Journal of Islamabad Medical & Dental College
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Potential of Gut Microbiome in mosquitoes for Dengue Vector Control
Get PDFMedically important mosquito species belonging to genus Aedes are a major public health concern due to their ability to be efficient vectors of dengue, Chikungunya, Zika, and other arboviruses. With limited vaccines available and no effective therapeutic treatments against arboviruses, the control of Aedes mosquito populations is currently the only strategy to prevent disease transmission. The risk of contracting dengue infection has increased dramatically since 190s. This upward trend is due to increases in long-distance travel, population growth and urbanization, lack of sanitation, ineffective mosquito control, and increases the surveillance and official reporting of dengue cases. Traditional control of mosquito vectors using various insecticides has caused toxic effect on environment and living communities, pro magnification, non- target effect and above all developed resistance in vector mosquitoes. Therefore, new tools and strategies are required to control mosquito vectors to control these diseases. Recent studies on midgut and other organs in mosquito vectors indicated the presence of diverse and dynamic microbial flora, known as microbiota. These microbes are mostly containing symbiotic microbiota play a key role in mosquito physiology, reproductive capacity and immunity. The midgut microbiota have also suggested to alter the competency of mosquitoes to transmit various pathogens (arboviruses, malaria parasites etc.). Many of these symbiotic bacteria have been explored for the potential to combat mosquito borne diseases such as dengue, malaria, Zika, yellow fever etc. The possibility to rear mosquitoes in which a particular bacterial species is dominant among the gut microbiota supports the development of strategies based on symbionts that induce antiviral responses or antiviral molecules in Ades mosquitoe
Comparing the Pretreatment with Lignocaine 40 mg and Fentanyl 100 ug as an Adjuvant for Preclusion of Pain Associated with Intravenous Propofol Injection
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Background: Propofol (2,6-di-isopropylphenol) is one of the most favored drugs used for induction of anesthesia. Pain on injection is a common problem. Various methods have been tried to alleviate this pain but with conflicting results.
Objective: To compare effectiveness of lignocaine versus fentanyl in patients receiving propofol for general anesthesia in population of Pakistan who come to PIMS hospital in Islamabad.
Materials and Methods: 120 participants of either sex, between 18 and 40 years of age, belonging to ASA physical status I and II, undergoing elective surgery under general anesthesia, were randomized into two equal groups of 60 participants. They received, intravenously, either lignocaine 2 ml (20 mg/ml )or fentanyl 2 ml (50 mcg/mL) as a pretreatment before propofol injection.
Results: The efficacy of lignocaine as a pretreatment drug injection was higher (96.7%) compared to fentanyl (85.0%). In the lignocaine group, 2.3% of the participants experienced pain as compared with 15% in the fentanyl group (P<0.05).
Conclusion: Compared with fentanyl, lignocaine pretreatment was more effective in preventing pain on propofol injection.
KEY WORDS: Comparison, Fentanyl, LIgnocaine, Propofol, Pain
Predictors of Relapse and Survival in Testicular Germ cell Tumors in Children
Get PDFBackground: Testicular germ cell tumors are common solid organ malignancies in children with a survival rate of more than 90 %. This study aims to assess the predictors of relapse and survival in testicular germ cell tumors in children.
Methodology: A retrospective review was conducted on children up to the age of 18-years from January 2010 to December 2020 with a diagnosis of primary testicular germ cell tumors. Factors related to relapse and survival like age, baseline levels of tumor markers in serum and on relapse, stage at diagnosis, histological type, tumor laterality & size of the tumor in testicular germ cell tumors were analyzed. The data was entered into SPSS version 20. Statistical significance was set at a p-value ≤0.05.
Results: A total of 115 patients with a mean age of 5.42+ 1.54 years having testicular germ cell tumor were treated. Seventeen patients (14.7 %) had relapse of disease. Relapse was highest in patients with stage I disease (64.7 %). Yolk sac tumor was the most common pathology that was noted in twelve (70 %) patients. The most common site of relapse was the retroperitoneum (70 %). Age of patient, stage of disease, and lymphovascular invasion were significant predictors of relapse and survival in testicular germ cell tumors.
