Journal of Islamabad Medical & Dental College
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Nutritional Status of Pediatric Cancer Patients and its Association with Repeated Hospitalizations
Get PDFBackground: Malnutrition is known to be a poor prognostic factor affecting the outcome of pediatric cancers. The objective of this study was to assess the pre-existing malnutrition in newly diagnosed pediatric cancer patients presenting at the Pediatric Oncology Department, Children Hospital, PIMS and their number of hospital admissions due to causes other than chemotherapy.
Methodology: Data of 44 newly diagnosed children with cancer was analyzed to find out the association of nutritional status according to z-score for weight and height for age, body mass index (BMI) and mid-upper arm circumference (MUAC) with their number of hospital admissions for 6 months since their date of diagnosis.
Results: The mean age of the study subjects was 4.25 ± 2.85 years, out of which 33(75%) were males and 11(25%) females. Most of the patients were diagnosed with leukemia or lymphoma. Nutritional status evaluation of thirty patients who got admitted was mild to moderate wasting in 24(80%) assessed by weight for age, mild to moderate stunting in 21 (70%) according to height for age and mild to severe malnutrition in 10 (33%) based on body mass index and mid upper arm circumference (MUAC). There was significant association between nutritional status of patients at the time of diagnosis with additional hospitalization with p value less than 0.05
Conclusion: Malnutrition at the time of diagnosis is significantly associated with an increase in the number of hospital admissions in pediatric cancer patients.
Key words: Hospitalization, Malnutrition, Oncology, Pediatric
 
Functional Outcome of Ilizarov Technique in Managing Proximal Tibial Fracture in Combined Military Hospital, Rawalpindi: Ilizarov in Tibial Fractures
No full textBackground: Tibial plateau fractures involve injuries affecting the major weight-bearing joint and result in functional impairment which can be prevented by implying competent treatment techniques including dual column plating, assisted reduction, internal fixation with plating and Ilizarov circular fixator. The objective of this study was to evaluate the functional outcome of Ilizarov technique in treating closed tibial plateau fractures.
Methodology: A Quasi experimental study was conducted in the Orthopedic department of Combined Military Hospital, Rawalpindi from 30th July 2019 to 29th January 2020. A total of 100 patients with tibial plateau fractures of Schatzker type III to VI, 20 to 60 years of age of either gender were included. In all patients, Ilizarov technique was performed. Data were entered in SPSS 22. Descriptive analysis was done for quantitative variables and percentages were calculated for qualitative variables. Chi square test was applied to determine association of variables with functional outcome.
Results: Mean age of patients was 37.42 ± 8.94 years. Out of 100 patients, 70% were males and 30% were females, 76% patients managed with Ilizarov technique in treating closed tibial plateau fracture had excellent functional outcome, 15% good outcome, 5% fair and 4% poor outcome. Functional outcome with respect to age, gender, BMI and DM showed statistically significant difference with p value 0.017, 0.016, 0.004 and 0.001 respectively.
Conclusion: Functional outcome of Ilizarov technique in treating closed tibial plateau fracture is significantly better.
Keywords: Ilizarov Technique, Orthopedic Fixation Devices, Tibial Fracture
Sexually Transmitted Diseases and Associated Risk Factors Among Transgenders in Peshawar
Get PDFBackground: Transgenders, male to female, are exceptionally predominant in India-Pakistan, dreaded to be alarming for sexually transmitted diseases. The objective of this study was to determine the frequency of sexually transmitted diseases and their associated risk factors among transgenders.
Methodology: This cross-sectional study was conducted amongst transgenders at Institute of Paramedical Sciences (IPMS), Khyber Medical University Peshawar from January to July,2021. About two ml of venous blood was collected in a gel tube under aseptic conditions among 100 individuals to check for HBsAg, anti-HCV, HIV and syphilis by ICT rapid strip method. Positive samples of HBsAg and anti-HCV were confirmed by Polymerase Chain Reaction (PCR), while positive cases of syphilis were confirmed by Treponema Pallidum Hemagglutination (TPHA). Chi-square test was applied to determine the association between sexually transmitted disease and associated risk factors.
