Journal of Islamabad Medical & Dental College
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Mastalgia: Risk Factors and Treatment Strategies Used at Two Breast Clinics in Pakistan
Get PDFBackground: Mastalgia is one of the commonest symptoms of breast disorder and a major cause of anxiety amongst women. The aim of this study was to determine the risk factors associated with the onset and severity of mastalgia, their association with various breast disorders, and response to strategies used for its treatment.Material and Methods: This prospective descriptive study was carried out at Combined Military Hospitals (CMH) of Rawalpindi and Thall over a period of six months from January to July 2017. Women presenting to breast surgery clinic with complaints of breast pain, heaviness, and tenderness were included in the study. Patients were initially evaluated at the time of presentation, treatment was initiated, followed by re-evaluation after six months. A multiple logistic regression model was used to determine association of mastalgia with various conditions and their effect on severity of mastalgia.Results: A total of 93 women presented to the breast clinics during this period. Cyclical mastalgia was noted in 39.8% women while 60.2% had non-cyclical mastalgia. In 41.9% patients no underlying pathology was noted, 49.5% patients had benign disorders while 8.6% had malignancy. Increased BMI (P = .002) and lack of exercise (P = .01) were associated with onset of mastalgia while use of oral contraceptive pills (P < .001) was associated with low risk of mastalgia. Of all the patients, 45.1% responded to measures like reassurance, dietary and lifestyle modifications while 54.9% were treated with pharmacological therapy. Those diagnosed having underlying malignant disorder were treated according to the type and stage of malignancy.Conclusions: Various factors affect the onset and severity of mastalgia and different treatment strategies can be used to alleviate the symptoms. Hence, complete and thorough evaluation of the patients presenting with mastalgia should be carried out to rule out any underlying pathology
Frequency of Post-Operative Wound Contamination in Bakhtawar General Hospital, Jamshoro
Get PDFBackground: Surgical site wound infection (SSI) imposes a great challenge worldwide. It is the third most commonly reported nosocomial infection. The objective of the study was to assess the frequency of postoperative wound infections in a newly developed health organization.Material and Methods: This cross-sectional study was conducted from June 2017 to May 2018 in Bakhtawar General Hospital, Jamshoro. A total of 364 cases of surgery, from Obstetrics and Gynecology and General Surgery department were included. Surgical interventions involving an incision were assessed. Infection (SSI) rate was noticed and data was analyzed by SPSS version 18.Results: Healthy discharge rate was 97%. The overall surgical site wound infection rate was 3.1%. These infections were high in genitourinary surgeries (9.09%). Among Obstetrics & Gynecology surgeries, maximum number of SSIs were reported in cases of emergency Lower Segment Cesarean Section (LSCS).Conclusions: The overall rate of SSI for different types of surgeries performed at Bakhtawar General Hospital, Jamshoro was only 3.1%. Frequency of SSI was highest in genitourinary surgeries followed by gastrointestinal and obstetrics and gynecology surgeries, respectively.Key words: General Surgery, Genitourinary surgery, Obstetrics & Gynecology surgery, Post-operative wound contaminatio
Assessment of Complete Coverage of Expanded Program on Immunization in Children at Mayo Hospital Lahore, Pakistan
Get PDFBackground: Goal of the expanded program on immunization (EPI) is to ensure full immunization of children under one year of age to globally eradicate poliomyelitis, tetanus, measles-related deaths and to extend all new vaccines and preventive health interventions to children in all parts of the world. Demographic and health survey 2012-13 showed that in Pakistan complete immunization coverage is very low (54%) to achieve this goal. The objective of this study was to assess any improvement in terms of vaccination coverage in Pakistan in the last 3-4 years.Material and Methods: This descriptive cross-sectional study was carried out at outpatient department of Pediatric Medicine of Mayo Hospital Lahore from May, 2016 till November, 2016. The non-probability purposive sampling technique was used to include patients after taking informed consent. Demographic details were collected and parents were questioned about different vaccinations received and confirmed through vaccination card. Data analysis was done through SPSS version 20 and results were presented as frequencies and percentages. Chi-square test was applied for association among categorical variables.Results: Complete coverage of expanded program on immunization was achieved in 86% children. A statistically significant difference was noted between mother’s education and immunization coverage of children (P-value 0.013).Conclusions: Education of mother and socioeconomic status were two significant factors affecting immunization coverage. In order to meet target of 95% immunization coverage rate set by WHO, more awareness should be created among people with low socioeconomic status along with improvement of immunization facilities in these areas.Key words: Children, Expanded Program on Immunization, Immunization Coverag
Combined Effect of Nicotine and Caffeine on Orthodontic Tooth Movement in Rats
Get PDFBackground: The individual effects of nicotine and caffeine have been reported in previous studies but their combined effect on tooth movement needs to be elucidated. The objective of this study was to evaluate the combined effect of nicotine and caffeine on the magnitude of orthodontic tooth movement (OTM) in rats.