Conclusion: Management of patients with testicular germ cell tumors requires standardized follow-up protocol for early detection and treatment of disease relapse. Complete surgical excision with meticulous control of the residual disease is critical to prevent disease relapse.
Keywords: Chemotherapy, Children, Outcome, Relapse, Testicular Tumor
 
Pattern of Biopsy-Proven Renal Disease in Pakistan: A Single Center Experience
Get PDFBackground: This study was conducted to determine pattern (spectrum) of renal diseases on basis of renal biopsy in a tertiary care hospital in Islamabad.
Methodology: This retrospective observational study was conducted at Nephrology department of Pakistan Institute of Medical Sciences Islamabad from February 2012 to April 2020. Results of all biopsies done during this period were analyzed to determine the prevalence of different renal diseases on basis of histopathology and immunofluorescence.
Results: There were 254 kidney biopsy samples studied during the course of study. Out of total 254 patients 133 (52.4%) were male and 121 (47.6%) were female. Mean age of participants was 34.47±7.67 years (Range:15-60 years). Primary glomerulonephritis and secondary glomerulonephritis was found in 169 (66.5%) and 48 (18.9%) respectively, while tubulo-interstitial disease was reported in 37 (14.6%) of the total biopsies. Among 169 biopsies that showed primary GN, IgA Nephropathy (IgAN) was the most common in 16% of the biopsies, followed by membranous GN in 15.4% while membranoproliferative GN (MPGN) was seen in 13.6%, and focal and segmental glomerulosclerosis (FSGS) was seen in 13% of primary GN. Among 48 biopsies with secondary GN, lupus nephritis (LN) was found to be most common in 83.3% followed by amyloidosis in 6.3%. Among 37 biopsies having tubulo-interstitial disease, acute tubular nephritis (ATN) and renal cortical necrosis was seen in 29.7% each followed by tubulo-interstitial nephritis in 18.9% and acute interstitial nephritis (AIN) was seen in 16.2%.
Conclusion: This study shows that primary GN is the most common finding on renal biopsy. Among them IgA Nephropathy is the commonest lesion followed by membranous nephropathy, MPGN and FSGS. Among secondary GN, Lupus Nephritis is the commonest lesion.
Key words: Glomerulonephritis, Renal Biopsy, Renal Disease, Renal histopatholog
Effect of Pretreatment of Lignocaine Versus Midazolam in the Prevention of Etomidate Induced Myoclonus
Get PDFBackground: The myoclonus after induction of anesthesia with etomidate can lead to increased risk of regurgitation and aspiration. We conducted this study to compare the effectiveness of midazolam and lidocaine for the prevention of etomidate induced myoclonus.
Methodology: This randomized controlled trial was done in the Department of Anesthesiology and Intensive Care, Holy Family Hospital, Rawalpindi from January-June 2015 after approval of hospital ethical committee. Informed consent (written) was taken from 224 patients. Patients were allocated into 2 equal groups randomly with the help of computer-generated numbers. Two minutes after induction with etomidate, Group A got 1 ml of 2% lidocaine, and one ml (1 mg) of midazolam was given to Group B. Myoclonus was evaluated in the following one minute, after which 0.5 mg/kg of succinylcholine was given to the patient to facilitate endotracheal intubation.
Time of onset of induction was marked by loss of eyelash reflex. Myoclonus was recorded at 20, 40, and 60 seconds. Drug was found to be effective if there was no myoclonus within one minute of etomidate induction. Analysis of data was done using SPSS 17.
Results: Lignocaine was effective in preventing myoclonus in 55.40% of patients and Midazolam prevented it in 69.60%. The variation between the results of the groups was found significant statistically. (P< 0.05)
Conclusion: Both midazolam and lignocaine are effective in preventing the occurrence of myoclonus associated with etomidate. However, midazolam is the more effective of the two drugs.