Results: Out of 100, seven (7%) samples were positive for HBsAg, five (5%) for anti-HCV and nine (9%) were positive for syphilis while there were no positive cases of HIV. HBV infection was significantly associated with blood transfusion, a drug injection history and some surgical procedure (p<0.05). For syphilis, the data were significantly associated with a history of blood transfusion and drug injection (p<0.05).
Conclusion: Frequency of HBV, HCV and syphilis infections are high in transgenders with common associated risk factors to be sexual activities, drug injection, unsafe blood transfusion and surgical procedures.
Keywords: Chromatography, Hepatitis B surface antigen, Hepatitis C Antibodies, HIV, Syphilis, Transgender
Large gallbladder Removed by Laparoscopic Cholecystectomy A Case report
Get PDFGallbladder stones impacted at neck of gallbladder can result in acute calculous cholecystitis with mucocele gallbladder. Laparoscopic cholecystectomy is performed in such cases as an emergency surgery. We present a case long gallbladder with mucocele formation that was managed by laparoscopic approach. The gallbladder removed was 27.8cm in length. This is the longest gallbladder removed by laparoscopic cholecystectomy in Pakistan so far. The patient had uneventful recovery
Does Laparoscopic Lens Contamination Effect Operative Time? A Study on the Frequency and Duration of Lens Contamination and Commonly Used Measures to Maintain Clear Vision
Get PDFObjective: To determine factors affecting lens fogging and different methods used for decreasing lens fogging and operation time.Methods: This cross-sectional study was conducted in General surgery department of Gulab Devi Hospital, Lahore from January 2022 to July 2022. A total of 70 patient undergoing laparoscopic surgery were recruited in this study. Operative time, duration of time the lens remained cleaned or dirty, time wasted during cleaning, methods used for cleaning of lens and causes of lens contamination were the variables of this study.Results: Total operative time in all 70 laparoscopic procedures was found to be 53 hours and 13 minutes with a mean of 43.8 ± 8.3 minutes. A total of 288 lens contamination events were observed in all these operations with an average of 4.11 lens contamination events per case. According to study an average, 60.9% of the operational time lens remained clear, 31.2% of the operational time lens remained contaminated and 7.92% of the operative time was spent in cleaning the laparoscope.Conclusion: Our study demonstrates that a significant period of a laparoscopic surgery is performed with foggy display. A lot of time is wasted in lens cleaning
Leiomyoma of the Trachea: A Rare Tracheal Tumor
Get PDFThis is a case of a rare tracheal tumor, in a 45year old male farmer who presented with recurrent dyspnea for four years, initially misdiagnosed as asthma. The patient experienced worsening symptoms, including cough, hemoptysis, weight loss, and respiratory failure. Imaging and bronchoscopy revealed a tracheal mass, later identified as leiomyoma. The patient underwent tumor resection via rigid bronchoscopy, resulting in successful removal and tracheal recanalization. Postoperatively, the patient showed improvement, and follow-up examinations confirmed resolution of symptoms and absence of tumors, such as leiomyoma, are rare, often causing airway obstructions. Treatment approaches vary, including surgical resection and endoscopic techniques. In the case of wide-based tumors, surgical intervention is recommended to reduce recurrence risks. Anesthesia management is crucial due to potential airway compromise during the procedure. Although recurrence rates for leiomyoma are unknown, incomplete bronchoscopic resection has been associated with reoccurrence, necessitating surgery and carinal reconstruction
Role of Steroids in Reducing Recurrence of Urethral Stricture after Direct Vision Internal Urethrotomy
Get PDFBackground: Recurrence of urethral strictures is the most frequent and bothersome complication, with majority of stricturesrecurring after optical internal urethrotomy. The objective of this study was to establish the role of oral steroid therapy after direct vision internal urethrotomy (DVIU) in minimizing recurrence of urethral stricture.
Methodology: It was a randomized controlled trial carried out at Armed Forces Institute of Urology, Rawalpindi from January 2018 to March 2021. A total of 180 male patients with urethral stricture of ≤2 cm were included. Patients with traumatic stricture, post-anastomotic urethroplasty strictures, neurogenic bladder and history of steroid intake were excluded. Patients were randomly categorized into two groups i.e. Group A patients were given oral prednisolone (6 mg tablet twice daily for 4 weeks) while group B was control group. Patients were followed up to 12 months for recurrence of stricture.
