Journal of Islamabad Medical & Dental College
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C - Reactive Protein as A Predictor of Sepsis in Children Up to 5 Years of Age
Get PDFObjective: To determine frequency of raised CRP levels in children clinically diagnosed to have sepsis. Patients and Methods: In this cross-sectional study, a total of 91 children up to 5-year age, clinically diagnosed as having sepsis, were enrolled and were screened for a raised CRP level. The outcome of the study was recorded as the frequency of raised CRP level in children clinically suspected of having sepsis. Results: The results of the study showed that 95.6% (87/91) of our patients had a raised CRP level. Conclusion: CRP can be used as an early sensitive tool for diagnosis of bacterial sepsis
Precipitants of Acute Decompensated Heart Failure and their Correlation with the Severity of Decompensation in a Resource Poor Country
Get PDFObjective: 1. To determine the frequency of various factors (patient related, disease related and physician related), causing immediate precipitation of congestive cardiac failure in a tertiary care hospital. 2. To establish correlation between these variables and severity of decompensated heart failure. Patients and Methods: This cross-sectional study was carried out over a period of March-August, 2016. All patients admitted to cardiology ward and Coronary Care Unit (CCU) of Pakistan Institute of Medical Sciences during the study period were enrolled in the study using consecutive sampling technique. An arbitrarily predetermined sample size of 115 patients was taken. Precipitants were classified as patient related, disease related and physician related. Data was recorded and analyzed using SPSS version 22. Qualitative variables were reported as percentages and quantitative variables by using mean ± standard deviation. Spearman correlation coefficient was used to determine the correlation between variables and outcome measures. Results: A total of 115 patients were enrolled in this study. The mean age of the population was 51.13±13.6 years. Among these 38.3% of the population was obese. The patients remained admitted to the hospital for the index episode of decompensation for a mean period of 4.14±1.2 days. Infections were found to be the leading precipitant contributing to 57.6% of all decompensation episodes. This was followed by drug non-compliance (17.4%) and arrhythmias (8.7%). Ischemia was noted in 5.2%. Heart failure severity at presentation was found to correlate significantly with the presence of hypertension (Spearman coefficient 0.62, p-value 0.04), baseline hemoglobin (Spearman coefficient -0.58, p-value 0.03), creatinine levels (Spearman coefficient 0.71, p-value 0.05) and precipitant of heart failure (Spearman coefficient 0.257, p-value 0.007). Conclusion: A sizeable majority of heart failure hospitalizations can be prevented by inculcating measures directed at effective infection control at community and health care level and educating patients regarding recognition of early signs of infection that may target the most important immediate precipitant for acute decompensated heart failure.  
Inhibitory Effect of Sodium Cromoglycate on Insulin Induced Airway Hyper-Reactivity
Get PDFObjective: To explore the acute effect of insulin on airway reactivity of guinea pigs and protective effects of sodium cromoglycate against insulin induced airway hyper-reactivity on isolated tracheal tissues of guinea pigs in vitro. Subjects and Methods: Effects of insulin (10-7- 10-3 M) and insulin pretreated with sodium cromoglycate (10-6 M) were observed on isolated tracheal strip of guinea pig (n=12) in vitro by constructing cumulative concentration response curves. The tracheal smooth muscle contractions were recorded with Transducer on Four Channel Oscillograph. Results: Insulin produced a concentration dependent reversible contraction of isolated tracheal muscle of guinea pig. The mean ± SEM of maximum amplitudes of contraction with insulin and insulin pretreated with sodium cromoglycate were 35 ± 1.13 mm and 14.55 ± 0.62 mm respectively. Cromoglycate shifted the concentration response curve of insulin to the right and downwards. Conclusion: Sodium cromoglycate significantly reduced the insulin mediated airway hyper-reactivity in guinea pigs. So we suggest that pretreatment of inhaled insulin with cromoglycate may have clinical implication in amelioration of its potential respiratory adverse effects such as bronchoconstriction
Metallo-βeta-Lactamase Detection Comparative Evaluation of Double-Disk Synergy versus Combined Disk Tests