Keywords: Etomidate, Lignocaine, Midazolam, Myoclonus
 
Association of PVL Gene with SCCmec Typing in MRSA (both community associated and hospital-acquired) from a Tertiary Care Hospital, Lahore
Get PDFABSTRACT
Introduction: Antibiotic resistance is a major problem in staphylococcal infections. Resistance against Methicillin in S. aureus is due to the transfer of mobile cassettes of specific genes in S. aureus called Staphylococcal Cassette Chromosome mec (SCCmec). 13 types of SCCmec have been identified till now. Various clinical syndromes are associated with the presence of the PVL gene. Therefore, the present study was designed to check the prevalence of PVL gene and SCCmec types in CA-MRSA and HA-MRSA.Materials and methods: This cross-sectional descriptive study was done in LGH/PGMI, Lahore. MRSA isolates were phenotypically confirmed by Cefoxitin (30) disc on Mueller-Hinton agar. DNA extraction was done by using a Genomic DNA purification kit. Detection of PVL gene and SCCmec types was done with PCR using specific primers.Results: Out of 89 isolates, the maximum isolates were from pus swabs (45%), followed by wound swabs (15.5%). It was found that 55 (61.8%) were HA-MRSA isolates, while 34 (38.2%) were CA-MRSA isolates. PVL gene was found in 37% of isolates. Among PVL-positive samples, 36.4% were HA-MRSA, while 63.6% were CA-MRSA. The most common SCCmec in HA-MRSA was type III (69%), while in CA-MRSA, SCCmec type IVa was predominant (35.4%).Conclusion:The present study provides insight into the prevalence of the PVL gene and different SCCmec types in CA-MRSA and HA-MRSA. The most common SCCmec type is linked with HA-MRSA
The Paradigm Shift in Dentistry: Embracing Digital Innovations for Enhanced Patient Care
Get PDFAdvanced technology in the form of computer aided design and computer aided manufacturing (CAD/CAM) was introduced to the dental profession in 1987.
Dental providers can utilize digital technology in various practice settings, including private offices and public health centers. Learning how to use new technologies broadens dental and dental hygiene practitioners’ skill sets, strengthens job marketability, expands roles in comprehensive care delivery, and provides opportunities to improve patient comfort and enhance preventive patient education. Implementing advanced technology into clinical practice is essential in order to continually raise the level of care and fuel the evolution of future workforce models
Analysis of Therapeutic Phlebotomy in Patients of Polycythemia: A Single Center Study
Get PDFIntroduction: Polycythemia is increased red cell mass according to age and sex of the individual. It could be primary (Polycythemia Vera), or secondary, due to chronic hypoxia or increased erythropoietic drive. Polycythemia is managed with therapeutic phlebotomy along with treating the underlying cause if determined. Phlebotomy of one unit whole blood should result in fall of Hb of at least 1g/dl. This study was conducted to see the effect of phlebotomy on fall in Hb level.Different parameters which can affect Hb levels in polycythemia patients, like age, JAK-2 mutation status and underlying cause were also studied.Methodology: A cross sectional study was conducted at blood bank of Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad Pakistan January 2020 to December 2020. Data were collected from 121 patients of Polycythemia vera who reported in blood bank for phlebotomy.Results: The average pre phlebotomy hemoglobin of the patients was 17.45g/dl, which dropped to 15.97g/dl after phlebotomy. In total, 89 (73.5%) patients who underwent phlebotomy had a fall in Hb of greater than or equal to 1g/dl, while in 32 (26.4%) patients, Hb drop was less than 1g/dl. One hundred and five patients underwent multiple therapeutic phlebotomies to maintain their hemoglobin within normal range.Conclusion: This study has shown that there is fall in Hb as result of recommended phlebotomy leading to relief in symptoms due to Polycythemia. Phlebotomy is the basis of treating polycythemia, although in secondary polycythemia the underlying cause should also be diagnosed and treated
Prolapsed Fibroid in Pregnancy
Get PDFUterine fibroids are commonly encountered in clinical practice. Majority of the fibroids are usually asymptomatic during pregnancy, however they may lead to complications in all three trimesters of pregnancy and even in the post natal period, causing a management dilemma. Vaginal prolapse of uterine fibroids is a rare phenomenon during pregnancy, delivery or puerperium. While most of the fibroids are managed conservatively, a few require surgical intervention Despite of multiple publications in the medical literature on the gynecological aspects of fibroids, scanty data is available on management during pregnancy and labor, posing a therapeutic dilemma. We present a case of a G4P3, presenting at 30weeks gestation with large degenerated prolapsed uterine fibroid which was successfully managed by vaginal myomectomy concurrently with cesarean section
