Journal of Islamabad Medical & Dental College
Not a member yet
636 research outputs found
Sort by
Audiometric Characteristics of Presbycusis: A Hospital-Based Study
Get PDFBackground: Presbycusis is related to degenerative changes of aging resulting from deficient cochlear microcirculation. It is characterized by bilateral, symmetrical, sensorineural hearing loss (SNHL) in which recruitment and speech discrimination is affected in the absence of noise exposure. The objective of this study was to analyze the pure tone audiogram characteristics in Presbycusis.
Methods: This descriptive study recruited n=192 cases of presbycusis of both genders, aged 50 to 80 years with convenience sampling technique. The study was conducted at Yusra General Hospital and the National Institute of Rehabilitation Medicine, Islamabad from1st July 2017 to 30th September 2017. Pure tone audiometry was used to collect audiometric data. SPSS-24 was used for data analysis. Chi-square and Pearson’s correlation were used to determine association between variables with p < 0.05 taken as significant.
Results: Pure tone audiometry revealed 58 (30.2%) right and 65 (33.9%) left ears with high frequency gently sloping audiogram, while the second commonest configuration being high frequency steeply sloping curve in 51(26.6%) right and 52(27.1%) left ears. There was a significant correlation between the configuration of the audiogram and age with p=0.000, while no significant correlation with gender (p=0.71). The majority,77 (40.10%) right and 71(36.98%) of left ears had moderately severe hearing loss, while severe hearing loss was second commonest with 60(31.25%) right and 70(36.46%) left ears affected. The severity of hearing loss had a significant (P=0.000) positive correlation with age but no significant relationship with gender.
Conclusion: High frequency gently sloping audiogram was the commonest configuration followed by high frequency steeply sloping curve. Moderately severe hearing loss was most commonly seen followed by severe hearing loss
Response of Hepatitis B Vaccine in Children with Celiac Disease – An Experience at Ayub Teaching Hospital, Abbottabad Pakistan
Get PDFBackground: Celiac Disease (CD), characterized by chronic small intestinal inflammation, is an immune-mediated disorder, with a strong family history and association with DQ2 HLA haplotype. It has been postulated that children with CD show less response to hepatitis B vaccine due to overexpression of HLA-DQ2 haplotype. This study was done to determine the response of hepatitis B vaccine in children with CD in our tertiary care setting in the Hazara region of eastern Khyber Pakhtunkhwa, Pakistan.Material and Methods: This cross-sectional study was conducted in the Pediatrics outpatient department (OPD) of Ayub Teaching Hospital, Abbottabad Pakistan from April 2018 till March 2020. Children with CD (n=38) aged 1-14 years with completed HBV vaccination, anti-tissue transglutaminase IgA antibody (tTG-IgA) >150 IU/ml and/or typical histological findings of CD on small-bowel biopsy, were included in the study. Hepatitis B surface antibody (HbsAb) titer of ≥10 mIU/ml was taken as antibody positive, while HbsAb levels < 10 mIU/ml were considered as vaccine non-responsive. Data was analyzed using SPSS version 20.0. Chi square test was applied for comparison with P-value < .05 taken as significant.Results: Out of 38 diagnosed cases of CD, 15 (39.5%) were males and 23 (60.5%) were females. Mean age of children was 8.32±3.26 years with an age range of 3-14 years. HbsAb levels ranged from 0.10 to 62.7 mIU/ml with a mean of 11.2+17.42 mIU/ml. HbsAb levels were less than 10.0 IU/ml in 73.7% of children with CD. Small intestinal biopsy was performed in 11 (28.9%) patients. There was a significant relationship between anti tTG-IgA levels and histopathology findings with P-value of .001.Conclusions: In children having celiac disease, there was low rate of protective antibody response to hepatitis B vaccine
Iniencephaly
Get PDFIniencephaly is an uncommon form of neural tube defects which is characterized by retroflexion of the head and absence of neck as a consequence of defective closure of the vertebral body and arch. Multiple identified risk factors for its causation include environmental, genetic and drugs. We report a case of 38-year-old woman with prior history of still birth and abortions who presented at 35 weeks of gestation with lower abdominal pain and high blood pressure. Mother had consanguineous marriage. Her hypothyroidism was untreated in the first and second trimester. She delivered an iniencephalic baby girl via emergency c-section with multiple malformations at 38 weeks gestation secondary to fetal cardiac deceleration. Baby survived for less than 18 hours. In this case, proper antenatal care and follow up visits were needed along with postnatal genetic and pathological evaluation including assessment of risk factors. Appropriate management is important to prevent complications and recurrence in subsequent pregnancies.
