Journal of Islamabad Medical & Dental College
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Seasonal trends of Influenza in Islamabad, Pakistan
Get PDFBackground: Viral outbreaks have always been a challenging task for clinicians and Influenza virus has been on top of the list. The history of influenza epidemic reveals its devastating effects in the form of multiple deaths and economic burden. Hence this study was planned to recognize the peak activity time span of Influenza infection and its frequency in our set-up at Shifa International Hospital, Islamabad Pakistan.
Material and Methods: A cross sectional study was performed in Pathology Laboratory, Shifa international hospital Islamabad from April 2016 to March 2019. Nasopharyngeal swabs were collected from patients of all age groups, with clinically suspected influenza infection throughout the year, irrespective of gender, according to hospital’s standard policy. Samples were analysed on GeneXpert kit (Xpert Flu Assay). Data collected was entered and then analysed in SPSS version 17.
Results: Of the total 591 samples included in study, 233 (39.4%) were positive for influenza (Flu A or Flu B), while 358 (60.6%) showed negative results. Total 172 (73.8%) were positive for Flu A while 61 (26.1%) were positive for Flu B. Among Flu A cases, 107 (62.2%) were positive for H1N1. Most of the positive cases (n=206; 88.4%) were reported in the months of January and February during the three-year period (2016-2019) of this study.
Conclusions: Influenza virus has peak activity in the months of January and February. Both Influenza A and B are circulating in the environment but Flu A is predominant and H1N1 is more prevalent
Frequency of Stress Urinary Incontinence in Pregnant Females
Get PDFBackground: Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life. The objective of this study was to determine frequency of stress-induced urinary incontinence in pregnant females.
Methodology: A Cross-sectional survey was conducted among 600 pregnant females selected via non probability purposive sampling technique from January to June 2018. Data was collected from major cities of Pakistan using validated questionnaires; International consultation on incontinence questionnaire” (ICIQ-SF) and self-structured questions assessing the referrals of pregnant women to physiotherapy, for stress urinary incontinence. Statistical analysis was done using SPSS. Frequency of qualitative variables was determined. Association of urinary incontinence with pregnancy related characteristics was determined by chi-square test.
Results: Out of 600 females, 84.3% (506/600) had experienced stress urinary incontinence in pregnancy with 64.5% reported among multigravida. 35.5% of the participants complained of increased urinary incontinence during the 9th month. Quality of life was moderately affected by stress urinary incontinence. Only 6.2% of the participants were referred to a physiotherapist for exercise. There was statistically significant difference between primigravida and multigravida in having urinary incontinence (p< .001).
Conclusion: Frequency of stress urinary incontinence was high in pregnant women especially during the 9th month. Referral to physiotherapy for urinary incontinence in pregnancy was extremely low
Immunohistochemical Expression of BCL-2 in Malignant Salivary Gland Tumors
Get PDFBackground: Malignant salivary gland tumors (MSGTs) consist of a heterogeneous group of neoplasms with complex clinicopathological features and biological behaviors. The purpose of this study was to determine the expression of Bcl-2 antiapoptotic protein in mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ADCC), acinic cell carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA) of salivary glands and to find out its association with different grades of these tumors.
Material and Methods: This descriptive study included 55 cases of MSGTs. Tissue sections were stained with routine hematoxylin and eosin stain as well as Bcl-2 immunostain. MSGTs were graded as low grade (Low grade MEC, ACC, PLGA, and tubular pattern of ADCC), intermediate grade (cribriform pattern of ADCC, and intermediate grade of MEC) and high grade (high grade of MEC and solid pattern of ADCC) tumors on H&E sections. Bcl-2 expression was scored as ‘negative’ (<5% of neoplastic cells), ‘1’ (5-19% of neoplastic cells), ‘2’ (20-49% of neoplastic cells), and ‘3’ (>50% of neoplastic cells), respectively.
Results: MSGTs most commonly involved the parotid gland (52.7%), while ADCC (40%) and MEC (38.2%) were the most common tumors. Expression of Bcl-2 was strongly positive in 56.4% cases of MSGTs which included ADCC (71%), MEC (19.4%) and ACC (9.7%), respectively. A significant association was found between Bcl-2 staining and types of MSGTs i.e., MEC, ADCC, ACC (P = .001) as well as between Bcl-2 staining and grades of MSGTs (P = .013).
Conclusions: Bcl-2 protein is expressed in malignant salivary gland tumors. Its expression maybe helpful in grading small biopsies, predicting behavior, and planning targeted therapy of MSGTs.
