Journal of Islamabad Medical & Dental College
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Immunohistochemical Approach to the Study of Pulmonary Neuroendocrine Tumors
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Background: Tumors that arise from neuroendocrine cells can present throughout the body, most commonly in the gastrointestinal tract and pulmonary systems. Neuroendocrine tumors (NETs) of the lungs account for about 25% of primary lung cancers, as well as 20–25% of primary NETs
Objective: To analyze the immune-histochemical aspects of Neuro-endocrine Tumors and apprise the reactivity of various immune-histochemical markers.
Methodology: This cross-sectional study was conducted in Pathology Department of Gulab Devi Hospital Lahore from January 2021 to December 2021. Total 112 patients with pulmonary NETs cases diagnosed with medical records patients data, clinical features and radiologic images were obtained and both genders with CT scan findings of lung mass were included in the study. Data was entered and analyzed in SPSS. Gender, diagnosis, techniques etc. were presented as frequency and percentage. Age was presented as mean and SD.
Results: The mean age was 45.2+12.1 years. The age range between 20 to 60 years. There were 96(86%) male and 16(14%) female. Typical carcinoid was prevailing in young age group while small cell neuro-endocrine tumor was dominant in older patients. Most of the samples were collected using bronchial biopsy 86(77%), 18(16%) of the samples were collected by CT guided biopsy while 7(6%) were collected by ultrasound guided biopsy and 1(1%) by surgical resection. Patients were diagnosed as small cell lung carcinoma 96(86%), typical carcinoid was the second most common diagnosis 10(9%), large cell lung carcinoma was 4(3.0%) and atypical carcinoid tumor was seen in 2(2%) in cases.
Conclusion: SCLC was found to be the predominant pulmonary NET. Chromogranin is less sensitive than synaptophysin, raised Ki67 and TTF1 demarcates SCLC from carcinoid particularly in minute biopsy with obscure morphology.
Key words Immunohistochemistry, Neuroendocrine carcinoma, Small cell lung carcinoma
KAP Survey of Dental Students About Scientific Research
Get PDFBackground: Research is an essential component of the academic curriculum and its importance in health care must be appreciated. It enables the students to critically analyses the information in clinical decision making and care of patients. The objective of the study was to evaluate research-oriented knowledge, attitude, and practices amongst undergraduates and house surgeons.
Methodology: A cross-sectional study was conducted among undergraduate dental students and house surgeons of Baqai Dental College from November to December-2018. Ethical approval was obtained from the ethical committee of the Baqai Dental College. Permission for data collection was obtained from the Research and Development Department, and the Principal of the Dental College. The sample size was calculated to be 243 using Open Epi version 3.03 by taking 20% prevalence rate with 95% confidence interval and ????=5%. Participants were selected by convenience sampling technique and a pretested Questionnaire, was distributed.
Results: Out of total,84 participants were males and 159 females. 1st and 2nd year students were more confident in interpreting and writing research paper. Final year students and house surgeons were more interested in reading research journals and participating in research methodology workshops. 41.2% of the respondents preferred Google scholar for literature search.
Conclusion: Adequate knowledge about research was found among all the participants while research-based practice was more among final year dental students and house surgeons
Future Trends in the Treatment of MRSA in Pakistan
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Background: The Methicillin resistant Staphylococcus aureus (MRSA) is accountable for community and hospital acquired infections. Due to over and misuse of antibiotics, MRSA isolates are becoming multidrug resistant even with linezolid and vancomycin. The objective of this study was to determine recent antimicrobial profile of MRSA, isolated from different clinical samples and current treatment options for MRSA, other than vancomycin and Linezolid.
Methodology: This cross-sectional study was conducted at Foundation university medical college from Jan 2019 to Dec 2020. Total 918 samples of blood, pus swab, throat swab, tracheal swab, wound swab, endotracheal tube (ETT) tips, Catheter tips, axillary swab and suction tips received by using aseptic techniques, for culture and sensitivity in different hospitals of Rawalpindi and Islamabad, were taken. Isolated pathogens were identified using standard protocols and susceptibility testing was done by Kirby-Bauer disc diffusion method.
