Journal of Islamabad Medical & Dental College
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Clinical Risk Factors and Angiographic Pattern of Coronary Artery Disease in Young Females
Get PDFBackground: Coronary artery disease (CAD) is associated with the highest mortality in women around the world. The objective of this study was to compare the clinical risk factors and angiographic pattern of coronary artery disease in young versus old age females having CAD.Material and Methods: This cross-sectional study was conducted at the Department of Cardiology, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology Multan, Pakistan from April 2018 to December 2018. All females with diagnosis of angina and consistent ischemic changes on ECG were enrolled in the study. A total of 230 females were included with 123 patients aged <45 years and 107 patients aged >45 years. Comparison of patient characteristics, clinical risk factors and angiographic pattern in young and old age females was done by using SPSS version 21 statistical software.Results: Prevalence of hypertension (P=0.001), dyslipidemia (P=0.06) and diabetes mellitus (P=0.007) was significantly higher in females of older age group (>45 years). Similarly, a larger number of older age females (32; 29.9%) presented with ST-Elevation Myocardial Infarction (STEMI) as compared to young female patients (22; 17.88%) (P=0.03). Regarding angiographic patterns of CAD, there was no difference in the prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) between the groups. Normal angiogram was found in 13 (12.3%) old age females versus 35 (28.8%) young females, respectively (P=0.002).Conclusions: The risk factors profile and clinical presentation of CAD is different in young female patients with CAD. There is an essential need to determine the coronary atherosclerosis factors in young females and these women should be treated more aggressively to prevent adverse cardio-vascular outcomes.Key words: Angiographic Pattern, Coronary Artery Disease, Clinical Pattern, Young Female
Antibiotic Sensitivity Pattern of Uropathogens in Diabetic Women with Asymptomatic Bacteriuria
Get PDFBackground: More than 150 million people around the globe are diagnosed with urinary tract infections every year. Failure to treat these infections with proper antibiotics can lead to serious complications. The objective of this study was to investigate antibiotic sensitivity and resistance pattern of urinary isolates in type-2 diabetic women with asymptomatic bacteriuria.
Material and Methods: This cross-sectional descriptive study was conducted at the HBS General Hospital, Islamabad, from March 2017 to August 2019. A total of 270 females with the diagnosis of type-2 diabetes mellitus were included in the study. Uropathogens were isolated from urine samples and antibiotic sensitivity testing was conducted. Demographic and clinical information was recorded on a pre-designed proforma. The data was analyzed using SPSS version 20.
Results: The mean age of the study sample was 50 years (SD ± 5.5) while the mean HbA1c levels were 8.98 g/dL (SD ± 0.8 g/dl). Uropathogens were found in the urine cultures of 106 (39.3%) patients. Extended Spectrum Beta-Lactamase producing (ESBL) Escherichia coli (E. coli) was the most common organism (n=46, 43.4%) which was sensitive to tazobactam, tazocin and co-trimoxazole. Nitrofurantoin was the most effective antibiotic with 62.5% isolates sensitive to it. All of the pathogens were resistant to ciprofloxacin.
Conclusions: Asymptomatic bacteriuria is common in type-2 diabetic women with ESBL E. Coli being the most common organism isolated from urine cultures. There is a significant resistance to antibiotics among the uropathogens isolated from these patients
Diagnostic value of Transthoracic Ultrasonography for COVID-19 Pneumonia: A Prospective Study
Get PDFBackground: Corona virus infection requires early detection and precise diagnosis for an effective control in community. COVID-19 PCR is the gold standard diagnostic test having low sensitivity and adequate availability constraints. Because of high false negative rate, a large number of undetected patients remain a constant source of inadvertent disease dissemination in the community. This study was conducted to explore the diagnostic usefulness of transthoracic ultrasonography for COVID-19 pneumonia during the current pandemic.
