Journal of Islamabad Medical & Dental College
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Frequency of Surgical Site Infection in Response to Single Dose Antibiotic Prophylaxis in Lumbar Intervertebral Disc Excision
Get PDFObjective: To measure the frequency of infection with single dose antibiotic prophylaxis in surgery for intervertebral disc prolapse.Patients and Methods: This cross-sectional study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad for ten months. In total 400 patients both male and female, undergoing surgery for lumbar disc herniation (single level lumbar intervertebral disc), meeting inclusion criteria, were selected for the study. Postoperative frequency of surgical site infection was measured using redness, pain, raised local temperature and wound discharge as diagnostic criteria. Postoperative surgical site infection was measured using the above criteria scale on 3rd postoperative day and 15th postoperative day. The frequency of infection in the studied patients on day 3 and day 15 was calculated. P-value of <0.05 5 was considered as statistically significant.Results: Out of total 400 patients, 290 were males and 110 were females, the age distribution was from 24 to 70 years. Mean age was 48.2± 10.8 SD. ESR for the patients ranged from 2 to 36 with a mean of 11±4.6. White cell count of the patients ranged from 2900 to 20100 with a mean of 7342±2100. Only 7 patients (1.7%) developed infection on third day of surgery and it persisted in only 4 patients (1%) till day 15 of surgery.Conclusion: Single dose preoperative antibiotic is effective in postoperative wound infection prophylaxis. This protocol if followed can prevent drug resistance and multiple doses related side effects and can cut hospital cost
Comparison of Septoplasty with and without Nasal Packing: Its Association with Post-Operative Nasal Adhesion Formation
Get PDFObjective: To compare the septoplasty with and without nasal packing in patients having deviated nasal septum in terms of frequency of post-operative nasal adhesion.Patients and Methods: In this randomized control trial, total 180 patients of deviated nasal septum (DNS) associated with persistent nasal obstruction, breathing difficulty, sinonasal infections were enrolled and admitted in the department of ENT, Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad. Patients were randomly divided into “Group A” (Septoplasty with nasal packing) and “Group B” (septoplasty without nasal packing) by lottery method. Demographic data was recorded. Septoplasty was performed under general anaesthesia. Nasal splints were applied at the end of procedure. Packing was removed postoperatively from „Group A‟ patients after 24 hours. Development of post-operative nasal adhesion was calculated superlatively for both the groups. Data was recorded and analysis was done using SPSS version 19. Chi square test was used to compare the two groups. P value < 0.05 was taken as significant.Results: Our study comprised 180 patients which were divided into 2 groups equally (n=90 each). Patient‟s age ranged from 17– 45 years. Mean age was 22.77±6.038. Male to female ratio was 2:1. Total males were 125 (69.4%) and females were 55 (30.6%). In “Group A” 64 (71.1%) were male and 26 (28.9%) were female while in “Group B” 61 (67.8 %) were male and 29 (32.2%) were females. Septoplasty was done in all 180 patients out of which 125 (64 in Group A and 61 in Group B) were male whereas 55 (26 in Group A and 29 in Group B) were female. Nasal adhesion was seen in 13 (14.44%) patients of group A, while 3 (3.33%) patients of group B developed the same. P value was 0.005 which is statistically significant.Conclusion: Septoplasty with nasal packing has more chances to develop nasal adhesion as compared to septoplasty done without packing
Spectrum of Mutations of Beta Thalassemia
Get PDFObjective: To identify gene mutations known to cause thalassemia major and intermedia amongst patients coming to thalassemia Centre of Pakistan Institute of Medical Sciences(PIMS). Patients and Methods: Hundred transfusion dependent thalassemia patients were recruited from PIMS. Genome DNA was isolated by using phenol-chloroform method. Allele specific PCR was performed by using primers specific for twelve known disease causing mutations, prevalent in Pakistan. The PCR product was run on 6% polyacrylamide gel electrophoresis and visualized by silver staining technique. Results were recorded and data were entered and analyzed using SPSS version 16. Results: Total Number of patients included in the study was 100, among them 46% were males and 54% were females. Parenteral consanguinity was seen in 95% cases. Most common homozygous mutations were Fr 8-9 [23(28.7%)], followed by IVSI-5 [17(21.3%)] cases. Compound heterozygous mutations were seen in 20% cases, among them the most common was Fr 8-9/IVS1-5 (5/20 cases), and Fr 8-9/del 619 (3/20 cases). Analysis of type of mutation in different ethnic groups showed that Fr 8-9 was the most common mutation in Punjabis and Pathans seen in 14/63 and 6/28 cases respectively, followed by IVS1-5 seen in 11/63 and 5/28 cases respectively. The most common mutation in Thalassemia major was Fr 8-9 seen in 22 (25%) cases followed by IVS1-5 seen in 15 (17%) cases and Fr 41-42 seen in 10 (11.4%) cases. The number of patients of Thalassemia Intermedia was low in this study (n=12), however among these the commonest mutations were Cap +1, Fr 8-9, IVS1-5 and del 619, presenting as homozygous or compound heterozygous mutations. Conclusion: Molecular characterization of Thalassemia major and intermedia patients is very essential so that we can set trigger of hemoglobin level accordingly before putting them on regular transfusion. Less frequent transfusion, iron chelation and HU therapy will significantly reduce serum ferritin, liver and spleen size of this group of patients and thus significantly improve their quality of life. 