Results: Out of 918 samples, MRSA was isolated in 96 (10.4%) samples and most frequently observed in 27% (n=26) blood samples. The mean age of enrolled patients was 52.02 (SD±16.1) years, the infection was largely seen in age group 46-55(24%) and in 57% (n=52) male population. MRSA showed higher resistance to levofloxacin 78.1% (n=75), ciprofloxacin 75% (n=72), erythromycin 70.8% (n=68) and gentamycin 62.5% (n=60). The susceptibility of older drug chloramphenicol and Trimethoprim-sulfamethoxazole was found 61% & 49% respectively. MRSA isolates were highly susceptible to vancomycin (96.8%), linezolid (89.5%) and teicoplanin (70.85%). Alarmingly, 2.1% (n=2) MRSA isolates showed resistance to vancomycin.
Conclusion:Vancomycin resistant MRSA is a matter of great concern, because of unawareness among health administrative departments and public, self-medication, lack of surveillance system and non-availability of antibiotic policy.
Keywords: Antibiotics, MRSA, Vancomycin, Chloramphenicol
 
Clinical Presentation and Outcome of Covid-19 Infection in Patients Undergoing Maintenance Hemodialysis: Covid-19 infection in hemodialysis
No full textBackground: WHO declared Covid-19 a pandemic disease; although 80% of patients with CoV-2 infection have no or mild symptoms, the remaining 20% of patients develop complications. In patients undergoing dialysis, mortality could be higher than that in the general population. This study was conducted to assess the frequency, clinical presentation, and outcome of COVID-19 infection in patients of end-stage renal disease (ESRD) on maintenance hemodialysis.
Methodology: This Cross-sectional study was conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, from April to September 2020. This study included 130 patients of either gender of End-Stage Renal Disease on maintenance hemodialysis for at least 3 months. Two Samples for COVID-19 PCR were taken through nasal swab. Blood samples were collected for hemoglobin level, total and differential leucocyte count, platelet count, intact Parathyroid hormone, vitamin D level, Urea, Creatinine, ferritin, transferrin saturation, procalcitonin, D-Dimer, C-reactive proteins, and lactate dehydrogenase. Radiological assessment was done by X-ray Chest. Urea reduction ratio and single pool Kt/V was used for assessment of adequacy of hemodialysis.
Results: Out of 130 patients on hemodialysis, COVID-19 was detected in 52 patients, of which males were 69.2% and females were 30.8%. The most common presentation was shortness of breath (28.8%), followed by cough (19.2%). Home isolation was advised to 38.5% while noninvasive ventilation was given to 34.6%. Mechanically ventilated patients were 26.9%. There were 63.5% patients who recovered and were discharged from the hospital or home-isolated, while 19 patients died (36.5%).
Conclusion: COVID-19 pandemic has high chances of infection with increased mortality in people with chronic diseases, especially those having ESRD on hemodialysis. This spreading of infection can be hampered with standard measures of disinfection in centers, social distancing in patients, and the use of a face mask.
Keywords: Covid-19, Cough, Hemodialysis, Home isolation, Ventilation
 
Effect of Replacement of Vit-D in Diabetic Painful Neuropathy among Chronic Type 2 Diabetic Patients
Get PDFBackground: Painful symptoms of diabetic neuropathy are more common in patients having type 2 diabetes. The objective in this trial was assessment of mean change in pain score upon giving Vit-D supplementation in patients with diabetic painful neuropathy.
Methodology: This study was conducted from December 2019 to June 2020 in OPD of Fauji Foundation Hospital, Rawalpindi after the ethical approval. A total of 251 diagnosed cases of diabetes (both male and female patients), with high HbA1c and low Vit-D levels were included in the study. Patients having Vit-D deficiency and chronic diabetic neuropathy were given Vitamin supplementation and results were assessed after 1 month through change in pain score according to Douleur Neuropathique 4. A document of consent form was filled by patients who were recruited for this study. Data analysis was done on SPSS version 16.Paired sample t- test, was used to compare pain score where p value less than 0.05 was considered statistically significant.
Results: Among the participants mean age was 48.22+17.06. There were 106 (42.2%) males and 145 (57.8%) female patients. A statistically significant (p<0.05)mean reduction in pain score of 2.20±1.19 was observed, upon giving Vit-D supplementation in Vit-D deficient patients having painful diabetic neuropathy.
