Journal of Islamabad Medical & Dental College
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Patterns of Traumatic Brain Injuries in Patients Presenting at a Tertiary Care Unit
Get PDFObjective: The purpose of this study was to evaluate the distribution of traumatic brain injuries.Patients and Methods: Questionnaire based data was collected from an inpatient population of patients who presented to the Neurosurgical Unit of Ayub Teaching Hospital with traumatic brain injuries. CAT scan (Computerized Automated Tomography scan) was used as the imaging modality for preliminary diagnosis. The data was collected over a period of three years. Non-probability purposive sampling was used as the sampling technique. Patients of both sexes and all ages were included in the study.Results: Out of a total of 1938 patients, 1470 (75.9%) were males and 468 (24.1%) were females. Patients from 20 to 40 years’ age group (38.1%) represented the greatest number. Fall (52.6%) was found to be the most common external cause of Traumatic brain injury, followed by Road Traffic Accidents (34.1%). Most of the patients (42.4%) had a GCS score falling between 8 and 12. No lesion was found at the initial CAT scan in most of the patients (27.2%). Depressed Skull Fracture (21.4%) was the most common abnormal finding in initial imaging. Conservative (78.3%) treatment was provided to most of the patients keeping in view the appropriate management requirements. 97.8% of the patients were treated successfully.Conclusion: The quality of care at Neurosurgery Ayub Teaching Hospital was found to be up to the mark for traumatic brain injuries patients. However, the standard of care at Kashmir and Balakot needs to be re-evaluated
Leptin to Adiponectin ratio as Atherogenic Index in Ischemic Heart Disease Patients
Get PDFObjective: To determine plasma adiponectin and leptin levels in subjects with and without ischemic heart disease (IHD) and to find the correlation between leptin, adiponectin to the number of coronary vessels disease-using angiography.Patients and Methods: This is a cross-sectional study conducted Ziauddin University. 80 subjects were recruited who were undergoing angiography. Height, weight, Waist and hip circumference were measured. BMI and WHR were calculated accordingly. Venous blood was drawn to measure adiponectin and leptin using ELISA.Results: Leptin to adiponectin ratio (LA ratio) was significantly increased in three and two vessel disease compared with single vessel and non-significant groups.Conclusion: The study shows that adiponectin decreases and leptin increases in multivessel disease. LA ratio has been found to correlate well in two and more than two vessel disease
Commonly Occurring Bacteria in Diabetic Foot Infections and their Sensitivity to various Antibiotics
Get PDFBackground: Diabetic foot infections are a common cause of morbidity in type 1 & 2 Diabetes mellitus. The selection of appropriate empirical treatment is thus essential while treating such patients. The main objective of this study was to find out most prevalent bacteria and their sensitivity to various antibiotics in patients with diabetic foot infections.Material and Methods: This cross-sectional study was conducted in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2017 to December 2017. A total 118 patients were included through consecutive sampling technique. Samples were collected in the form of swab, pus or tissue material and were cultured on blood agar and microorganisms were identified using standard microbiological methods. Antimicrobial sensitivity was also checked. StatisticalPackage for Social Sciences (SPSS) version 22 was used to analyze data.Results: Out of 118 patients, 72% (n=85) were males while 28% (n=33) were females. Cultures of 105 patients were positive and most common organisms isolated were S. aureus (32.4%; n=34), E. coli (17.1%; n=18), P. aeruginosa (14.3%; n=15), Polymicrobials (14.3%; n=15) and K. pneumoniae (7.6%; n=8). Antibiotics to which organisms were most sensitive included Piperacillin/Tazobactam (69.5%; n=73), Imipenem (55.2%; n=58), Amikacin (43.8%; n=46), Vancomycin (40%; n=42) and Levofloxacin (38.1%; n=40).Conclusion: Most common organisms causing diabetic foot infections in our study were S. aureus, E. coli, P. aeruginosa, Polymicrobial and Klebsiella. Overall most sensitive antibiotics to these organisms included Piperacillin/Tazobactam, Imipenem,Amikacin, Vancomycin and Levofloxacin
Use of Pregabalin as a Pre-Medication for Post-Operative pain in patients undergoing Laparoscopic Cholecystectomy
Get PDFBackground: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain
Peutz-Jeghers Syndrome presenting as Intussusception in a young female: A Case Report