Material and Methods: This cross-sectional study was conducted in the Pulmonology OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan from April 1, 2020 to July 30, 2020. A total of 237 patients with dry cough, fever and shortness of breath of sudden onset, clinically diagnosed as COVID-19 pulmonary infection, were included in the study. Patients were investigated with chest x-ray/HRCT, transthoracic ultrasonography, COVID-19 RT-PCR on nasopharyngeal samples and hematological tests. Sensitivity, Specificity, PPV (positive predictive value), NPV (negative predictive value) and diagnostic accuracy of transthoracic ultrasonography was calculated with P-value <0.05 considered as statistically significant. SPSS-26 software was used for statistical analysis.
Results: Of the total 237 patients (mean age 41.23±17.5 years) presenting with complaints of a pulmonary infection, 228 were diagnosed as COVID-19 pulmonary infection by transthoracic ultrasonography and PCR. Bilateral lesions and B-lines were the most frequent characteristic features on ultrasonography (n=237 patients; 100%). Transthoracic ultrasound diagnosed 228 patients as cases of COVID-19 pneumonia with 100% sensitivity, 66.67% specificity, 98.7% PPV, 100% NPV, and 98.73% diagnostic accuracy. Only 135 /228 (59.21%) patients were diagnosed by RT-PCR. The P-value by Fisher exact test was highly significant at 0.001 (cut-off P- value < 0.05).
Conclusion: Transthoracic ultrasonography is a useful diagnostic tool with a high sensitivity, is free- from radiation exposure and capable of providing foundations for evidence based, early detection of corona virus pneumonia in a pandemic situation. 
Nosocomial Blood Stream Infections in Pediatric Intensive Care Unit of Fauji Foundation Hospital, Rawalpindi Pakistan
Get PDFBackground: Nosocomial blood stream infections with bacterial organisms are one of the most common problems faced by health care professionals in admitted patients, since these infections complicate the treatment and affect the outcome. The objective of this study was to determine the frequency of most common bacterial organisms in nosocomial blood stream infections in children admitted in Pediatric Intensive Care Unit of a tertiary care hospital at Rawalpindi, Pakistan.Material and Methods: This cross-sectional study was carried out from 6th July 2017 to 6th January 2018 in the Pediatric Intensive Care Unit (ICU), Fauji Foundation Hospital, Rawalpindi, a tertiary care hospital. A total of 385 patients, aged 14 days to 12 years, admitted in the ICU were monitored from the time of admission till their blood culture reports were positive for bacterial growth along with signs of clinical sepsis Blood samples for culture were collected aseptically and the bottles were incubated for 7 days. Patients were monitored from time the blood culture yielded growth of bacterial pathogens till final blood culture report with antibiotics sensitivity against the pathogen became available. Data was analyzed using SPSS Version 20. Effect modifiers like age, duration of admission and gender were controlled by stratification and chi-square test was applied for comparison with P-value less than .05 considered as statistically significant.Results: Pseudomonas aeruginosa and Salmonella typhi were the most common bacterial organisms (n=83; 21.6% each) causing nosocomial blood stream infection, followed by Escherichia coli (n=77; 20%) and Klebsiella (n=67; 17.4%), respectively. Effect modifier, like gender (stratified and compared by Chi-square test) had a statistically significant relationship with frequency of most common bacterial organisms in nosocomial blood stream infections (P=.001). However, effect modifiers like age and duration (hours) of admission to PICU had a non-significant relationship with frequency of bacterial organisms in nosocomial blood stream infections (P>.05).Conclusions: There is a high frequency of common bacterial organisms in nosocomial blood stream infections in children with predominance of gram-negative bacteria including Pseudomonas aeruginosa and Salmonella typhi. Thus, early initiation of appropriate antibiotic therapy can help in decreasing mortality, significantly in hospitalized patients
Histomorphometric Variations of the Placenta in Normal and Hypertensive Pregnancies
Get PDFBackground: Pregnancy-induced hypertension is a leading cause of deleterious changes in the placenta resulting in decreased blood supply towards the placenta. The objective of the current study was to analyze the histo-morphometric variations in the placenta of women with or without known pregnancy-induced hypertension.
