Journal of Islamabad Medical & Dental College
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Vascular Preoperative Venous Mapping Decreases the Frequency of Negative Exploration in Arteriovenous Fistula Creation
Get PDFObjective: To assess the impact of preoperative venous mapping on the incidence of negative exploration for arteriovenous fistula (AVF) in patients requiring hemodialysis. Patients and Methods: This case control study was conducted in Department of Vascular Surgery Combined Military Hospital Lahore and Peshawar, from January 2016 to June 2016. A total of 200 consecutive patients fulfilling the inclusion criteria were divided into Case (with preoperative mapping) and Control (without mapping) groups. Negative exploration rate along with fistula maturation rates were recorded and compared. Results: In Control group 24% patients had negative exploration when compared with 0% in Case group (p-value 0.000). In Case group, 16 % patients had change in type and site of AVF based on the results of venous mapping hence bringing down the negative exploration rate to zero in this group. Conclusion: Routine preoperative venous mapping decreases negative exploration in AVF creation and is helpful in deciding the best site and type of AVF
Effects of Therapeutic Ultrasound and Manual Physiotherapy in Shoulder Impingement Syndrome in Volleyball Players
Get PDFObjective: To look into the effectiveness of ultrasound therapy in addition to physical therapy and exercises on relief of pain, increase in the range of movements and improvement in muscle power in patients of Shoulder Impingement Syndrome (SIS). Patients and Methods: A total of 30 patients, aged 18-30 years, of SIS were randomly selected amongst volley ball players. They were divided by convenient sampling into two groups of 15 patients each: therapeutic ultrasound manual physiotherapy & exercise treatment (TUMPET) Group and manual physiotherapy exercise treatment (MPET) Group; the latter served as the control group. Both group were tested twice once before the start of treatment and once after completion of treatment. Results: The measurement of shoulder Rang of Movement and muscle power show significant results in both control and treatment groups at the end of 14th week’s treatment period. In control group (Group MPET) the range of motion degree scale has improved from 135.53±10.88 to 136.67±9.94 P-value 0.000 and muscle strength grades has improved from 3.33±0.49 to 4.00±0.000. In the interventional group (Group TUMPET) the range of motion degree scale has improved from 134.00±6.80 to 164.33±8.42 P-value 0.000 and muscle strength grades has improved from 3.47±0.52 to 5.60±0.50 P-value 0.000. Conclusion: Those individuals who received ultrasound treatment along with manual and exercises therapy showed significant improvement at fourteen weeks’ treatment
Cystic Hygroma with Difficult Airway in an Adult
No full textCystic hygroma (CH) is an uncommon benign lesion usually occurring in the cervicofacial region and was first described by Wernher in 1943. It is commonly seen in neonates and in early infancy. CH is rare in adults with less than 150 adult cases with only few with difficult intubation have been reported in literature and 2-6% die of airway compromise. We report a rare case of CH in a 61-year-female occupying whole of oral cavity and extending to the neck, with feeding and breathing difficulty. This was classified as de Serres stage 5 and Mallampati grade IV. This case highlights that cystic hygroma be considered in the differential diagnosis of cystic neck masses in adults and considering the issue of difficult intubation, identification and appropriate plan for airway management is key to successful outcome. In this case surgical airway was on the cards, intubation by a skilled expert anesthetist using mackintosh laryngoscope made complete surgical removal through a trans cervical approach possible
Mortality Analysis in Children during Induction Therapy for Acute Lymphoblastic Leukemia
No full textObjective: To find out the death rate and analyze the causes of death in children with Acute Lymphoblastic Leukemia (ALL) during induction chemotherapy. Patients & Methods: This cross-sectional study was conducted at Children Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad. All children ranging from 1-13 years of age, and diagnosed as ALL, registered at Children Hospital PIMS, from January 2014 to September 2015 were included in the study. All patients were treated with the BFM protocol. Mortality data during induction therapy was collected and analyzed including rate and cause of death. Results: Out of 48 newly diagnosed cases of ALL, 10 (20.8%) patients died during induction phase. So, the induction death rate in the study period was 20.8 %. Bleeding was observed in 5 (50%) patients and was thus the commonest cause of death, followed by sepsis which was observed in 4 (40%) patients. Tumor lysis syndrome was observed in 1 (10%) patient. CNS was the major site of bleeding. Conclusion: The death rate during induction therapy is high in our setup. The major cause of death in the present study was bleeding, followed by sepsis. High death rate in our study was attributed to failure to arrange platelet and blood transfusions, and increased rate of infections particularly in low income families. It is emphasized that supportive therapy in the form of platelets and blood transfusions should be given on urgent basis to the children who present with low platelet counts. A good antibiotic cover should be given to treat infections and most important aspect is that patient’s caretaker’s education regarding the patient care is ensured. Keyword
Association of Portal Hypertensive Gastropathy with Esophageal Varices among Patients of Viral Cirrhosis
