Journal of Islamabad Medical & Dental College
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Comparison of Laparoscopic Total Extraperitoneal (TEP) Repair and Transabdominal Peritoneal (TAPP) repair of Inguinal Hernia
Full text linkIntroduction: The study compares the outcomes of laparoscopic total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair of inguinal hernia, focusing on operative time, post-operative pain, and hospital stay, following widespread use of laparoscopy.
Methods: The study design employed for this research was a randomised controlled trial. A total of 62 patients with inguinal hernia, 25 to 65 years of age of both genders were included. Patients with irreducible hernia, strangulated hernia, obstructed hernia, recurrent hernia, radiation to pelvic tumors and previous history of gut surgery were excluded. Group A included the cases in which TEP repair was done while group B included the cases in which TAPP repair was done. Operative time in both groups was noted. All the patients were followed by the researchers.
Results: In this study, the mean operation time was 64.52 ± 7.58 minutes for TEP repair versus 87.35 ± 3.77 minutes for TAPP repair (p-value = 0.0001). Mean duration of hospital stay for patients in TEP repair group was significantly shorter when compared to TAPP repair group (9.70 ± 2.15 versus 21.90 ± 6.91 hours) which was statistically significant (p = 0.0001). Mean post-operative pain was 1.68 ± 1.08 for TEP repair versus3.32 ± 1.45 for TAPP repair (p-value = 0.0001).
Conclusion: This study concluded that operative time, post-operative pain and hospital stay is less after laparoscopic total extraperitoneal (TEP) repair of inguinal hernia as compared to transabdominal preperitoneal (TAPP) repair
Relationship Between Platelet to Lymphocyte Ratio and Presence of Spontaneous Echo Contrast in Patients With Mitral Stenosis
No full textObjective: To evaluate the relationship between platelet-to-lymphocyte ratio (PLR) and spontaneous echo contrast (SEC) in patients diagnosed with mitral stenosis.
Methodology: This comparitive cross-sectional study was conducted for six months (Nov 2024 to April 2025) at the Cardiology Department of Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi. A consecutive sampling technique was employed to select diagnosed moderate to severe mitral stenosis patients aged ≥18 years. Transthoracic echocardiography (TTE) was performed to identify the presence of SEC. Total platelet count was divided by the lymphocyte count to calculate PLR.
Results: Overall, 100 patients (males: 67, female: 33) having mean age 42.06±7.38 years were the study participants. PLR was significantly elevated in SEC-positive individuals (150.98±44.65 vs. 129.77±50.04, p=0.036). The area under the ROC curve was 0.635, indicating moderate predictive ability. A PLR cutoff 115.23 yielded 80.9% sensitivity and 53.1% specificity, with 95% CI (0.513–0.757). Binary logistic regression confirmed the predictive potential of PLR (β=0.010; 95% CI: 0.01(1.001-1.019) and the significant relationship between PLR and SEC (p<0.05).
Conclusion: PLR is significantly associated with SEC in mitral stenosis patients. Additionally, PLR shows potential as a predictor of SEC.
Keywords: Lymphocyte, Mitral Valve Stenosis, Platele
Predicting Suitable Diameters of Radial Artery and Cephalic Vein for Long Term Patency of Radiocephalic Arteriovenous Fistula
Full text linkObjective: To find out the cut-off values of vascular arterial and venous diameters effecting patency of arteriovenousfistula (AVF) at wrist.Methodology: In this longitudinal study with non-purposive consecutive sampling, all consecutive patients fulfillingthe inclusion criteria and undergoing radiocephalic AVF (RC-AVF) were included. Log-Rank test was applied to find thecut-off points and Kaplan-Meier survival was used to detect vascular diameter effects on cumulative patency of RCAVFat 2 years.Results: A total of 150 RC-AVF were analyzed. Mean age at presentation was 53.5 (SD ± 4.76, Range 46-64) years.Cardiac (P-value: 0.000) and peripheral vascular arterial disease (P-value: 0.004) had a strong negative associationwith long term patency of access. Dichotomized cutoff point of radial artery was 2mm and cephalic vein was 2.5mm.Radial artery diameter of less than 2mm (SE 1.155; CI: 5.66-525.2; P value: 0.001) and cephalic vein diameter of 2.5mm(SE 1.155; CI: 5.66-525.2; P value: 0.001) are strongly associated with poor long-term patency of RC-AVF.Conclusion: Cephalic vein of <2.5mm and radial artery of <2mm diameter is associated with statistically significantfailure rates of RC-AVF.Keywords: Arteriovenous fistula; Fistula failure; Radiocephalic; Vascular diameter
Spectrum Of Surgical Site Infections in the Surgical Ward
Full text linkObjective: To analyze the spectrum of bacterial pathogens causing SSIs in surgical patients, and to determine the antibiotic resistance and susceptibility patterns of these organisms.
Methodology: A cross-sectional observational study was conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, from January to December 2024. A total of 300 patients who underwent surgery and developed SSIs were included. Pus samples were collected from infected surgical sites, cultured, and analyzed for microbial identification and antibiotic susceptibility using standard microbiological techniques. Data were analyzed using SPSS version 25.