Methods: Cross-sectional study was carried out in the Gynecology and obstetrics section of Nazeer Hussain Medical Complex, Hyderabad in collaboration with Isra University, Hyderabad from March 2019 to August 2019. A total of 100 placentae were selected and divided into two groups (control and study groups) based on the presence or absence of hypertension in pregnancy. The observations of the control group placenta were compared with the study group placentas. All placentae were observed for morphometric and histological changes. SPSS ver. 22 was used to analyze the collected data.
Results: There was an increase in the mean weight of placentae among the control group as compared to the group having known hypertension cases and the difference was statistically significant (p-value <0.05). The fetoplacental weight ratio was increased among the hypertension group when compared to the statistically insignificant control group (p-value <0.05). Various gross (infarction, calcification) and histological changes (hyalinised villi, intervillous hemorrhage, decreased villous vascularity) were observed in the placentae of the hypertensive group as compared to the normal group.
Conclusion: The findings of the study concluded that Preeclampsia/PIH poses harmful and serious histo-morphometric variations in the placental tissues that affect fetal outcome
Intraparotid Facial Nerve Schwannoma in a 40-Year-Old Male with Hearing Loss – A Case Report
Get PDFSchwannoma is a benign tumor of axonal nerve sheath. Head and neck area, particularly parotid gland is an uncommon site for Schwannoma, however it can rarely arise from the intraparotid part of facial nerve and present as either a symptomless mass or facial paresis. Its diagnosis before surgical intervention is important for the conservation of parotid gland and facial nerve. On clinical examination and imaging studies, it can be misdiagnosed easily. FNAC is a helpful tool for its diagnosis. This entity should not be ignored while dealing with parotid masses. We present a case of a patient who came with the complaint of a parotid mass. Magnetic resonance imaging (MRI) scan suggested a parotid tumor which proved to be a spindle cell neoplasm on Fine Needle Aspiration Cytology (FNAC). A definite diagnosis of schwannoma of intraparotid facial nerve was made on histopathological examination of the excision sample
Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective
Get PDFSwallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty
 
Impact of Endoscopic Retrograde Cholangiopancreatography on Laparoscopic Cholecystectomy
Get PDFBackground: For Common Bile Duct (CBD) stones an Endoscopic Retrograde Cholangiopancreatography (ERCP) is done prior to cholecystectomy. However, the ideal timing of cholecystectomy following ERCP is still a matter of debate. The aim of the present study was to observe the possible impact of ERCP on subsequent laparoscopic cholecystectomy.Material and Methods: This case control study was carried out in the Department of Surgery Unit 1, Holy Family hospital, Rawalpindi, from January 2018 to March 2019. A total number of 300 patients of symptomatic gallstones presenting to outpatient department were enrolled. Two groups, A (control group) and B (case group) were made on the basis of absence or presence of CBD stones, respectively. Group A underwent laparoscopic cholecystectomy within three working days of admission. In group B, ERCP was performed prior to cholecystectomy. Primary operating surgeon filled structured questionnaires for each patient immediately after surgery to compare operative differences between both groups. The baseline demographic details, clinical characteristics, laboratory investigations and peri-operative findings of both groups were recorded. Means and percentages were calculated with P value <0.05 regarded as statistically significant.Results: Majority of patients in this study were females (81%) of middle age group (42.5+15 years). Biliary colic was most common presenting complaint in both groups (33%). Dissection in triangle of Calot (P=0.00) and removal of gallbladder from liver bed (P=0.00) was significantly more difficult in group B than A. Intra-abdominal lavage was also done more often in post ERCP group (P=0.00). However procedural time did not vary between the two groups (P=0.19).Conclusions: Preoperative ERCP increases difficulty in laparoscopic cholecystectomy but does not prolong procedural time.Key words: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectom
