severe or critical patients. This has been linked with hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. Our study aims to evaluate the relationship between inflammatory markers and disease outcomes in COVID-19.
Methodology: This cross-sectional study was conducted at Federal Government Polyclinic (FGPC) Hospital, Islamabad for a period of 3 months. All the patients who had either RT-PCR for COVID-19 or HRCT findings suggestive of COVID were included in the study. The inflammatory markers like C-reactive protein (CRP), D-Dimers, and Lactate dehydrogenase (LDH) were done and a combined score DLC was calculated. The need for Oxygen (litres/min), Bilevel positive airway pressure (BIPAP), or Mechanical Invasive Ventilation was documented.
Results: The study was conducted on 213 patients which included 119(56%) male patients and 94(44%) female patients. COVID-19 PCR was positive in 193(90.6%) while 20 patients (9.4%) had a negative PCR but HRCT suggestive of COVID. HRCT was done in a total of 46 patients out of the 213 patients and 45 had features suggestive of COVID-19. The AUROC was 0.686(0.61-0.75) for D dimers, 0.688(0.61-0.75) for LDH, and 0.649(0.517-0.72) for CRP respectively, and Spearman rho values of (0.326, 0.328 and 0.266) respectively with a p-value (0.000).
Conclusion: D-dimer, LDH and CRP individually as well as a combined score of the inflammatory markers (DLC) and Oxygen requirement had a significant correlation with the mortality of the COVID-19 patients.
Key words: COVID-19, CRP, LDH, D dimers, DLC score
Vascular Complications and their Risk Factors in Patients of Diabetes Mellitus, Type 2
Get PDFIntroduction: To evaluate the vascular complications and their correlation with different risk factors among type-2 diabetic patients in Hyderabad, Sindh, Pakistan.
Methodology: Cross-sectional study was conducted at the department of medicine Isra University Hospital, Hyderabad from March to September 2021. Type 2 diabetics of either sex, between ages 20 and 70 years, on diabetic medication, were included in the study. While patients with type I diabetes, unconscious or with any mental health issues were excluded. A Non-random consecutive sampling technique was applied for the selection of participants. Socio-demographic, disease and medication information was collected using a written questionnaire while serum glucose level, albumin and lipid profile was analyzed.
Results: Over half of the participants (51.72%) were females, while most (70.87%) of the participants were aged < 40 years. A total of 124(28.5%) patients showed symptoms of macro-vascular complications with most (16.78%) of them having coronary artery disease. A significant relation (p<0.05) was found between coronary artery disease and age, duration of diabetes, blood pressure, body mass index and serum triglycerides. Peripheral vascular disease was significantly related (p<0.05) to the duration of diabetes, systolic blood pressure and serum triglyceride. While significant relation (p<0.05) between cerebrovascular disease with age, systolic and diastolic BP was there.
Conclusion: Coronary artery disease seems to be the most common macro-vascular complication among type 2 diabetic patients, with a high prevalence of risk factors such as advanced age, duration of DM, male sex, hypertension, Body Mass Index, and serum triglycerides.
Keywords: Coronary artery disease, diabetes mellitus type 2, Macro-vascular complications, peripheral vascular disease
Frequency of Gallstones in Fatty Liver disease in a Tertiary Care of Suburban Islamabad
Get PDFBackground: Gallstone disease and Non-Alcoholic Fatty Liver Disease (NAFLD) share common etiological pathways. The objective of this study was to determine the frequency of Gallstones and Non-Alcoholic Fatty Liver disease (NAFLD) in patients undergoing abdominal ultrasounds in our hospital and to compare the frequency of Gallstone disease in patients with NAFLD and without NAFLD.
Methodology: This cross-sectional study was carried out at HBS General Hospital, Islamabad from January 2020 till December 2020. Patients undergoing routine ultrasounds in the out-patient department of the hospital were included in the study. Patients having Emergency Ultrasounds, history of Alcohol intake, history of chronic liver disease and pregnant patients were excluded from the study. Data was analysed using Microsoft Excel 2016 and IBM SPSS 22.
Results: A total of 689 patients were included with a 3:1 Female to Male ratio. Mean Age was 40.65± 15.610 years. The prevalence of Gallstone disease was found to be 20.9% while that of NAFLD 27.6%. A higher percentage of patients with NAFLD had Gallstones as compared to those who did not have NAFLD (24.2% vs 19.6% respectively) however for overall data, statistical significance was not reached. A statistically significant greater number of young patients with NAFLD had Gallstones as compared to those who did not have NAFLD (50% vs 6%, p<0.001). Mean age was greater in patients who had NAFLD as well as those having Gallstones.
Conclusion: The frequency of Gallstones was greater in patients with NAFLD as compared to those without NAFLD.