Get PDFPeutz-jeghers syndrome is rare condition with autosomal dominant inheritance. It is due to the mutation in a tumor suppressor gene SK 11 at chromosome no 9. It has a very characteristic presentation. Patient usually presents at a young age with intestinal obstruction due to polyps leading to intussusception. Also there is melanosis at perioral, digits and perineal regions. There is very strong association of cervical and breast carcinoma in females and testicular tumors in males. GIT, pancreatic and lung malignancies occur in both sexes. Regular follow up and screening are necessary for early detection of malignancies. We present a case of young girl who presented with intestinal obstruction along with other signs and symptoms of peutz-jeghers syndrome. Exploratory laparotomy revealed jejunoileal intussusception and hamartomatous polyps. Patient and other family members were advised screening studies of associated malignancies and regular follow up
Effectiveness of Tympanic Thermometry for diagnosing Acute Otitis Media
Get PDFBackground: Acute Otitis Media (AOM) is a common upper respiratory tract infection (URTI) in children and usually presents with fever and otalgia. AOM is characterized by congested tympanic membrane and possible increase in temperature, which might be picked up by infrared tympanic thermometry. The objective of this study was to compare the temperature difference of tympanic membrane of affected ear with the unaffected ear and axilla in unilateral acute otitis media, and compare it with the control group.Material and Methods: This case control study comprised of 200 cases of both genders, aged up to 5 years. They were divided into two groups; Group A included 100 clinically diagnosed cases of acute otitis media (AOM), who reported in the ENT Outpatient Department (OPD) and Group B included 100 controls who presented in General Filter Clinic with no ear complaints. Cases with chronic ear disease, ear discharge, and use of local drugs including ear drops, impacted ear wax, tragal tenderness and congenital malformations of the ear were excluded by taking a detailed history. Clinical examination including otoscopy by an expert was done before subjecting patients to axillary and tympanic thermometry measurements and data recording. Data was collected and tabulated using Microsoft Excel Worksheet and analyzed by SPSS 16. Qualitative data like gender were presented as percentage and ratio, while means and standard deviation were calculated for the quantitative data. Difference between the means of experimental and control groups were analyzed by independent sample t-test and P value of less than or equal to 0.05 was taken as significant.Results: This study included 100 cases of unilateral AOM and 100 normal controls without AOM. In patients with AOM, the mean temperature difference between the affected ear and axilla was 1.41ºF as compared to 0.075ºF in controls (p=0.026). While the mean temperature difference between the affected ear and other ear was 0.65ºF as compared to 0.19ºF in controls (p=0.069).Conclusion: In acute otitis media, the temperature of affected ear is significantly higher than axilla but was not significantly higher than the other ear. The finding may help establish thermometry as a diagnostic tool in clinics manned by doctors not competent to do otoscopy
Antibiotic Sensitivity Patterns of Uropathogens in Children: The Current Trend
Get PDFBackground: The emergence of antibiotic-resistant infections has led to increased health care costs and mortality among children. The purpose of this study was to determine the causative organisms responsible for urinary tract infection and their antibiotic sensitivity pattern among pediatric patients of Rawalpindi/Islamabad.
Material and Methods: This cross-sectional study was carried out from June 2014 to June 2015, in the Department of Microbiology, Army Medical College, Rawalpindi, affiliated with the Military Hospital, Rawalpindi. About 270 urine samples of children with UTI were analyzed through Analytical Profile Index (API) 20E and biochemical test strips system. Their antibiotic susceptibility was determined by using standard techniques. Data were assessed and analyzed by SPSS version 17.
Results: Most common uropathogen was Escherichia coli (61.48%), followed by Proteus (15.5), Klebsiella (12.3%), Pseudomonas (4.5%), Enterococcus (3.7%) and Enterobacter (2.5%). Gram-negative rods, were most sensitive to imipenem (100%), Gentamycin (86%) and Amikacin (78.3%). They were least sensitive to Ampicillin (4.2%) and Norfloxacin (5.5%). Gram-positive cocci showed highest sensitivity for Vancomycin (100%) while displayed relatively less sensitivity for Nitrofurantoin (61.2%) and Gentamycin (48.7%). Cephalosporins also showed increased resistance with only 14% of gram-negative rods showing sensitivity to Cefotaxime. These organisms were highly resistant to Penicillin, showing a sensitivity of only 12.4%.