 
Effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats.
Get PDFBackground: Central obesity a worldwide metabolic and cosmetic problem poses significant health risk. Ajwa date seed has antioxidant property and its high fiber content may prevent fat absorption and reduce fat deposition. The objective of this research was to evaluate the effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats.
Methodology: Thirty-six healthy rats of four weeks age were divided into three groups and followed for 12 weeks. Group A (normal control) received regular diet. Group B (HFD control) received high fat diet, while group C (HFD+Ajwa group) received high fat diet along with 2% Ajwa date seed powder. Body weight was measured weekly. Blood samples were drawn for the estimation of serum IL-6 and leptin levels by ELISA method at 12th week, after which, rats were euthanized; perinephric fat was removed and weighed in grams.
Results: HFD+Ajwa group gained less body weight as compared to HFD control group (p value = 0.012). There was a remarkable reduction in perinephric fat weight (p value ≤ 0.001) and level of IL-6 in HFD+Ajwa group (p value ≤ 0.001) as compared to HFD control. There was no significant difference in serum leptin level of the rats of all groups (p value = 0.567).
Conclusion: Ajwa date seed can prevent visceral adiposity and gain in body weight. Moreover, it has anti-inflammatory effect; but no significant effect on satiety hormone
Non-Motor Symptoms and Their Associated Factors in Parkinson’s Disease
Get PDFBackground: Parkinson's disease is a common neurologic ailment that causes tremor and bradykinesia. The prevalence of Parkinson's disease is estimated to be 1–2 in 1000, affecting about 1% of the population over the age of 60 years. The objective of this study was to find the frequency of Non-Motor Symptoms in patients with Parkinson’s Disease (PD) and its association with various factors.
Methodology: A cross-sectional study was carried out in Rehman Medical Institute, Peshawar for 1 year from 1st Oct 2019- 30th Sep 2020. A total of 68 patients with idiopathic Parkinson’s disease (PD) were included by consecutive nonprobability sampling. Non-motor symptoms (NMS) were evaluated and noted in a predesigned proforma. Data was entered and analyzed by SPSS 21.
Results: The age of the participants was 62.10±10.01 years. 58.82%(n=40) were males, 47.05%(n=32) belonged to urban residence. Mean duration of illness was 4.52±3.82 years. NMS were found in 100% (n=68) patients. Among NMS, sleep disturbance was the most common symptom found in 77.9% (n=53) followed by constipation that was present in 75% (n=51) of patients. Among associated factors with NMS, hallucinations were significantly associated with advanced age (P = 0.004). Orthostatic hypotension was associated with longer duration of disease (P = 0.03). Depression was significantly associated with other comorbid states.
Conclusion: Non-Motor Symptoms were seen in all the patients presenting to Neurology OPD of Rehman Medical Institute. The most common NMS was sleep disturbance followed by constipation and depression. Hallucinations were observed significantly more in elderly patients.
 
Knowledge of otic barotrauma among air travelers in Sialkot, Pakistan
Get PDFBackground: Otic barotrauma (OBT) is defined as traumatic inflammation in human middle ear that occurs at the time of avian drop. However, it can be avoided using its adequate knowledge. The objective of present study was to evaluate the knowledge of the trauma among air travelers in Sialkot city of Punjab, Pakistan.