Estimation of Serum Ferritin Level to Detect Iron Deficiency Anemia in Children less than 5 Years of age
Get PDFObjective: To evaluate serum ferritin levels in children less than five years as screening measure for iron deficiency anemia (IDA). Subjects and Methods: A cross-sectional study was conducted at Benazir Bhutto Hospital Rawalpindi from 1st March 2010 to 31st Jan 2011. A simple random sampling technique was adopted for study proceedings. Fifty children of less than five (5) years of age were enrolled in the study. The study population included children, aged less than five presenting at pediatrics outpatient department. The children with known hematological abnormality, infection, inflammation were excluded from the study. Blood complete picture for hemoglobin and serum ferritin level estimation were the diagnostic tools used and correlated afterwards. Data were collected and entered in Statistical Package for Social Sciences (SPSS, version 16) for analysis. Descriptive statistics were calculated. Chi-square test was applied for evaluation and calculation of significance in each of the characteristics of the population at P ≤ 0.05. Results: A total of 50 children with age range of 3-60 months, were recruited for the study. The study population was categorized into three groups; Infants (3-12 months), Toddlers (13-23 months) and Preschool-age (24-60 months) groups. The mean hematocrit of the study population was 33.5 (2.8%) and the mean serum ferritin level was 52.4 ng/ml with a range value of 0.2-353.0 ng/ml. Thirty-eight (38) patients of the study population were iron-deficient, with serum ferritin levels of less than 12 ng/ml. Conclusion: Serum ferritin level is a good screening test for detection of iron deficiency in children Key words: Children less than five years, Iron deficiency anemia, Serum ferritin levels
Bactiguard, A Useful Tool to Reduce Urinary Tract Infection in Patients Requiring Indwelling Urinary Catheter
No full textObjective: Urinary tract infection is one of the most common types of catheter associated hospital acquired infection. A lot of efforts are being done to reduce catheter-associated infection. Now a day’s catheters are being coated with noble alloys like silver, gold and palladium. This catheter prevents the sticking of bacteria and reduces the chances of infection. Patients and Methods: This cross-sectional study was carried out at District Head Quarter Hospital Rawalpindi Neurosurgery Department for a period of 1 year from 1st March 2015 to 31st March 2016. A total of 30 patients of either sex were included in the study. Urine routine examination and urine culture was performed at the start of the study. Bactigaurd catheter was inserted under aseptic measures. After fourteen days of insertion catheter was removed and tip of the catheter was sent for urine culture and sensitivity. Frequency of Urinary Tract Infection was calculated based on the clinical features and urine culture and sensitivity report. Results A total of 30 patients were included in the study, among them 17 (56.66%) were males and 13 (43.33%) were females. Patient’s age ranged between 7-65 years with mean age of 37 years. Out of 30 patients, four patients (13.33%) had urinary tract infection. Conclusion: With use of Bactiguard catheter, the frequency of urinary tract infection was 13.33%. It is thus concluded that Bactiguard catheter should be used in patients requiring indwelling catheter to drain the urinary bladder. 