Results: The study identified Klebsiella (23.3%), Escherichia coli (17%), Pseudomonas (12.7%), and Staphylococcus aureus (9.7%) as the most common pathogens in SSIs. Across the bacterial isolates, a common trend of resistance was observed against amoxicillin, cefixime, ceftriaxone, cotrimoxazole, and penicillin. In contrast, higher sensitivity was seen with amikacin, tobramycin, vancomycin, chloramphenicol, colistin, and minocycline, though the degree of susceptibility varied among species.
Conclusion: There is a predominance of gram-negative bacteria, including Klebsiella and E. coli, among the bacterial pathogens causing SSIs. Among these, significant antibiotic resistance was noted against commonly used antibiotics. Amikacin and tobramycin were found to be effective against a wide range of pathogens. The results underscore the importance of judicious antibiotic use, continuous monitoring of antimicrobial resistance, and the development of alternative treatment options to effectively manage SSIs
Dermatological Manifestations in Healthcare Workers Due to Use of Personal Protective Equipment During COVID-19 Pandemic
Full text linkObjective: To evaluate the prevalence and types of dermatological manifestations among healthcare workers (HCWs) due to prolonged personal protective equipment (PPE) usage during the COVID-19 pandemic.Methodology: This cross-sectional study was conducted at Pakistan Air Force (PAF) Hospital, Islamabad, from March 7, 2023, to September 6, 2023. A total of 134 HCWs aged 20–60 years, using PPE for over 6 hours daily, were enrolled. Clinical examination was conducted to document dermatological complications.Results: Of the participants enrolled, 34.3% were males and 65.7% were females (mean age 35.31 ± 10.3 years). Among the reported adverse dermatological signs and symptoms, xeroderma was the most frequently observed, affecting almost 70.1% of participants.70.1% of participants. Other prominent dermatological manifestations included itching (13.4%), burning sensations (11.2%), skin fissures (2.2%), erythema (1.5%), and scaling (1.5%) were also noted. Notably, xeroderma was particularly prevalent among nursing staff.Conclusion: Healthcare workers faced dermatological adverse effects due to the extended use of personal protective equipment (PPE) during the COVID-19 pandemic. This highlights the need for preventive measures to reduce the adverse cutaneous effects, by improving PPE design and consistent skincare practices.Keywords: COVID-19 Pandemic, Dermatological manifestations, Healthcare workers, Personal Protective Equipment PPE, Xeroderma
Diagnostic Accuracy of Leukocyte Esterase Dipstick Test in Early Detection of Spontaneous Bacterial Peritonitis in Cirrhotic Patients
Full text linkObjective: To assess the investigative precision of the leukocyte esterase dipstick test in detecting SpontaneousBacterial Peritonitis (SBP) among cirrhotic patients.Methodology: During the study period. 132 cirrhotic patients were enrolled reported with grade 2 or 3 ascites.Investigative abdominocentesis was completed under stringently sanitised circumstances. A smaller sample of asciticfluid (10mL) screened for the analysis whereas, a larger sample (30mL) was kept for the dipstick test to determine thegranulocyte esterase activity. Using a color-calibrated scale, Leukocyte levels were computed. ++ and +++ dipstickresults were marked as positive. Critical investigative metrics were measured discretely for positive dipstick grades.Results: The results of the study showed that with LERS++, the confirmation rate for SBP was 85.7% in contrast to thepatients with LERS+++ which was increased to 87.5%. LERS++ threshold was calculated as follows: overall diagnosticaccuracy, 79.5%, specificity, 96.7%, sensitivity, 42.9%, PPV, 85.7%, NPV, 78.4%. LERS+++ threshold was as follows:overall diagnostic accuracy 81.8%, sensitivity 50%, specificity, 80.6%, PPV 87.5%, and NPV 80.6%.Conclusion: In order to detect SBP in cirrhotic patients, the LERS (leukocyte esterase dipstick) test appears to possessspeedy, cost-economical, and sensible diagnostic benefits having affordable diagnostic precision.Keywords: Ascitic Fluid Analysis; Cirrhosis; Diagnostic Accuracy; Leukocyte Esterase Dipstick Test; SpontaneousBacterial Peritonitis
Trends in Gender Specific Mortality Differences Post Burn Injury; Evidence from Burns Care Centre, Pakistan Institute of Medical Sciences, Pakistan
Full text linkObjective: To evaluate the effect of gender following burn injury on mortality outcomes.Methodology: This retrospective cohort study was conducted at Burn Care Centre, PIMS, Pakistan. Secondary datawas collected and reviewed via HMIS database. Annual mortality patterns observed from 2019-2023 across multipleage groups revealed differences in gender for several confounding variables.Results: Mortality rate stated in females was (13.17%) compared to males (12.76%). No significant difference wasobserved across various age intervals when viewed heterosexually. Similarly, although flames showed higher mortalityamong females and males had greater mortality as a result of scald, electric & cylinder burns, the data proved to bestatistically insignificant. Total burn surface area (TBSA) was reported to be insignificantly higher among males ofchildhood & reproductive ages and females of old age. Length of stay (LOS) also displayed analogous patterns inmortality irrespective of age except for a rise in mortality among women of childbearing age in comparison to postpubertal males (10.3 vs 6.7).Conclusion: Our study depicted trends in post-burn mortality across reproductive age group, emphasizing genderdisposition. Females are at greater risk of mortality particularly among those with prolonged hospitalization. Rest ofthe confounding factors i.e. TBSA, degree and mechanism of burn injuries did not show significant fluctuations withrespect to morality in both genders on statistical grounds.Keywords: Burn Type; Burn injury; Gender Differences; Length of Stay; Mortality; Total Burn Surface Area
ENHANCED DIAGNOSTIC ACCURACY OF ELECTROCARDIOGRAM USING ADDITIONAL ECG MARKERS FOR DETECTING ACUTE CORONARY OCCLUSION IN MYOCARDIAL INFARCTION
Full text linkAbstract
Objective
The aim of this study was to evaluate the diagnostic accuracy of using additional electrocardiographic markers alongside traditional ST-segment elevation (STE) in the detection of acute coronary occlusion (ACO) in patients presenting with myocardial infarction taking angiographic evidence of coronary artery occlusion as the gold standard.