 
Frequency of Incidental Carcinoma in Thyroids Operated for Multinodular Goiter
Get PDFBackground: Multinodular goiter (MNG) is a common disease in Pakistan. However, malignancy can be found occasionally on histopathological examination of resected goiter specimens. The objective of this study was to determine the frequency of malignant lesions on histopathological examination in thyroid specimens operated for multinodular goiter.Material and Methods: A total of 154 patients undergoing thyroid surgery with preoperative diagnosis of multinodular goiter (MNG) at Al Nafees Medical College and Hospital Islamabad, Pakistan were included in this study. The preoperative diagnosis of MNG was made upon physical examination of thyroid and ultrasound (n=62 cases) and FNAC (n=43 cases) was done in selected cases. Gross examination was done and sections were taken from areas of thyroid with varied appearances including hemorrhagic, solid, firm, white, gray, gelatinous as well as necrotic areas. Qualitative variables, were calculated in terms of percentages and mean and standard deviation were used for quantitative variables.Results: Of the 154 patients with preoperative diagnosis of MNG, there were 139 (90%) female and only 15 (10%) male patients. The age range was 14-60 years with a mean age of 36 ± 10 years The incidence of thyroid carcinoma in patients operated for clinical diagnosis of MNG was 8% (n=12). Papillary thyroid carcinoma was the most frequent type of malignancy (83.3%; n=10). Multifocality (60%; n=6), bilaterality (33.3%; n=4) and left lobe involvement (80%; n=8) of thyroid were more common. Microcarcinoma (measuring 1cm or less) was found in 50% (n=5) of these PTC. Histological type of papillary carcinomas greater than 1 cm were follicular variant (n=3; 30%) and conventional (n=2; 20%) types. The maximum measurement of the tumor was 2 cm. In all cases of PTC, rest of the thyroid showed MNG on histopathology.Conclusions: Incidental finding of thyroid malignancy in clinically diagnosed cases of MNG is not unusual. Papillary carcinoma of thyroid is the most common incidental malignant finding in these cases. Multilocularity in thyroid is not an indicator of benign disease process
COVID-19 Vaccines in Pakistan: Efficacy, Adverse Effects and Availability
Get PDFIn this review article, we aim to document the efficacy, adverse effects, mode of action, required doses, and availability of the major vaccines available in Pakistan till 20 May 2021. We reviewed all available literature on COVID-19 vaccines in PubMed and Google scholar. We also reviewed articles from grey literature. Currently, Pfizer–BioNTech and Moderna, Sinopharm (China), Sputnik V (Russia), CoronaVac (popularly known as Sinovac) (China), Cansino, and Vaxzevria vaccines have been authorized for emergency use in several countries. Pakistan has sanctioned the use of all the aforementioned vaccines except Pfizer and Moderna. As per their efficacy, Pfizer and Moderna have been found most effective among all the vaccines with 95% effectiveness, while the Vaxzevria, Sputnik V, Sinopharm, and Cansino have shown 70%, 91.6%, 79.34%, and 90% effectiveness, respectively. All the vaccines have shown milder side effects like headache, fever, and pain on injection sites. To curb the pandemic, more clinical trials are being conducted throughout the world. Importantly public awareness is warranted to achieve the target of vaccinating a large population
New Onset Heart Failure after Right Ventricular Pacing in Patients with Normal Left Ventricular Function
Get PDFBackground: Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function.
Material and Methods: This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic.
Results: Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient.
Conclusions: Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six month
Ameliorative effects of Withania coagulans and Metformin on Ovarian morphology in Polycystic ovarian disease induced rats
No full textBackground: Various medicinal herb plants are being used in place of metformin for treatment of polycystic ovarian disease for their less harmful effects. Withania coagulans (WC) is a herb known for its insulin sensitizing and weight reducing properties. The present study was done to determine the influence of aqueous extract of Withania coagulans (aqWC) and metformin on ovarian weight and ovarian folliculogenesis in polycystic ovarian disease-induced rats.
Material and Methods: An experimental animal study was carried out at the Physiology Department of Islamic International Medical College, Rawalpindi from April 2016 to March 2017. Forty female Sprague Dawley rats were divided initially into two groups. Group A (Normal Control) and Disease induced group. Standardized laboratory diet was fed to Group A while the disease induced group was given standardized laboratory diet and letrozole solution orally (1mg/kg) for 21 days to induce Polycystic ovary syndrome, which was established by observing estrous cycle of rats. Disease induced group was then split into group B (PCOS control), C (Aqueous Withania coagulans treated) and D (Metformin treated) and observed after 14 days. Groups A and B underwent ovarian dissection after 21 days and groups C and D underwent dissection at the end of experiment (after 35 days). Independent sample t-test was used for the comparison between the control and disease induced group.
Results: Group B showed a significant increase in ovarian weight in comparison to group A rats (P < .05). Treatment with Withania coagulans and metformin significantly decreased ovarian weight (P < .05) and increased primary, Graafian, antral follicular count and corpus luteum along with reduction in cystic follicular count in letrozole-induced polycystic ovarian disease rats. Improved folliculogenesis was also observed in the same groups (groups C & D).
Conclusions: Withania coagulans can be a substitute for improvement of ovarian follicular development in polycystic ovarian disease