Conclusion: Decreased sensitivity against penicillin and cephalosporins is seen in uropathogens causing UTI in children. High sensitivity towards Nitrofurantoin makes this drug an empirical treatment in UTI. Regular surveillance of the developing resistance in uropathogens due to inappropriate use of antibiotic is necessary to reduce complication in children with urinary tract infection
Efficacy of Microneedling with Dermaroller Alternating with CROSS Peeling with 30% TCA in Management of Acne Induced Scarring
Get PDFObjective: To study the effect of combination of two therapies i.e. Microneedling with Dermaroller alternating with Chemical Reconstruction Skin Scar (CROSS) peeling with 30% TCA in management of acne induced scarring.Patients and Methods: This experimental study was conducted in the department of Dermatology, Benazir Bhutto Hospital, Rawalpindi from March 2017 to December 2017. A total of 20 patients underwent microneedling with dermaroller at week=0 (baseline) and were subjected to CROSS peeling with 30% TCA on follow up after 2 weeks. Four sessions of each procedure were repeated at 2 weeks’ interval. Photographs were taken at baseline and 4 weeks after the end of therapy (week=18). The baseline and final photographs were assessed for acne scar grading as per Goodman and Baron qualitative scale by two dermatologists who were blinded to the whole study.Results: Out of 20 patients, 16 (80%) of the patients had grade IV acne scarring and 4 (20%) had grade III scarring at baseline (week=0). On assessment at 4 weeks after the end of therapy (week=18), 16 patients who were having grade IV acne 6 (37.5%) improved to grade III, and 10 (62.5%) improved to grade II. Out of 4 patients who were initially having grade III at week=0, all 4 (100%) improved to grade II by week=18. A Wilcoxon signed rank test showed highly significant improvement in the grading of scarring (z=-3.92, p=0.00008).Conclusion: The combination therapy of microneedling with dermaroller, alternating with CROSS peeling with 30% TCA was highly effective in treating all types of atrophic acne scarring
Appraisal of National Response to Chronic Hepatitis in Pakistan
Get PDFChronic hepatitis has emerged as a grave health crisis in Pakistan that is becoming increasingly difficult to control. The national response in the public and private sector is lacking realism, direction and strategy. The aim of the present review was to analyze the efforts directed towards elimination of this menace, outline the challenges and make pragmatic recommendations. We searched PubMed, Google Scholar and Google web search for relevant indexed literature in English using the Mesh terms ‘Chronic Hepatitis’, ‘Pakistan’, ‘Hepatitis B’, ‘Hepatitis C’, ‘Hepatitis prevention’, ‘National hepatitis control’, etc. Rigorous efforts to improve the capacity of the primary healthcare establishments are pivotal to contain further spread of hepatitis B and C infections. Combating quackery, regulating the use of medical sharps and making affordable hepatitis treatment accessible to the masses should be the principal focus of the government. Healthcare delivery units should be equipped to render complete coverage of essential quality hepatitis services in order to curb this menace
Comparative Efficacy and Safety of Low Dose versus High Dose Isotretinoin in Severe Acne Vulgaris Patients
Get PDFBackground: Oral isotretinoin is the recommended treatment for acne vulgaris, a skin disease especially common in teenagers and adolescents. This study was designed to compare the efficacy and safety of low dose with high dose isotretinoin in severe acne vulgaris patients.Material and Methods: This randomized controlled trial included 110 patients with a clinical diagnosis of acne vulgaris. They were divided into two groups. Both groups were matched for age (mean 18.2±3.7 vs 17.6±3.2 years), weight (mean 58±10.2 vs 60.7±9.3 Kg), gender and disease duration (3±1.1 vs 3±1.0 years). Group A received low dose oral isotretinoin (20 mg/day) while group B received standard high dose regimen (1mg/kg/day). All patients were followed up for 16 weeks to assess efficacy (assessment of complete remission) and safety (mucocutaneous side effects). All calculations were performed using SPSS v. 16 with p value <0.05 considered as statistically significant.Results: There was no statistically significant difference in efficacy. However, significantly fewer mucocutaneous side effects were reported in group A (80%) as compared to group B (100%). This safety profile spectrum was observed across all pre-defined subsets i.e chielitis (78.1% vs 98.2%), dry skin (69.1% vs 92.7%), dry mouth (47.2% vs 72.7%) and facial rash (12.7% vs 30.9%).Conclusion: In patients with severe acne vulgaris, efficacy (complete remission) of low dose oral isotretinoin is almost equal to conventional high dose regimen but it is statistically superior in terms of safety (mucocutaneous side effects)