Keywords: Cholelithiasis, Fatty Liver Disease, Gallstones, Non-Alcoholic, Ultrasonogram
 
Clinicopathological Features and Expression of Ki-67 in Odontogenic Keratocyst, Dentigerous Cyst and Radicular Cyst
Get PDFBackground: Biological behaviour of Odontogenic Keratocyst (OKC) is aggressiveness than others Odontogenic Cysts (OCs) like Dentigerous Cyst (DCs) and Periapical Cyst/Residual Cysts (RCs). The aim of the study was to determine clinicopathological features and expression of Ki-67 in Odontogenic Cysts of the oral cavity.
Methodology: This cross-sectional study was conducted at de’Montmorency College of Dentistry (DCD from Feb, 2020 to Feb, 2022 after approval from Institutional Review Board (IRB) of DCD. A total 78 cases of OCs were collected from hospitals which are affiliated with the DCD. Routine lab process for Hematoxylin & Eosin and Immunohistochemistry was performed. Data entry and statistical analysis was carried out in SPSS 21. A Chi- square test was applied to observe the association between cyst and Ki-67. P value < 0.05 was taken as statistically significant.
Results: Among total 78 cases the mean age was 25.08 ±14.5 years with an age range of 6-70 years. Most OCs (64.1%) were reported in males than females (35.89%). Most OCs were reported in mandible (56.4%. Ki-67 expression in OKC was high 7.7%, low in 76.9% and negative in 15.4%). Most of the DCs and RCs expressed low expression of Ki-67 (84.6% and 76.9% respectively).
Conclusion: Most of the odontogenic cysts expressed low expression of Ki-67 while few cases of OKC and DC expressed high expression.
Keywords: Dentigerous Cyst, Odontogenic Keratocyst, Immunohistochemistry, Ki-67, Odontogenic Cysts, Periapical Cyst, Radicular Cyst
Etiology and Pattern of Partially Dentate States with respect to Gender and Choice of Treatment
Get PDFObjectives: Edentulism is an irreversible chronic condition that seriously affects the stomatognathic system. Consequently, determining its etiology and pattern with respect to the choice of treatment may contribute to prioritizing preventive and rehabilitative oral health interventions. Therefore, the aim of this study was to identify the causes and patterns of partially dentate states with respect to gender and their respective choice of treatmentMethods: A descriptive cross-sectional study was conducted on 555 patients visiting the prosthodontics department of Altamash Institute of Dental Medicine for a duration of five months from 15th Oct’2019 to 15th March’2020. A close-ended well-structured questionnaire was used to collect the data. The descriptive analysis was carried out using SPSS-25 and Chi-square test was used, to find the effect of gender, and number of missing teeth on partially dentate arch classification. The p-value of ≤ 0.05 was considered as statistically significant.Results: The results of the study showed the two most common causes of missing teeth were caries (66.3%), and periodontal disease (13.8%). It was also found that Kennedy’s and Mauk’s class 3 to be the most prevalent in maxilla 159 (61.3%), 98(37.1%) and 148 (50%), 120 (41.23%) in mandible. Osborne’s class 2 was most prevalent with 127 (48.65%) in the mandible and 171 (58.16%) in the maxilla, respectively. Furthermore, both genders were found to have Kennedy’s and Mauk’s class 3 and Osborne class 2. Ironically, the majority of the patients choose acrylic partial dentures as a treatment option for the replacement of missing teeth.Conclusion: This study describes that Kennedys, Mauk’s Class 3 and Osborne Class 2 were found in the majority of participants. Dental caries and periodontal disease were the common cause of missing teeth with acrylic partial denture remained the most opted treatment option
Primary Diffuse Large B Cell Lymphoma Presenting as Chest Wall Mass: A Case Report
Get PDFPrimary chest wall masses or tumors can be of two types, either benign or malignant. Diffuse large B cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL). Though an aggressive malignancy, with timely and appropriate treatment, approximately two-third of all patients can be cured. We present a rare case of DLBCL presenting as chest wall mass. This case suggests the possibility of the presence of primary malignant B cell lymphoma, with the presentation as a chest wall lesion.
Keywords: Chest mass, Diffuse large B cell lymphoma, Mass, Non- Hodgkin’s lymphoma
Idiopathic Jejunal Diverticulitis: A Rare Case Report
Get PDFAcquired jejunal diverticulosis often produces few or no symptoms and is generally picked up incidentally on cross-sectional imaging or intra-operatively. Similar to what is observed in colonic diverticulosis, diverticulitis can lead to more complicated clinical presentations including; perforation, gastrointestinal bleeding or obstruction. Acute diverticulitis is the most common presentation, but other complications can occur, mainly perforation, bowel obstruction and hemorrhage. Diagnosis is often difficult and delayed due to its relative rarity and non-specific clinical symptoms which increase the mortality and morbidity of this pathology. We have discussed a patient who presented to us with features of intestinal obstruction and on investigations and exploratory laparotomy he was diagnosed as a rare case of jejunal diverticulitis. He was managed operatively and patient had uneventful recovery where after CT scan, exploratory laparotomy was done and proximal milking through NG tube was done without resection