Diastematomyelia due to Spinal intradural Extramedullary Teratoma in an Adult
Get PDFTeratomas are rarely found in the Central Nervous System and are approximately 2% of all other Teratomas. Spinal Teratomas are extremely rare as compared to the teratomas that are found intracranially and are almost 0.1–0.5% of all tumors of spinal cord. These tumors are even more infrequent in adults. Diastematomyelia, also known as split cord malformation causes complete or incomplete sagittal division of the neural axis and duplicates it. This condition is mostly accompanied by various malformations and in rare cases it is associated with intradural spinal teratoma. We report a case of 39 years old male who presented with complaints of severe pain in the left leg and weakness with power 2/5 in left leg and urinary obstruction. On evaluation, he was diagnosed as having Diastematomyelia due to Spinal intradural Extramedullary Teratoma
Emphysematous Cystitis along with Emphysematous Pyelonephritis in Type II Diabetes: A Case Report
Get PDFEmphysematous urinary tract infections (UTIs) are infections of the lower or upper urinary tract associated with gas formation. They may manifest as cystitis, pyelitis, or pyelonephritis. Diabetes mellitus is a major risk factor for these infections. The diagnosis of gas-forming UTI is usually made by plain films of the abdomen and/or computed tomography (CT). Escherichia coli and Klebsiella pneumonia are the predominant etiologic organisms. We present a rare case of emphysematous cystitis along with emphysematous pyelonephritis in a patient with poorly controlled diabetes. This patient underwent nephrectomy and 500 ml of puss was drained before nephrectomy. Puss C/S showed growth of Escherichia coli which was sensitive to pipercillin/tazobactam. We conclude that all female diabetic patients more than 60 years of age presenting with urinary symptoms, abdominal pain, fever and evidence of UTI on urine routine examination should have at-least an ultrasound abdomen and kidney ureter bladder (KUB) done and if presence of air is suspected, these patients should get CT scan KUB done so that diagnosis of emphysematous UTI be made and managed accordingly
Frequency of Feeding Problems in Children with Cerebral Palsy
Get PDFObjective: To determine the frequency of feeding problems in children with cerebral palsy. Patients and Methods: This cross-sectional study was conducted at developmental department of Children Hospital Lahore. Total 30 children with cerebral palsy were evaluated. The objective was to see the frequency of feeding problems in children suffering from cerebral palsy with age ranges between 1-9 years. A Performa was used for each patient, which was filled on the basis of history and clinical observation. Feeding skill assessment was based on Gisel and Patrick’s feeding behavior skill score. Score of 4 or less was regarded as normal, score of 5-8 was defined as marginal problem & score of 9 or more was regarded as inadequate feeding skills. All the collected data was entered in SPSS (statistical package for social sciences) for analysis. Results: Out of total 30 patients, maximum (60%) were between 1-3 years of age. Feeding skill score was normal in 50% children. About 20% had marginal feeding skills and 30% inadequate feeding skills. Regarding frequency distribution of feeding problems due to oral motor dysfunction, drooling of saliva was most common complaint (66.7%) followed by absent tongue lateralization (63.3%) an hypertonic tongue (60%). The most common complication that was found due to feeding problems was recurrent chest infection (53.3%). Conclusion: The present study concludes that in children with Cerebral Palsy, feeding problems due to oral motor dysfunctions are common and feeding problems produce different complications in these children
Acute Appendicitis: Relationship of Total Leucocyte Count with Per-Operative Stage
Get PDFObjective: To correlate total leucocyte count(TLC) with per-operative stage of acute appendicitis. Patients and Methods: This cross sectional study was conducted in department of surgery, Pakistan Institute of Medical Sciences (PIMS) from June 2016 to June 2017. A total 77 patients were included through consecutive sampling technique. Statistical Package for Social Sciences (SPSS) version 20 was used to analyze data. Results: A total of 77 patients were included in the study, among them 47 (61%) were males, and 30(39%) were females. Mean age was 22.25 ± 5.19 years. Mean TLC was 12,900 ± 4087 cells/µL Patients having acute appendicitis were labeled as, acute appendicitis stage I which included 59 (76.6%) patients, Gangrenous appendicitis was named as stage II which included 11 (14.3%) patients. Perforated appendicitis was labeled as Stage III in which 7 (9.1%) patients were inducted. In stage I, mean age was 21.89 ± 5.50 years and mean TLC was 12,344 ± 4162 cells/µl. In stage II, mean age was 22.36 ± 3.90 years and mean of total leukocyte count was 15,072 ± 3497 cells/µl. In stage III, mean age was 25.57 ± 3.50 years and mean leukocyte count was 14,214 ± 4141cells/µl (p-value >0.05). Conclusion: Significant statistical association was not found in patients in different stages of appendicitis with respect to TLC (p value >0.05), although patients in all stages had raised mean TLC with mean TLC highest in patients having stage II (Gangrenous appendicitis)
Lingual Thyroid Presenting as an Asymptomatic Pedunculated Oropharyngeal Mass
Get PDFLingual Thyroid is a rare developmental anomaly and constitute 90% of ectopic thyroids, first described by Hickman in 1869. Lingual Thyroid are usually symptomatic and commonly cause dysphagia and dyspnea and are rarely asymptomatic. They are usually seen arising from the tongue base in the midline. We report a very rare case of Lingual Thyroid in a 38-year-female presenting as an asymptomatic pedunculated mass in the oropharynx arising from the tongue base from the left side. The occurrence of Lingual Thyroid as a pedunculated virtually asymptomatic mass is very rare and literature search did not reveal a case of pedunculated Lingual Thyroid in this region. This case report highlights that Lingual Thyroid very rarely can present with pedunculated superficial mass and should be considered in the differential diagnosis of oropharyngeal masses