Conclusion: Vit-D supplementation significantly reduced pain in patients having diabetic painful neuropathy.
Keywords: Diabetes Mellitus, Diabetic Neuropathy, Vitamin D
An Audit of Laparoscopic Cholecystectomy; at a Tertiary Care Hospital in Islamabad
Get PDFBackground: Laparoscopic Cholecystectomy is a commonly performed surgery and is a gold standard for the treatment of cholelithiasis as it has fewer side effects. This study was conducted to determine indications and complications of this surgery at a tertiary care hospital in Islamabad.
Methodology: This retrospective study was conducted in the department of Surgery, Maroof International Hospital from March 2017 to March 2019. A total of 250 patients who underwent laparoscopic cholecystectomy were included through consecutive sampling technique. The data regarding age, gender, mode of presentation, types of presentation, per operative findings, operative complications and duration of hospital stay was collected from patients’ medical record. Statistical Package for Social Sciences SPSS version 23 was used to analyze data.
Results: Mean age of the participants was 46.24 ± 14.13 years. Female to male ratio was 2.73:1. Almost 38.4% patients had chronic cholecystitis, 35.2% had symptomatic gallstone disease, 24.8% had acute cholecystitis and 1.6% had gallbladder polyps. No major vascular or common bile duct injury were noted. 27.2% patients had per operative gallbladder perforation. Stone spillage occurred in 8.8% patients with retrieval in all of them. 75.2% patients were discharged on day 1. Per operatively, 98.4% patients had cholelithiasis, 59.6% had adhesions, 9.6% had mucocele, 1.6% had empyema and 0.8% patients had collections.
Conclusion: Laparoscopic cholecystectomy is a safe procedure in all types of gallstone disease presentations with low complication rate.
Key words: Cholelithiasis, Gallstones, Laparoscopic Cholecystectomy, Per-operative complication
Reference range of Amniotic Fluid Index (AFI) in primigravidae with gestational age from 37 to 42 weeks in a local (Pakistani) population.: AFI in primigravidae in Pakistan
No full textBackground: Amniotic fluid index (AFI) is a key element in fetal biophysical profile that predicts pregnancy outcome especially near term in primigravidae. The objective of the study was to determine a reference range of AFI in primigravidae of a local population having gestational age from 37 to 42 weeks.
Methodology: This study was carried out from January 2019 to December 2019 after approval from Institutional Review Board and Ethical Committee at Shifa International hospital, Islamabad, Pakistan. Applying inclusion and exclusion criteria, a sample of 272 was selected. AFI was calculated for each subject using ultrasound and recorded on a data collection sheet. For the sake of simplicity and clinical relevance, the population was further stratified as term pregnancy (gestational age 37-39 weeks) and postdates pregnancy (40-42 weeks). The reference range of AFI was then calculated using mean ±two standard deviations.
Results: The reference range of AFI for gestational age of 37-42 weeks (population as a whole) was 6.8- 17.2 cm. For term pregnancy, it was 7.5- 17.5 cm, and for postdate pregnancy, it was 5.8 to 15.4 cm.
Conclusion: The reference range of AFI for gestational age of 37 to 42 weeks in Primigravida women was 6.8 to 17.2 cm. There is a decreasing trend in AFI as pregnancy advances from term to postdate.
Keywords: Amniotic Fluid Index, Gestational age, Primigravida, Reference Range
Inflammatory Myofibroblastic Tumour of Lung, A Rare Entity
Get PDFInflammatory fibroblastic tumour of lung is a rare mesenchymal tumour usually affecting the children and young adults. It is usually considered as a benign entity however it has high potential for recurrence and local invasion. Exact pathogenesis of tumour is not known. Complete surgical excision is the treatment of choice. Due to high chance of recurrence, patients are usually kept on close follow up. Here we present a case of inflammatory myofibroblastic tumour of lung , who presented with history of pain and shortness of breath.She was diagnosed a case of inflammatory myofibroblastic tumour with the help of CT scan chest and CT Guided biopsy.She underwent right sided pneumonectomy and remained symptom free on follow up.
Key Words. Inflammatory, Myofibroblasts, Pneumonectomy, Tumour.
 
Quantum Physics: A Doorway for the Potential Treatment of Cancer
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