Get PDFObjective: To establish (i) if carbapenemases are a major cause of carbapenem resistance in Enterobacteriaceae and belong to metallo- β-lactamases (ii) Which one is the best phenotypic method for the detection of metallo- β-lactamases. Patients and Methods: This cross-sectional study was conducted at pathology department, Punjab Institute of Cardiology Lahore. Samples were randomly enrolled from daily lab work and analysed. During the period of September 2016 to January 2017, a total of 2970 clinical samples were enrolled and processed for bacterial culture. Every isolate of Enterobacteriaceae was processed for detection of carbapenem resistance and for the detection of carbapenemases producers by modified Hodge test. Metallo- β-lactamases detection (MBL) was done by three different phenotypic techniques, (i) Combined disk technique (0.1 M EDTA), (ii) (0.5 M EDTA). (iii) Double disk synergy technique (DSST). Results: Out of total n=2970 samples, 38.7% (n=1150) were culture positive of which 40.5% (n=550) were Enterobacteriaceae. Among these, 9.0 % (n=50) were carbapenem-resistant; 98% (49/50) were carbapenemase producers (modified Hodge test -Positive). According to (i) Combined disk technique (0.1 M EDTA), 98% (48/49) were metallo- β-lactamases positive (ii) Combined disk technique (0.5 M EDTA), 86% (42/49) were metallo- β-lactamases, 2% (1/49) were non-determinable (iii) Double disk synergy technique (DDST) showed 100% (49/49) isolates were metallo- β-lactamases positive. Chloramphenicol and Tigecycline were found sensitive in 28% and 16% respectively; all other antimicrobials were highly resistant against carbapenem-resistant isolates. Conclusion: Carbapenemases are a major cause of carbapenem resistance in Enterobacteriaceae. Double-disk synergy technique is good for the detection of MBL as compared to other phenotypic methods. Each carbapenemresistant isolate of Enterobacteriaceae should be process for the detection of Carbapenemase especially MBL
Role of Surgical Feeding Gastrostomy in Patients Requiring Prolonged Nutrition in a Neurosurgical Department
Get PDFObjective: To build up the nutritional status of the neurosurgical patients with an easy and practical way. Patients and Methods: This prospective study was conducted in Neurosurgery department of Pakistan Institute of Medical Sciences Islamabad in a six months’ time. In total thirty adult patients of either gender with H/O road traffic accident with severe head injury and GCS less than 8/15, persistent vegetative state, brain tumor patients who had developed lower cranial nerve palsies were included in the study. 28 for two way Foleys catheter was used in feeding gastrostomy. Results: Thirty patients, with the median age of 35 years (range, 18-55 years) underwent feeding gastrostomy. Before the gastrostomy tube insertion, 18 patients had enteral nutrition by a nasogastric tube and 10 had parenteral nutrition (PN), with a median duration of 14.5 (range, 4-60) and 12 (range, 7-25) days, respectively. Two patients accidentally pulled out the gastrostomy tubes 10 and 11 days after insertion. Buried bumper syndrome developed in 1 patient. Two patients died 8 and 34 days after the procedure in the neurosurgical ICU. Twenty-eight patients were discharged from the hospital while being fed via the gastrostomy tubes. In 11 patients who were able to resume oral feeding, the tube was removed, with a median interval of 62 (range, 25-150) days. There was no Procedure-related mortality. Conclusion: An improvised method of nutritional support according to our circumstances. This study can be extended to other surgical and medical patients who need nutritional support for longer period of time. 
Combined Effect of Alpha Tocopherol and Ascorbic acid on Body Weight of Rats Exposed to Chronic Restraint Stress
Get PDFObjective: This study was planned to determine the combined effect of ascorbic acid and alpha tocopherol on body weight of Sprague Dawley rats exposed to chronic restraint stress. Materials and Methods: The study was conducted in National Institute of Health (NIH), Islamabad. Ninety male Sprague Dawley rats (mean wt 250 ± 50 grams) were used and divided into 3 groups. Each group comprised of 30 rats. Group I was taken as control. Group II was exposed to chronic stress, whereas Group III was given combined doses of ascorbic acid and alpha tocopherol prior to restraint stress. Results: The comparison of weight gain by the different groups revealed that there was a significant decrease in weight gain of rats exposed to the chronic stress as compared to control group. Combined supplementation with ascorbic acid and alpha tocopherol resulted in significant improvement of their eating habits. Conclusion: Chronic stress has a detrimental effect on weight. This effect can be minimized by the intake of sufficient amount of antioxidants. 
