Journal of Islamabad Medical & Dental College
Not a member yet
636 research outputs found
Sort by
Structural Violence and Pakistan’s Health Situation
Get PDFStructural violence was first defined by Johan Galtung as “A form of violence wherein some social structure or social institution may harm people by preventing them from meeting their basic needs”1 The concept has been studied extensively over the years and is considered as a major reason for strangled development in various resource limited settings around the world. The idea of structural violence implies that people in power fail to provide essential services for the people they are responsible for; this failure can be intentional or unintentional, nevertheless long-term effects influence the marginalized population adversely.
Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline
Get PDFBackground: N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis.
Material and Methods: A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied.
Results: The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant.
Conclusion: Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly
Frequency of Noise Induced Hearing Loss Among Traffic Wardens of Lahore
Get PDFBackground: Noise-induced hearing loss (NIHL) is a major cause of disability throughout the world. It is the most common irreversible job-related hazard in the world with a higher burden in the developing regions of the world. Certain occupations are at high risk for NIHL. Traffic wardens could be considered highly vulnerable group as they are exposed to long hours of traffic noise. The objective of this study was to determine the frequency of noise induced hearing loss among traffic wardens of Lahore city.Material and Methods: It was a cross-sectional, descriptive study, carried out from 1st December 2018 to 31st May 2019, in which 329 traffic wardens appointed in 34 beats/sectors of Lahore city were included. Data was collected through a structured questionnaire, followed by Pure Tone Audiometry (PTA) of all the subjects.Results: A total of 329 traffic wardens were selected for this study. Mean age of the traffic wardens was 35.35 ± 1.21 years. NIHL was present in 174 (52.9%) traffic wardens, out of which, 138 (79.3%) had mild, 32 (18.4%) moderate, and 4 (2.3%) had moderately severe degree of hearing loss. Among the 329 traffic wardens, 165 (50.2%) had exposure to noise between 7am to 3pm (morning shift) and 42 (12.8%) had some problem with their hearing. Only 12 (3.6%) had ringing in the ears or tinnitus, 140 (42.6%) wore any hearing protection during duty hours and 42 (12.8%) said they had difficulty in hearing and frequently asked people to repeat themselves.Conclusion: In this study a high frequency of noise induced hearing loss was reported among traffic wardens of Lahore city with most of them having mild to moderate degree of hearing loss
Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis
Get PDFObjective: To analyze treated head and neck malignancies with reference to frequency of cervical metastases and frequency of nodal recurrence following neck dissection and/ or radiotherapy for cervical metastases.Patients and Methods: This observational prospective study was conducted at ENT Department, Pakistan Institute of Medical Sciences, Islamabad over a period of 16 months. Study population was comprised of 15 cases of either gender and any age, with treated head and neck primary who developed metastatic neck disease and were included through non-probability sampling technique. Patients with primary site recurrence or distant metastases were excluded from the study. They were treated with neck dissection, radiotherapy or both for neck disease and followed up for a 1 year. Clinical data including age, gender, site and histopathology of treated primary tumor, nodal involvement both clinical and histopathological, treatment and post treatment result were recorded. Data was collected, tabulated and analyzed using Microsoft excel worksheet.Results: Out of total 15 cases, 17% patients were with N1 disease, 33% patients with N2a disease, and 50% were with N2b disease. Total 3 (20%) patients received radiotherapy (2 being unfit for surgery and 1 due to refused consent) and 12 (80%) patients underwent surgery. Out of these 12, 3 underwent RND, 7 MRND and 2 SND. Total 20% (3) developed recurrence.Conclusion: Combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in controlled primary tumors
Etiological Spectrum of Pregnancy-Related Acute Renal Failure among Females at a Tertiary Care Hospital
Get PDFBackground: Acute renal failure in pregnancy can be induced by any of the disorders leading to renal failure in the general population, such as acute tubular necrosis due to infection, glomerulonephritis related to lupus, or drug toxicity. There are, however, pregnancy complications characteristic of each trimester that can result in renal failure. The objective of this study was to determine the frequency of various causes of pregnancy-related acute renal failure among females presenting to a tertiary care hospital
Effect of Nigella Sativa on Oxidative Stress in Post-Menopausal Females
Get PDFBackground: The permanent cessation of menstrual periods in menopause causes a decline in estrogen levels and increased oxidative stress. Both of these factors lead to menopausal symptoms, cardiovascular diseases and osteoporosis in the postmenopausal females that negatively affect the quality of their lives. Antioxidant properties of Nigella sativa are due to its natural ingredient “thymoquinone” and have been studied in various animal and human studies. This study was done to determine beneficial effect of nigella sativa. Material and Methods: Thirty postmenopausal females were recruited in the study after taking consent. Nigella sativa was administered at a dose of 1g/day for 2 months after breakfast. Blood sample was taken for pre and post treatment glutathione (GSH) estimation. The SPSS version 21 was used to analyze the data. Paired t- test was applied. P value of< 0.05 was considered significant.Results: Regarding the effect of the Nigella sativa on oxidative stress, result indicated a highly significant increase from baseline (p<0.0001) after 8 weeks’ consumption of Nigella sativa. The effect size was calculated both for biochemical parameter GSH and general parameter like weight and BMI. The result of the effect size calculation showed larger effect size for GSH levels (3.9) and moderate sized effect for weight and BMI.Conclusion: Nigella Sativa showed beneficial antioxidant effects in post-menopausal females and might be responsible for a better quality of life in these women
Prevalence of Cerebrospinal Fluid Leak in Traumatic Head Injury at a Tertiary Care Center
Get PDFBackground: Cerebrospinal fluid circulates around the surface of brain and spinal cord and through the brain’s ventricles. CSF leak is a condition that occurs when the CSF leaks through a defect in the dura or skull and out through the ear or nose. The most common causes of CSF leak include head injury, brain and sinus surgery. The objective of this study was to determine the frequencies of post-traumatic cerebrospinal fluid leak in traumatic head injury.
Material and Methods: A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar for a period of 1 year, from 1st February 2016 to 31st January 2017. A total of 422 patients presenting within 48 hours of acute trauma to the head were included in a consecutive manner and followed up till 7th day to determine the CSF leak.
Results: The mean age group of our sample was 37.37 + 12.3 years of which 79.6% were male patients and 20.4% female patients. Most of the patients (55.5%) were ≤ 40 years of age. CSF leak was observed in 5.2% of patients, with otorrhea seen in 2.1% patients and rhinorrhea in 3.1% patients, respectively.
Conclusion: CSF leak is quite common in our population after acute trauma to the head. The high prevalence may be due to high frequency of accidents in our society with high velocity impact and more commonly seen in the younger age group (≤ 40 years)
Marsupialization Followed by Enucleation and Chemical Cauterization for Treatment of Odontogenic Keratocyst Involving Maxillary Sinus: A Case Report
Get PDFOdontogenic keratocysts are odontogenic cysts which have locally infiltrative behavior. They mostly occur in second and fourth decades but can occur at any age throughout life. In majority of cases, they are located in the posterior region of mandible, but can also be found in the maxilla especially in the canine region. In this article, we have discussed the diagnosis and management of a large odontogenic keratocyst cyst involving the maxillary sinus. A 22 years old male patient presented with pain and swelling on right side of the face since last one year. There was history of pus discharge and gradual increase in size of the swelling since last 3-4 months. Patient took antibiotics but there was no improvement. Odontogenic keratocyst is a developmental pathology which arises from additional remnants of dental lamina of oral epithelium. They present with swelling, pain and pus formation/discharge as signs of infection. Often, when the lesion is large there can be paresthesia of the lower lip. These lesions can also be clinically asymptomatic. Mostly they appear as well-demarcated unilocular radiolucency having a thin, sclerotic well-defined margin. There are many treatment options like enucleation, marsupialization, decompression, curettage, use of chemical agents like Carnoy's solution, cryotherapy with liquid nitrogen or peripheral osteotomy and surgical resection of lesion
Comparison of Ranson’s Score, BISAP, and CTSI in Predicting the Severity of Acute Pancreatitis
Get PDFObjective: To use of Ranson’s, BISAP and CTSI scoring system in predicting the severity and outcomes of patients with acute pancreatitis.Patients and Methods: One hundred and six (106) patients of acute pancreatitis were studied prospectively. Data of patient’s baseline demographics, clinical and radiological investigation was collected. BISAP score was calculated by obtaining data within 24 hours of admission, while Ranson score was calculated at the time of admission and at 48 hours of admission. CTSI was based on findings from CT scan of selected patients. Severity of acute pancreatitis was defined in terms of ICU admission, development of associated complications and mortality.ResultsOut of 106 patients, 55.7% were females and 44.3% were male patients. Regarding complications of Acute Pancreatitis, 9 (8.5%) patients were admitted in ICU, complications occurred in 33 (31.1%) patients while mortality occurred in 9 (8.5%) patients. Out of 106 patients 11 patients had Ransons score greater than 3. 04(36.4%) patients required ICU admission, 07(63.6%) patients developed complications and mortality of 5(45.5%) patients occurred. Patients with Bisap score greater 03, 6 (26%) patients required ICU admission, 17 (74%) developed complications and mortality of 8(34.7%) patients occurred. 24 patients underwent CECT abdomen and 4 patients had modified CTSI score of 8 to 10 (severe AP) out of which 4(100%) patients required ICU admission, 4(100%) patients developed complications and mortality occurred in 4(100%) patients. Conclusion: BISAP score is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for intensive care during the course of their illness and therefore need early resuscitation; especially in resource-limited developing countries