Material and Methods: This experimental study was conducted on Sprague-Dawley rats (Animal House and Pathology Laboratory; Post Graduate Medical Institute, Lahore) in the department of Orthodontics, de’Montmorency College of Dentistry, Lahore from 8th July 2014 to 8th January 2015. Forty male Sprague-Dawley rats were divided into four equal groups: Control group (CR), nicotine group (NT), caffeine group (CF) and combined nicotine and caffeine group (CNC). Closed coil nickel titanium (NiTi) spring was placed between incisor and maxillary molar. Nicotine group (NT) was treated by intraperitoneal injections of nicotine. Caffeine was given to caffeine group and Combined nicotine and caffeine group (CNC) was treated in the same way as individual nicotine and caffeine groups daily for 14 days. All the rats were sacrificed on 15th day. Magnitude of the orthodontic tooth movement was measured using digital Vernier caliper. Means and standard deviation were calculated for orthodontic tooth movement. One-way ANOVA was used to determine the mean difference in OTM. Post hoc Tukey test was used for multiple comparisons among the groups.
Results: The mean orthodontic tooth movement (OTM) was 0.32 mm ± 0.05 in control group, 0.56 mm ± 0.04 in nicotine group, 0.52 mm ± 0.034 in caffeine group and 0.8 mm ± 0.06 in combined NC group, respectively. The difference between mean OTM among the groups was statistically significant (P-value <0.001). The mean OTM in CNC group was significantly higher as compared to other groups (CR, NT, CF, NT) (P-value <0.001).
Conclusions: In rats, the combined use of nicotine and caffeine results in greater orthodontic tooth movement as compared to their individual use.
Key words: Bone remodeling, Caffeine, Nicotine, Orthodontic tooth movemen
Thrombophilia and Pregnancy
Get PDFPregnancy is a state of hypercoagulation, most likely an adaptive mechanism, in order to reduce the risk of hemorrhage during and after the delivery. There are substantial changes in the haemostatic system during normal healthy pregnancy including rise in clotting factors I, VII, VIII, IX, and X, diminished protein S and fibrinolytic activity and resistance to activated protein C.¹ Reduced fibrinolytic activity is due to fivefold increase in PAI-1 (Plasminogen Activator Inhibitor type 1) levels.² In addition venous stasis increases during pregnancy as the lower-extremity veins dilate due to venous compression by the gravid uterus. Endothelial injury may also occur in antepartum or in postpartum period. The combination of these factors results in 4-5 times increased risk of venous thromboembolism (VTE) in the pregnant and postpartum patients.3 The prevalence of VTE in pregnancy is 0.8-2.0 per 1,000 pregnancies and accounts for 1.1 deaths per 100,000 pregnancies.4 The most important risk factor for women experiencing pregnancy-related VTE is prior personal history of VTE.5 The second most common risk factor is thrombophilia 6 7 Studies have shown that at least 20%, and possibly over 50%, of pregnant patients diagnosed with VTE have thrombophilia.8 There is a growing evidence that women with thrombophilia are also at risk of other vascular pregnancy complications, including recurrent fetal loss, pre‐eclampsia, stillbirths, abruption and intrauterine growth restriction
Teratogenic Effect of Sodium Phenytoin on Limb Development in Chick Embryos is Time-Mediated as Evident by Stereomicroscope
Get PDFBackground: Women suffering from seizure-related illnesses are prescribed phenytoin during pregnancy if the benefits outweigh the risks. But the teratogenic effect of this drug on limb development needs exploration. This study was designed to investigate the time-mediated teratogenic effect of sodium phenytoin on limb development of chick embryos on days 04 and 09 of development using the stereomicroscope and at the time of hatching. Material and Methods: This randomized control trial comprised of two main groups of fertilized chicken eggs (Egyptian Fayoumi breed), control group A and experimental group B, each having 90 eggs. Each experimental egg was injected with sodium phenytoin (3.5 mg, teratogenic dose) just before incubation. Both the groups were divided into three subgroups each A1, A2, & A3/B1, B2 & B3. Stereomicroscope was used to observe the limb buds and cartilaginous elements in subgroups 1 and 2 on days 04 and 09 of development respectively. The embryos of subgroups 3 were assessed for gross limb deformities on hatching. Survival was noted in all the subgroups.Results: The difference in limb bud size between experimental and controls was statistically insignificant. There was no variation or deformity in the bones. The experimental group 3 had gross limb defects on hatching and the difference in survival was also statistically significant in subgroups 3.Conclusion: Prenatal administration of sodium phenytoin induces limb defects in chick embryos as evident after hatching but limb anomalies are not observed on days 04 and 09 of development as investigated by stereomicroscope. We conclude that the teratogenic effect of phenytoin is time-mediated
Association of Serum PSA Levels with Histopathological Pattern of Prostate Lesions