Comparison of Effectiveness of Topical Versus Oral Nifedipine for Treatment of Chronic Anal Fissure
Get PDFObjective: To compare the effectiveness of topical and oral Nifedipine in the treatment of chronic anal fissure.Patients and Methods: In this randomized control trial total of 124 patients with chronic anal fissure (CAF) were selected through OPD and divided randomly into two equal groups. In Group A the topical Nifedipine (2%) was applied, while in Group B the oral Nifedipine 10mg TDS was used. Both groups were compared in terms of pain and healing measured one month after starting treatment.Results: Mean age of the patients was 38.81±11.81 years. In both groups there was statistically significant difference for the age but no difference was found regarding gender and baseline visual analogue scale. Group A had better healing rate and pain relieve as compared to Group B. There was no difference between groups regarding the effectiveness of treatment.Conclusion: The topical Nifedipine has better healing effects as compared to the oral Nifedipine. The oral form is better in relieving pain after one month of treatment. There was no difference between oral and topical form in terms of overall effectiveness
Leucodepletion in Thalassaemia Major Patients in Pakistan
Get PDFThalassaemia is a blood disorder in which an abnormal form of haemoglobin is made due to genetic aberration. Although no national database exists to calculate the exact number of thalassaemics, but it is estimated that there are 9.8 million carriers of the disease in Pakistan [1]. Consanguineous marriage is the leading cause for this high prevalence rate due to which the thalassaemia gene is trapped within the affected families. These patients are dependent on regular blood transfusions to sustain life in addition to expensive chelation therapy and other medical management. As a result, thalassaemia is a major healthcare challenge and places great psychological and financial trauma on the affected families and is a huge burden on the national healthcare delivery system [2]
Effect of Aloevera Whole Leaf Extract in Combination with Rosiglitazone on Oxidative Stress and Lipid Profile Levels in Type-2 Diabetic Rats
Get PDFObjective: To measure the synergistic effects of Aloevera and Rosiglitazone on plasma glucose, oxidative stress and lipid profile in Type-2 Diabetic Sprague-Dawley rats.Subjects and Methods: A Randomized control trail was carried out in Physiology department of Army Medical College, Rawalpindi. Twenty healthy rats were made diabetic according to Srinivasan model. After confirmation of type 2 Diabetes, they were randomly segregated into two equal groups. Groups were named as diabetic control group and Diabetic treatment group. Control group was injected normal saline and treatment group was given 150 mg/kg body weight of Aloevera extract and 2.5mg/kg body weight of rosiglitazone. It was half of the effective doses which were calculated through pilot study.Results: Plasma glucose, Malondialdehyde and lipid profile were significantly reduced (p<0.000) in diabetic treatment group as compared to diabetic control group.Conclusion: A significant reduction in plasma glucose, oxidative stress and lipid profile was obtained in diabetic treatment group although half of the effective doses were used. It would also be help in reducing side effects associated with use of rosiglitazone
Comparison of Use of Intralesional Artemether with Intralesional Meglumine Antimoniate in Cutaneous Leishmaniasis
Get PDFObjective: The objective of this study is to compare the efficacy and safety of Intralesional Meglumine Antimoniate and Intralesional Artemether in the Treatment of Cutaneous Leishmaniasis.Patients and Methods: Total 168 patients of cutaneous leishmaniasis were assigned randomly and equally to intralesional meglumine antimoniate (group A) and intralesional artemether (group B). The study outcome was measured after 6 weeks of therapy and treatment was considered efficacious if the lesion reduced more than 75% from its baseline size. The side effects in terms of pain, redness and swelling at the site of injection, fever, hepatitis and renal impairment were also noted.Results: Intralesional meglumine antimoniate achieved complete healing in 75 (89.3%) cases compared to 62 (73.8%) cases in intralesional artemether (p= 0.01).Conclusion: Intralesional meglumine antimoniate is better than intralesional artemether in the treatment of cutaneous leishmaniasis. Both drugs were found safe and no significant side effects were noted