Get PDFObjectives: To find out the prevalence of portal hypertensive gastropathy among patients of viral cirrhosis undergoing endoscopy and to determine its association with esophageal varices in patients of cirrhosis. Patients and Methods: This cross-sectional study was conducted at Medical Unit, Jinnah Hospital Lahore from 3rd September 2016 to 2nd January 2017. A total of 120 patients with liver cirrhosis fulfilling the inclusion criteria were approached and an informed consent was taken before enrolling in the study. All patients underwent upper gastrointestinal tract endoscopy by consultant endoscopist. Data was entered on SPSS Version 17 for further analysis. Results: Out of 120 patients, 43% were males and 57% were females. The mean age of participants was 39.71+11.6 SD years. Portal hypertensive gastropathy was present in 12.5% patients and esophageal varices in 42.5% patients. HBsAg and anti-HCV was positive in 60.8% and 45.8% patients respectively. Non-significant association was found between portal hypertensive gastropathy and esophageal varices (p-value 0.364). Conclusion: Emergence of portal hypertensive gastropathy and Esophageal varices was noticed among patients of viral cirrhosis. However non-significant association was found between portal hypertensive gastropathy and esophageal varices
Association of Diabetes with Various Risk Factors
Get PDFObjective: To investigate the association of possible risk factors with Diabetes Mellitus in Population of Rawalpindi. Patients & Methods: This case control study was conducted in Rawalpindi. A total of 99 cases of diabetes from OPD and 101 healthy controls from blood banks were included in the study. Self-developed closed ended questionnaires were used for data collection. Statistical analysis was performed using SPSS version 16. Results: A total of 200 respondents (cases and controls) were selected for this study. Results were interpreted in the form of odds ratio (OR) and p-value. A p-value < 0.05 was considered significant. OR for age group (41-50 yrs) was 8.3 indicating that there were 8.3 times more chances of having Diabetes mellitus in this age group as compared to age group of 21-30 years. Males had a 4.4 times higher chances of getting Diabetes Mellitus as compared to females. While OR revealed that there were 12.7 times more chance of getting Diabetes Mellitus with positive family history as compared to negative family history. Conclusion: Main risk factors identified in this study were age group 41-50 years, male gender and positive family history of Diabetes Mellitus. 
Demographic Determinants of Physical Injuries in Rawalpindi: Role of Rescue 1122
Get PDFObjective: To determine demographic characteristics, patterns and causes of physical injuries encountered in Rawalpindi. 2. To access the utilization status of publically available free of cost Emergency Medical Service System of Rescue 1122. Patients and Methods: This cross-sectional study was conducted from November 2016 to March 2017. Data was collected from Rescue 1122 and emergency departments of government hospitals. There were total 2556 reported injured, with no age or gender discrimination. In order to collect the information, briefly designed performas in Urdu language were circulated among the attendants of the injured and sometimes to the injured individuals. Results: Out of 2556 injuries reported during the study period, 1464 (57.30%) were due to fall from heights while 319 (12.5%) accidents were because of road crashes. Among the road crashes, the highest incidence rate for injuries was due to bikes (n=166). As evident from the study that minor injuries; mostly abrasions were most frequent compared with the rest of the types of injury. Out of 2556 cases, only 2.6% (n=67) were transported through Rescue 1122. Majority of the sufferers (27%) had to arrange a private transport to rush to the hospital. Cars were used by 18% and private ambulances by 21% to transport the injured from accident site. Conclusion: Roadside accidents comprise a significant cause of injury. In view of provision of services at the time of these mishaps, rescue 1122 service, though available free of cost, is underutilized
Clinico-Biochemical Profile in Neonates with Birth Asphyxia
Get PDFObjective: To study the biochemical derangements in neonates with asphyxia having different clinical presentation. Patients and Methods: This cross-sectional study was conducted at Neonatal Intensive Care Unit, Federal Govt. Polyclinic (PGMI) Hospital, Islamabad from 1st November 2016 to 30th April 2017. All neonates with history suggestive of birth Asphyxia were inducted in study. Complete history, examination and laboratory investigation (Complete blood count, Blood Sugar, Serum Calcium, Serum Electrolytes, Serum Urea, Serum Creatinine, Liver function tests, Cardiac Enzymes) were done. The data was entered in SPSS version 23 for further analysis. Results: Out of 39 babies, 66.7% had moderate and 33.3% had severe birth asphyxia. Severity of birth asphyxia was associated with lower APGAR Scores. Multi-organ involvement was observed with increasing severity of birth asphyxia as; respiratory system 71.8%, cardiovascular system (shock) 25%, central nervous system (convulsion)15.4%, renal tract (acute renal failure) 12.8% and gastro intestinal tract 5.1%. Significant mortality was noted with shock, convulsion and hypoglycemia. Cardiac and liver enzymes were deranged and were significantly related to severity of birth asphyxia. Conclusion: Multi-organ dysfunction is common in birth asphyxia. Early assessment of clinical and biochemical profile will help in managing disease, reducing severity and improving the outcome of illness
Inadequate Glycemic Control - Failure of Counseling or Compliance?