Material and Methods: This cross-sectional study enlisted male adult International air travelers (n=50) from Sialkot city, Pakistan between November 2018 and April 2019 using purposive sampling technique. A specially developed questionnaire (Cronbach’s alpha = .82) having 12 close-ended items on barotrauma (total possible score 12) was administered to the participants at their home. Level of knowledge was categorized as inadequate (score 0-6), moderate (7-9) and adequate (10-12). Pearson’s chi-squared test was used to see the association between adequate knowledge on the OBT and sociodemographic variables using a P-value < .05 as statistically significant.
Results: Mean age of the participants was 47.60±9.9 years. Most of them (n=36; 72%) travelled for work reason. Almost all i.e. 46 (92%) gave correct response against item 1 (information provider about air trauma) and 12 (treatment of otic barotrauma) of the administered questionnaire. The rate of adequate knowledge on OBT was found to be higher among those having more than two-time travelling experience (82.9%, P = .02). However, there was no significant difference in knowledge of the barotrauma between people having less than or more than 12 years of science education (P = .59). All the business tourists (n = 5) had adequate knowledge of barotrauma followed by jobbers (n=25) and pilgrims (n=3), respectively.
Conclusions: Business tourists have adequate knowledge on otic barotrauma associated with air travel than jobbers or Hajj/Umrah pilgrims
Auricular Cartilage Interposition Arthroplasty in Recurrent Temporomandibular Joint Ankylosis in Pediatric Patients
Get PDFBackground: Temporomandibular joint (TMJ) ankylosis in early childhood can lead to disturbances in growth, facial asymmetry and difficulties in eating as well as in breathing. The objective of the study was to evaluate the effectiveness of auricular cartilage as an interpositional material after gap arthroplasty in pediatric patients with temporomandibular joint ankylosis in maintaining the achieved postoperative mouth opening.
Material and Methods: This prospective study was conducted at the Oral and Maxillofacial Surgery Department of King Edward Medical University, Lahore, from 1st January 2019 to 30th November 2019. Thirty patients, aged 5 to 15 years with clinical and radiological diagnosis of TMJ ankylosis were included in the study. TMJ ankylotic mass was removed, the gap was created and interposition of auricular cartilage graft was done in these patients. Mouth opening was measured as a distance between the incisal edges of mandibular central incisors to maxillary central incisors using the scale. Preoperative and postoperative mouth opening was noted and compared using the paired t-test.
Results: Among the thirty patients, 19 were male and 11 were female. The mean (±SD) age of patients was 9.23±3.23 years (age range 5 to 15 years). The mean preoperative mouth opening (T1) was 7.3±3.1 mm, while the mean postoperative mouth opening (T2) was 29.2±3.3 mm. The mean interincisal distance was 29.0 mm (range 21 mm to 35 mm). The mean difference in pre- and postoperative mouth opening (T2-T1) was 21.6 ± 5 mm.
Conclusions: Autogenous auricular cartilage graft is an efficient and reliable interpositional material for achieving early postoperative mouth opening in TMJ ankylosis patients
Benefits of Near-Peer Tutoring in Small Group Discussions: A Pilot Study
Get PDFBackground: A year senior medical students can prove to be a useful teaching resource with added benefits for the tutors. The objective of this study was to explore the perceptions of near-peer tutors after facilitating small group discussions while delivering an integrated curriculum in preclinical years.
Material and Methods: This qualitative exploratory pilot study was conducted in Rawal Institute of Health Sciences Islamabad, Pakistan from July 2017 to November 2017. Students of First year MBBS class (n=100), were divided into six small groups. Seven Second year MBBS students who had secured more than 60% marks throughout year one assessments and in Professional examination were selected as Near-Peer tutors after informed verbal consent. In the first discussion, three groups were taught by three tutors and three by junior faculty. In the second discussion, the groups were swapped and exposed to the same strategy as above, with new learning objectives, but the remaining three tutors now took batches. One tutor acted as a substitute. Qualitative data was collected after interviewing the tutors individually and responses were audio recorded. The collected data, both notes and audio recordings of the interviews, was transcribed into text to generate codes, theme and sub themes.
Results: Transcription of data revealed that the tutors enjoyed teaching and were of the opinion that Near-Peer tutoring is more effective in small groups, for both tutors and the learners. The tutors felt a boost in self-confidence and improvement in communication skills, after facilitating a small group. Tutoring also helped in developing their higher order cognitive thinking, learning skills and time management.
Conclusions: Near-Peer tutoring helped the tutors develop learning and communications skills while facilitating small group sessions, thus helping them in their future medical roles.
Key words: Integrated curriculum, Near-Peer tutoring, Peer Assisted Learning, Small group discussions
Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan
Get PDFBackground: Infected nonunion of long bones after fractures is one of the most challenging complication to treat in clinical practice. It is commonly treated by a two-stage approach; controlling infection initially and then application of external fixator and bone graft. Treatment with Ilizarov had been the gold standard but is associated with few complications. The objective of the study was to evaluate the clinical, radiological and functional outcomes of infected non-union of long bones treated with single-stage bone grafting and external fixation.Material and Methods: This retrospective study was carried out at Orthopedics Department of Northwest General Hospital, Peshawar Pakistan from 2014 to 2019. Medical records of 17 patients, aged 32 years and treated with Single-stage bone grafting and external fixation were reviewed. Nonunion included 7 humerii, 5 femurs, 3 tibias and 2 radius/ulna. Preoperative plain radiographs for any sequestrum or sclerosed bone margins and baseline investigations (like CBC, ESR, CRP and Vitamin-D status) were reviewed. All patients underwent radical debridement, reaming of intramedullary canals, external fixation and autogenous bone grafting. The outcomes evaluated were union of the bone (clinically and radiologically), resolution of infection, complication rate and number of re-intervention surgeries.Results: Among 17 patients, 10 were males and 7 were females. After treatment, mean follow-up duration was 9.414.48 months (4–18 months). None of the patients were lost to follow-up, had recurrence of infection or required further surgery. The mean duration of bone union was 8.4 4.48 months (range 3 to 17 months) and all of the patients achieved infection free union with satisfactory functional outcome.Conclusions: Single-stage bone grafting and external fixation is an effective technique in terms of resolution of infection and satisfactory bone union without any complications and can be used as an alternative to Ilizarov for treating cases of infected nonunion of long bones
Changing Antimicrobial Susceptibility and Resistance Pattern of Acinetobacter Species over the Last Eight Years in a Tertiary Care Hospital in Lahore, Pakistan
Get PDFBackground: Acinetobacter spp. is a highly resistant nosocomial pathogen that leads to a broad range of human infections resulting in high morbidity and mortality. Due to unpredictable MDR patterns of Acinetobacter spp., it is imperative to know the institutional prevalent susceptibility profiles of these residing pathogens. The objective of this study was to determine the antimicrobial susceptibility pattern of Acinetobacter species over the last 8 years in a tertiary care hospital in Lahore, Pakistan.Material and Methods: A retrospective study was carried out in Lahore General Hospital, a tertiary care hospital in Lahore, Pakistan. Eight-year data was gathered from January 2012 to December 2019. All specimens were handled according to standard operating procedures in the microbiology laboratory of the Pathology department of Lahore General Hospital. The Acinetobacter spp. were identified in the laboratory by Gram staining, oxidase test, catalase test and Triple sugar iron fermentation and their antibiotic sensitivity pattern was noted.Results: The highest yield of Acinetobacter spp. from the clinical specimen was isolated from pus followed by tracheal secretion, blood, and urine in the last three years (from 2017 to 2019). Most of the isolates were multi-drug resistant (MDR). There was a progressive increase in resistance of Acinetobacter spp. The highest progression in resistance was observed among the cephalosporin and quinolone group of antibiotics.Conclusions: Increased resistance to commonly used antimicrobials against Acinetobacter species has been observed with the highest resistance to quinolones and cephalosporins