Get PDFBackground: Pathological changes that mainly affect prostate gland are prostatitis, benign prostatic hyperplasia (BPH) and cancerous lesions. Digital rectal examination (DRE), Transrectal Ultrasonography (TUS), and prostate specific antigen (PSA) followed by histopathological examination, are routinely used tests for diagnosis of prostate lesions. The aim of the present study is to determine the role of serum PSA levels in differentially diagnosing the different types of prostate lesions.Material and Methods: This retrospective (observational) study was conducted in Ibn-e-Sina Hospital Multan. Data of 2189 patients who were operated from 2007 to 2017 due to prostatic lesions were included in this analysis. Patients with BPH, prostatitis, prostate carcinoma and Prostatic Intraepithelial Neoplasia (PIN) were grouped according to serum PSA levels (ranging from 0 to >100 ng/ml) into five groups. Frequencies and percentages were calculated for different histopathological findings. Association of PSA levels with different histological patterns was determined with chi-square test with P-value < 0.05 taken as significant difference.Results: Mean age of patients was 62.45+10.64 years. On histopathology, BPH was diagnosed in 1676 (76.56%) patients, prostatitis in 133 (6.07%), carcinoma in 378 (17.26%) and PIN in 02 (0.09%) patients, respectively. Serum PSA levels of 4.01-10 ng/ml were found in 1050 (62.64%) BPH patients and in 59 (44.36%) prostatitis patients. Serum PSA levels of 10.01-20 ng/ml were found in only 40 (2.4%) BPH patients, 47 (35.33%) prostatitis patients, 22 (5.82%) carcinoma patients and in 1 (50.0%) PIN patient. Serum PSA levels of 20.01-100 ng/ml were found in 32 (1.9%) BPH patients, 11 (8.27%) prostatitis patients, 302 (79.89%) carcinoma patients, and in 1 (50.0%) PIN patient. Serum PSA levels of >100 ng/ml were absent in patients with BPH and PIN, and present in 1 (0.75%) prostatitis and 54 (14.28%) carcinoma patients.Conclusion: Benign prostatic hyperplasia was the commonest lesion in our patients (76.56%) with serum PSA levels >10 ng/ml reported in all patients with prostate carcinoma and prostatic intraepithelial neoplasia (PIN) patients
Diagnostic Value of Immature-to-Total Neutrophil Ratio in Neonatal Sepsis
Get PDFBackground: Neonatal sepsis is the third most common reason of neonatal mortality in Pakistan. Blood culture, the gold standard test for diagnosis of neonatal sepsis, is time consuming. Therefore, rapid diagnostic tests with good specificity and sensitivity is needed for accurate and early diagnosis of this condition. The objective of this study was to determine the diagnostic value of abnormal (≥ 0.2) immature-to-total-neutrophil ratio in neonatal sepsis.Material and Methods: This cross-sectional study was carried out on 288 neonates, aged 0-28 days, admitted with suspected sepsis. Detailed history of the neonates was recorded including gender, age, birth weight, maternal age, gestational age and clinical features. Blood culture and Peripheral blood films were done in each case. Differential leucocyte counts, total Polymorphoneutrophil count (PMN), immature neutrophil count, mature neutrophil count and calculation of I/T ratio was carried out in the Pathology Department of PIMS, Islamabad. The study outcome was divided into three groups on the basis of positive or negative blood culture and I/T ratio as normal, probable sepsis and proven sepsis group. Data was analyzed by SPSS version 21.0. Diagnostic value of I/T ratio was determined in NS by calculating values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) by considering the blood culture as the gold standard test of NS.Results: The mean age and weight of the neonates at the time of admission was 1.1 (± 0.6) days and 2.51 (± 0.40) kg, respectively. About 60% of the neonates were males and 118(41%) neonates had I/T ratio of ≥ 0.2. On the basis of positive or negative blood culture and I/T ratio, 82 (28.5%) neonates were diagnosed as proven sepsis, 43 (14.9%) neonates had probable sepsis and remaining 163 (56.6%) neonates were declared as normal. Out of 82 neonates with positive blood cultures, 75 (91.5%) had I/T ratio ≥ 0.2, while 7 (8.5%) had I/T ratio ≤ 0.2. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of abnormal I/T ratio to diagnose neonatal sepsis was 91%, 79%, 64%, 96% and 83%, respectively.Conclusions: Due to substantially high diagnostic accuracy of I/T ratio ≥ 0.2, we recommend it as a useful, rapid and cost-effective tool in accurate diagnosis of neonatal sepsis
Synovial Lipomatosis; A Clinicopathological Study of a Rare Entity
Get PDFObjective: This study was conducted to analyse the clinicopathological and radiological features associated with Synovial lipomatosis.Patients and Methods: Cases diagnosed as Synovial lipomatosis from 2008 to 2018 were retrieved and clinical information and histology were reviewed.Results: Thirteen cases of Synovial lipomatosis were diagnosed between 2008 and 2018. Most common site was knee joint and mean age of presentation was 28.6. About 62% of subjects were males and mostly presented with joint pain and swelling. Two of the subjects had significant history of trauma and disease was bilateral in one of the cases. Microscopically, villous proliferation of synovium with infiltration of mature adipocytes was noted. Focal synovial hyperplasia and inflammatory infiltrate were other findings in some of the cases.Conclusion: Synovial lipomatosis should be considered in the differential diagnosis of joint pain and swelling and should be distinguished from Pigmented villonodular synovitis, Synovial haemangioma and intra-articular synovial lipoma (IASL) using radiological and histological features