Study design and Setting
This cross-sectional study was conducted at Army Cardiac Hospital.
Methodology
After the permission from institute review board this study was conducted from 11 August, 2025 to 11 November, 2025 under the principles of Helsinki Declaration. Consecutive sampling technique was used to enroll patients in this study.
Results
In this study the mean age of the cases was 60.80 ± 8.40. There were 105 (70%) male and 45 (30%) females found in this study. The comparison of ECG type, ECG ACO, angiographic ACO and composite ACO showed significant results with p-values < 0.001, <0.001, 0.002 and < 0.001. The sensitivity and specificity of angiographic results was computed as 73.56% and 93.65%, PPV and NPV was 94.12% and 71.95%.
Conclusion
Electrocardiogram can be used to detect the culprit coronary in the settings of automated prehospital 12 lead ECG machine so that the paramedics can identify the coronaries involved and appropriately refer the patient to PCI capable centers and reduce the time required for the triage of patients with STEMI and the duration of their appropriate treatment hence it will help the physician reduced the door to needle time.
Key Words: Acute coronary occlusion, Electrocardiogram, ST-segment elevatio
From Free Flaps to Pectoralis Major Flaps: A Workhorse in Limited Resources
Full text linkObjective: To assess the functional and aesthetic outcomes of using pectoralis major flaps in patients with head and neck region soft tissue defects after oral squamous cell carcinoma tumors in a resource-limited setting.
Methodology: This prospective study was conducted on patients who received repair of post-ablative defects at the plastic surgery unit of Liaquat University of Medical and Health Sciences and Bilawal Medical College, Jamshoro, between October 2022 and March 2023. All patients admitted to the plastic surgery unit during the study period for reconstruction of post-ablative defects using subsequent PMC flap repair for head and neck region soft tissue defects after oral squamous cell carcinoma that were surgically treated and aged between 20 and 70 years. All major and minor PMC flap-related and flap-unrelated complications were assessed.
Results: Among 78 patients, 63 (80.7%) were male and 15 (19.3%) were female, with a mean age of 34.10 ±12.10 years (range: 24-70 years). The Buccal mucosa was the most common location for oral cavity cancer, whereas the base of the tongue and floor of the mouth were used for reconstruction. Infections and wound dehiscence were the most common consequences, and the reconstruction site was statistically significant (p<0.05).
Conclusion: Despite encountering a few minor complications both associated and isolated to the PMMC flap, the survival rate of the flap remains high, while the occurrence of complete flap necrosis is extremely rare
Hemostatic Net Sutures: A New Solution to an Old Problem
Full text linkObjective: The use of hemostatic net sutures, known for their efficacy in reducing hematoma formation in rhytidoplasty, is emerging as a promising technique for skin graft fixation. This research focuses on evaluating the effectiveness of hemostatic net sutures in securing full-thickness skin grafts, aiming to improve graft uptake and minimize complications.Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi, From July 2022 to December 2023.Methods: We conducted a prospective study at a single institution, involving 30 patients who underwent full-thickness skin grafting in the head and neck region and required hemostatic suturing over a period of 1.5 years. Results: The study encompassed 30 full-thickness skin graft reconstructions, with a follow-up period extending up to three weeks. A notable graft take rate of 90% was observed, with half of the cases achieving 100% adherence. The average time for the procedure was approximately 26.7 minutes across an average defect area of 58 cm². Major hematoma formation was observed in only 3% of the cases, with no significant influence of age, sex, or defect area on the graft take rate.Conclusion: Hemostatic net suturing demonstrates its efficacy in ensuring adequate graft adherence while simultaneously minimizing tissue manipulation, reducing surgical time, and lowering complication rates