Journal of Islamabad Medical & Dental College
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Diagnostic Accuracy of Fiber Optic Laryngoscopy
Get PDFBackground: Laryngeal examination of patients with hoarseness is essential to diagnose a wide range of pathologies. Laryngeal visualization has progressed from simple indirect mirror examination to virtual laryngoscopy with flexible fiber optic laryngoscope as an acceptable option. This study was done to determine the diagnostic accuracy of fiber optic laryngoscopy in patients with hoarseness.Material and Methods: This cross-sectional comparative study included a sample of 155 participants, of both genders, aged 20 to 60 years with hoarseness of at least 1 month duration. Participants were recruited through non probability consecutive sampling technique from ENT department, Sir Ganga Ram Hospital Lahore, Pakistan over a period of six months (October 2015 to March 2016). Patients fulfilling the selection criteria were subjected to Fiber Optic Laryngoscopy (FOL) under local anesthesia followed by Direct Laryngoscopy (DL) under general anesthesia and findings recorded. Data was collected, tabulated and analyzed using SPSS 17. Diagnostic value of FOL versus DL was calculated with frequency, percentage, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).Results: Out of 155 participants, 48.39 % (75) were males and 51.61 % (80) females, with mean age of 31 ± 9.54 years. Assessment of diagnostic accuracy of fiber optic laryngoscopy taking direct laryngoscopy as criterion standard showed an accuracy of 80.65% with 89.19% sensitivity, 77.96% specificity, 55.93% PPV, and 95.83% NPV.Conclusions: Fiber optic laryngoscopy is an excellent tool for the diagnosis of hoarseness, with a diagnostic accuracy of 80.65%
Frequency of Isolation of Coagulase Negative Staphylococcus from Blood Cultures and its Antibiogram
Get PDFBackground: Coagulase-negative Staphylococci are members of stable skin inhabitants. They are frequent contaminants in blood cultures and can lead to unnecessary exposure of patients to antimicrobial drugs and excess hospital costs. This study aims to estimate the frequency of Coagulase-negative Staphylococci in blood cultures and their antibiograms.
Materials and Methods: This cross-sectional study was performed in a tertiary care hospital over one year from April 2018 to March 2019. Blood cultures received in the laboratory were processed to isolate Coagulase-negative Staphylococci. Susceptibility to various antimicrobial drugs was detected by disc diffusion method and E-strips.
Results: A total of 13802 blood cultures were processed in one year. 1750 blood cultures yielded bacterial growth and 374 blood cultures were positive for Staphylococci. Out of these 374 blood cultures, 97 were categorized as Staphylococcus aureus and 277 were Coagulase-negative Staphylococci. Out of 13802 total blood cultures performed during study period, 277 blood cultures positive with Coagulase negative Staphylococcus means contamination rate of 2% out of total blood cultures. 277 Coagulase negative Staphylococcus positive cultures out of 1750 positive blood cultures means contamination rate of 15.8% out of positive blood cultures. Among Coagulase-negative Staphylococci, 68.2% isolates were resistant to Cefoxitin, 95.3% to Penicillin, 85.1% to Erythromycin, 37.5% to Ciprofloxacin, 59.6% to Gentamicin, 68.6% to Fusidic acid, 3.6% to Teichoplanin, and 1.4% to Linezolid. All isolates were sensitive to Vancomycin.
Conclusion: The rate of blood culture contamination was 2% out of total blood cultures and 15.8% out of positive blood cultures
Vaccination Status and Clinical Spectrum of Children with Pyogenic Meningitis in A Tertiary Care Hospital of Hazara Division, Pakistan
Get PDFBackground: Pyogenic meningitis is one of the serious causes of mortality and morbidity in children. It is more prevalent in third world countries with poor vaccination coverage. This study was done to determine the vaccination status and clinical spectrum of pyogenic meningitis in children presenting to a tertiary care hospital.
Methods: This cross-sectional study was carried out from August, 2017 till January, 2020 over 2.5 years. Records of children who got admitted in pediatric B ward, of either gender between ages of 1 month to 14 years diagnosed as case of pyogenic meningitis were included. Records of vaccination status along with signs of meningeal irritation, complications and outcome during hospital stay were documented. Data was analyzed by SPSS 20 and chi square test applied. P value < 0.05 was taken as significant.
Results: There were 117 patients, 78 males and 39 females. Age ranged from 1 month to 14 years with mean age of 5.51± 4.19 years. Patients who were vaccinated up to date were 49.6% and 37.6% were not vaccinated at all. Main presenting feature was fever and seizures especially under one year of age. There was significant association between seizures and age group with p value of 0.001. Signs of meningeal irritation (neck stiffness, brudzinski sign, kerning sign) and paradoxical irritability were present in 85 (72.6%) patients mostly above 1 year of age. There was significant association between signs of meningeal irritation and age group (5 years and above) with p value of <0.001. 110 (94%) got discharged and one (0.9%) patient was referred while 6 (5.1%) patients expired. There was significant association between stay duration and vaccination status. (p = 0.018)
Conclusion: Fever was the most common presentation and vaccinated children with pyogenic meningitis had shorter stay in hospital
Comparing the Outcomes of Thyroid Surgical Procedures for Benign Diseases with Expertise of the Surgeon in a Tertiary Care Hospital in Rawalpindi, Pakistan
Get PDFBackground: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P<.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P<.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure
Issues in Clinical Learning Environment among Undergraduate Nursing Students in Khyber Pakhtunkhwa, Pakistan
Get PDFBackground: Nursing students apply theoretical and evidence-based knowledge on real patients in clinical placements, thus poor clinical education may affect their performance along with patient care. The perceptions of nursing internees may serve as a solid evidence of issues in clinical learning. The objective of this study was to identify issues regarding clinical learning among undergraduate nursing students.
Material and Methods: A descriptive cross-sectional design was employed to collect data from a sample of 72 graduated Nursing Internees from Nursing Colleges in the Khyber Pakhtunkhwa (KPK) province of Pakistan. This study was conducted from April 2019 to August 2019. A Questionnaire in the form of Likert scale was developed for data collection regarding past experiences of their undergraduate studies. SPSS 22 was used for analysis. Chi-squared test was used to compare between male/female, public/private clinical placements and public/private colleges, respectively.
Results: Of the participants 79% (n=57) were male and 21% (n=15) were female. Mean age of participants was 24.29±1.72 years. Four barriers in clinical education due to deficiencies in educational institutions included: shortage of clinical teachers (76.4%), clinical teachers rarely visited students (75%), too many students were supervised by a single teacher (81.9%) and students are overloaded with too many written assignments (75%). The P-value for shortage of clinical teachers was statistically significant (P=.016). The main barriers in clinical education attributed to clinical settings or the hospitals were behavior of the hospital staff resulting in the loss of students’ confidence (73.6%) and anxiety of students to perform wrong procedures (73.6%). However, none of these barriers in clinical education were statistically significant (P>0.05).
Conclusion: Findings of the study illustrated dissatisfaction of graduate nursing internees regarding the clinical education as almost all the issues received more than 50% responses.
Key words: Clinical placement, Clinical Nursing teacher, Nursing internees, Student nurse
Symptom Analysis of Confirmed Covid-19 Patients Managed at Allied Hospitals of Rawalpindi Medical University, Pakistan
No full textIntroduction
Coronavirus can cause respiratory disease ranging from mild upper respiratory tract illness to severe pneumonia, severe acute respiratory distress syndrome, and death. The purpose of this research was to study the symptoms of confirmed Coronavirus disease (COVID-19) cases and their relationship with gender and age groups.
Materials and Methods
This observational cross-sectional study was conducted at Rawalpindi Institute of Urology and Transplantation (RIUT) that is the COVID-19 management center of Rawalpindi Medical University, Rawalpindi during the month of March 2020. Consecutive sampling methodology was used, and all real-time polymerase chain reaction (RT-PCR) confirmed patients of COVID-19 were included. Data regarding age, gender, and symptoms with onset was recorded and analyzed.
Results
Thirty-five patients, 22 (62.9%) males, and 13 (37.1%) females were included. Seven (20%) patients were ≥60 years old, and 12 (34.8%) ≥40 years old. 21 (60%) were symptomatic and the rest of them were asymptomatic. The mean duration of symptoms was 2.8±1.1 days. Fever (13, 61.9%), persistent cough (12, 57.1%), sputum (6, 28.6%), shortness of breath (4, 19%), anorexia (3, 14.3%), fatigue (3, 14.3%), myalgia (1, 4.8%), were presenting symptoms. Cough, anorexia, and fatigue were significantly more frequent in the patients ≥40 of age. Anorexia and fatigue were common in the age groups ≥40 and ≥60 years. Myalgia was significantly frequent in patients aged ≥60 years.
Conclusion
Fever, persistent cough and shortness of breath are commonest symptoms of COVID 19 patients. COVID-19 can be asymptomatic in many cases
Transmission Routes and Infection Control of Novel Coronavirus-2019 in Dental Clinics – A Review
Get PDFThe novel Coronavirus (nCoV-19) pandemic began in Wuhan, China with Severe Acute Respiratory Syndrome (SARS) in December, 2019. The virus transmitted from China to other countries by traveling of the infected individuals. The number of infected populations with Coronavirus is increasing day by day with an increased mortality rate. The signs and symptoms of the disease include fever, non-productive cough, dyspnea, and fatigue. The transmission routes of the virus include respiratory secretions or droplet infection and direct contact with the infected person. Dentists are a group of professionals that are highly exposed to infectious diseases. The nCoV-19 is transmitted from patient to dentist and dentist to patient mainly through aerosol and splatter produced by the dental procedure and saliva of an infected person. To avoid transmission of the virus from patient to dentist and from dentist to other patients, screening tests should be done at dental setups. The use of gloves, face shields, masks, gowns, and antiseptic handwash are mandatory for the dentist. Awareness programs should be conducted to prevent further transmission of the disease. We searched Google, Google Scholar, WHO website for coronavirus and National Institute of Health website (nih.org.pk) for relevant literature by using various MeSH terms including ‘2019-nCoV’, ‘transmission of 2019-nCoV in dental clinics’, ‘dentistry and COVID-19’ and ‘infection control’, etcKey words: COVID-19, Dental clinics, Infection control, Transmissio
Altered Coagulation Pattern in Different Histological Grades of Squamous Cell Carcinoma
Get PDFBackground: The incidence of squamous cell carcinoma has doubled in the last three decades associated with a high rate of morbidity and mortality. The incidence of bleeding and/or thrombosis in advanced stage cancer necessitates a need for research in blood coagulation abnormalities in malignancy. The objective of the present study was to determine the alteration in coagulation pattern among patients diagnosed with squamous cell carcinoma (SCC).
Material and Methods: This cross-sectional study was conducted in Pathology department of Isra University Hospital, Hyderabad over a period of 06 months. A total of 126 samples were selected through non-probability convenient sampling. Both male and female patients of all age groups having SCC of skin, gastrointestinal and genital tract were included. The coagulation profile was analyzed by Sysmax CA 50 and Nycocard reader II. Data was entered into SPSS version 22.0 and results were analyzed.
Results: The mean age of the patients with SCC in the present study was 55.5 ± 12 years with more male patients (n=81; 64.3%) as compared to females (n=45; 35.7%). Oral SCC was found to be the most common site of squamous cell carcinoma (43.7%). Majority of the patients had well differentiated SCC (42.1%) followed by moderately differentiated (40.5%) and poorly differentiated SCC (17.4%). The comparison of severity of SCC with coagulation profile revealed that PT (P=0.01), APTT (P=0.001), D-dimers (P=0.01 and TT (P=0.01) were significantly increased, whereas fibrinogen was significantly decreased (P=0.001).
Conclusions: The histological differentiation of SCC (from well differentiated to poorly differentiated tumors) showed a highly significant association with different coagulation profile parameters like PT, APTT, BT, CT, D-dimer, TT, and fibrinogen levels