Results: The mean age of patients in group A was 44.38 ± 8.03 years while in group B was 46.64 ± 6.66 years. The mean length of stricture in group A was 0.93 ± 0.26 cm and in group B was 0.95 ± 0.27 cm. Recurrence of stricture was seen in 18 (20.0%) patients in group A (oral steroids group) and 42 (46.67%) patients in group B (no oral steroids) with p-value of 0.0001.
Conclusion: Oral prednisolone therapy after internal urethrotomy waseffective in decreasing the rate of recurrence of urethral stricture.
Keywords: Oral, Recurrence, Steroid, Urethral Stricture
Comparison of Seroma Formation in Modified Radical Mastectomy: Conventional Scalpel Versus Ligasure™ Technique
Get PDFObjective: This study aims to compare the outcome of scalpel versus LigaSure™ dissection with respect to seroma formation in the skin flaps.Methods: The study was conducted at the Department of General Surgery, Federal Government Polyclinic Hospital (FGPC), Islamabad. The study spanned over a period of twelve months, i.e. October 2020 to September 2021 which recruited 60 patients with breast cancer which were randomly assigned to two equal groups. Modified radical mastectomy with axillary lymph node dissection was done in all the patients. Group-I underwent traditional scalpel dissection while LigaSure™ dissection was done in the group- II. The primary outcome was to assess the seroma formation. The demographic data along with time required for surgery, duration of drain placement, and hospital stay was recorded. The recorded data was constructed and analyzed using SPSS (version 22.0).Results: Among 60 enrolled patients, the mean age was 38.3 ± 11.4 and 39.8 ± 9.4 years in group I and II, respectively. A total of 6.7% (n=2) patients in group-I and 10% (n=3) patients in group-II showed seroma formation in skin flaps after surgery (p-value = 0.640). The mean time required for surgery was 109.9 ± 7.9 and 105.1 ± 8.3 minutes in group-I and group-II, respectively (p-value = 0.027). The average duration of hospital stay in group-I and group-II was 4.8 ± 1.7 and 5.3 ± 1.9 days (p-value=0.335).Conclusion: Compared to traditional scalpel dissection, the use of LigaSure™ assisted dissection shows no significant benefit in terms of reduced post-operative seroma formation, and duration of hospital stay. However, LigaSure™ assisted dissection significantly reduces the time-of-surgery. In resourceful hospital settings, LigaSure™ assisted dissection can be used to reduce the morbidity associated with longer anesthesia time by reducing the time-of-surgery
Assessment of Inhaler Use Techniques among the Patients of Chronic Obstructive Lung Diseases at a Government Hospital of Islamabad
Get PDFObjective: To study the frequency of incorrect techniques used for Metered Dose Inhalers in patients with chronic obstructive lung diseases.Study Design: Cross-sectional, Observational StudyPlace And Duration Of Study: The study was conducted for six months from Ist March 2019 to 31st August 2019, on all patients with chronic obstructive lung diseases visiting the outpatient department of Medicine in Federal Government Polyclinic (FGPC) Hospital as a part of their regular follow-up.Methodology: All patients visiting the outdoor clinic were checked for their inhaler technique which was explained to them as a 6-step procedure. The record of using the inhaler correctly or otherwise was noted in a proforma.Results: A total number of 250 patients were included in the study with their ages between 13-70 years. Mean age of patients was 46.5±15.7 years. A total of 6 steps of the inhalation technique were observed. The mean number of steps followed was 3.8±1.4. Incorrect inhaler technique (≤5 steps) was adopted by 220 patients (88%) and correct technique (6 steps) was adopted by only 30 patients (12%). Stratification for age, gender, duration of disease, education, marital status, occupation, and Body Mass Index (BMI) was also carried out.Conclusion: This study demonstrated that a significant no of patients could not perform the inhalation technique correctly. This implies the need for their clinicians to make it imperative during their follow-up visits to check their inhaler technique periodically.
KEY WORDS
Metered dose inhalers (MDI), Chronic obstructive lung disease (COLD), Correct technique