Get PDFObjectives: To find out the level of counseling provided by physician to diabetic patients with HbA1c > 6.5% and to determine the patient’s compliance regarding diabetes and its control. Material & Methods: In this cross-sectional study type 2 diabetic patients were inducted using convenient sampling technique. A structured questionnaire with closed ended questions was used. Interviews were conducted by researchers after obtaining written informed consent. SPSS version 20 was used for analysis. Chi-square test was applied to find association between variables. Result: Out of 155 participants, 141 (91%) patients knew that they have high glucose level but they have no information regarding reason of these elevated levels. Counselling regarding, pharmacological therapy, dietary changes, importance of exercise and about regular foot examination was provided to 92.3%, 86.5%, 61.9% and 19.4% patients respectively. Patients compliance was highest to pharmacological treatment (67.7%) followed by regular visits and physical exercise (51.6% and 51%) respectively. However, 49.7% (n=77) of the participants do not check their blood glucose levels at all. There was statistically strong association between level of counseling with compliance of the participants regarding both pharmacological treatment (p=0.03) and exercise (p<0.001). Conclusion: Counseling played a pivotal role in compliance of treatment. In this study counseling was good about treatment regimens as compared to lifestyle changes. Therefore, a large number of the participants showed good compliance for treatment. Patient tailored approach should be adopted by physicians dealing with diabetes, with more emphasis to introduce lifestyle changes. 
Role of Magnetic Resonance Imaging in Caries Spine
Get PDFObjective: To evaluate the usefulness of Magnetic Resonance Imaging (MRI) in Caries spine, avoiding invasive procedures for the diagnosis of the spinal tuberculosis. Patients and Methods: This cross-sectional study was conducted at Department of Orthopedic and Spine surgery, Ghurki |Trust Teaching Hospital Lahore, from January 2012 to May 2016. Patients who underwent surgery for cervical, thoracic and lumbar spinal tuberculosis were inducted in the study. Their MRI were reviewed and eight parameters namely T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement, anterior subligamentous extension, paraspinal extension and no spinous process involvements were noted. Each of the variables were given 1 point when present and zero when absent. Score of ≥ 6 favored a tuberculous pathology whereas ≤4 were suggestive of non-tuberculous etiology. Results: We evaluated 243 patients of histopathologically proven cases of caries spine. Among these, 129 (53.08%) were females and 114 (46.91%) were males. Mean age of patients was 39.04 years ranging from 8 years to 71 years. Dorsal spine was mainly involved in 105 (43.21%) patients followed by lumbar spine in 91(37.45%) and cervical spine in 47 (19%) patients. Number of vertebrae involved were two or more in each case. Data showed that 238 (97.94%) patients had score ≥ 6 which favored a tuberculous spine whereas 5 (2.06%) patients had scores 5 which suggest antituberculous cause. Conclusion: Our study revealed that objectively outlined eight-point MRI criteria of vertebral lesions is expected to diagnose caries spine with confidence in majority of cases. The proposed scoring system will mitigate the dependency on histopathological diagnosis or invasive method, so that early initiation of anti-tuberculous therapy may be possible