Journal of Islamabad Medical & Dental College
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Aetiology of Cytopenias in Children Admitted to a Tertiary Care Hospital
Get PDFObjective: To determine the aetiology of cytopenias (pancytopenia and bicytopenia) in children and to assess their relationship with demographic factors, clinical manifestations and disease outcome. Patients and Methods: This cross-sectional study was carried out at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2015 to June 2016. Total of 154 children between the ages of 2 months to 12 years presenting with bicytopenia or pancytopenia, at the time of admission were enrolled in the study. Patients with known causes of cytopenias and those with chronic illnesses and on long term medications like chemotherapy or immunosuppressant were excluded. Results: The causes of cytopenia in order of frequency were Acute Leukemia (25%), Aplastic Anemia (20%), Enteric fever (19%) and megaloblastic anemia (11%).Out of 38 Acute Leukemia patients, 61 % presented with bicytopenia and 39% with pancytopenia, whereas out of the 31 patients of Aplastic anemia, 29 (94%) presented with pancytopenia. Among 19 patients of enteric fever, 13(68%) had bicytopenia and 6 (32%) patients presented with pancytopenia. Total patients of megaloblastic anemia were 17 out of which 10 (59%) presented with bicytopenia and 7 (41%) with pancytopenia. All patients of Idiopathic Thrombocytopenic purpura ITP (N=9), Osteopetrosis (N=3), Amegakaryocytic thrombocytopenia (N=2), and Myelodysplastic syndrome (N=2) presented with bicytopenia. Conclusion: The most common cause of cytopenia was found to be acute leukemia followed by aplastic anemia, enteric fever and megaloblastic anemi
Role of Cytogenetics in Gender Confirmation
Get PDFObjective: To determine the Karyotype of referred cases of Gender Ambiguity through Cytogenetic study. Patients and Methods: This cross-sectional study was carried out at Islamabad Diagnostic Centre, Islamabad from April 2010 to June 2017. A total of 72 cases of Gender Ambiguity aged 1day to 35 years were referred to IDC for chromosomal analysis and karyotyping during above mentioned period. Out of these 72 cases, 37 presented with somewhat male-like external genitalia and 35 with more of female-like external genitalia but clear-cut gender differentiation was not possible on external physical examination. Hence Cytogenetics was performed on peripheral blood to confirm their chromosomal makeup. Results: Out of the total 72 cases, 12 cases that were suspected to be female on external physical examination, turned out to have male karyotype (46, XY). Conversely 7 cases that were suspected to be male on external physical examination, turned to have female karyotype (46, XX). Twenty seven cases with male-like clinical gender were confirmed to have male karyotype (46, XY) and 22 cases with female-like clinical gender were confirmed to have female karyotype (46,XX). Conclusion: Cytogenetic study is essential in confirming the chromosomal makeup of individuals born with ambiguous gender. It should be carried out as early as possible in life for appropriate brought up and social adjustment of the affected individual. Keyword
Role of Pre-Medicational Ondansetron and Ketamine to Prevent Shivering During Spinal Anaesthesia: A Comparative Study
Get PDFObjective: Shivering is a common problem during anesthesia. Ketamine has been used for preventing shivering during anesthesia. Ondansetron (8 mg) has been recently evaluated for its peri-operative anti-shivering effect in patients undergoing spinal anesthesia. The objective of my study is to compare low dose Ondansetron with low dose Ketamine among patients undergoing spinal anesthesia in elective surgery in terms of frequency of shivering. Patients and Methods: Patients undergoing elective general surgical procedures at Department of Anesthesiology, Holy Family Hospital, Rawalpindi, were inducted in the study. The study design was a randomized control trial and conducted from Jan 2016 to June 2016. Patients were included through a consecutive non-probability sampling. After spinal anaesthesia, patients were randomly assigned to receive Ketamine 0.25 mg/kg (group A) or Ondansetron 4mg (group B) by lottery method. During surgery, shivering was recorded at 10 min interval and recorded in terms of frequency. Results: Out of the total 256 study participants, 128 patients in each group received the study drug (Ondansetron/ Ketamine) before surgery for prevention of shivering. Overall, there were 158 male and 98 female patients. The mean age of study population was 36 ± 11 yrs (range 21–40 yrs). Shivering occurred in 11 (4.3%) patients only. There was no significant difference between the gender distributions between the two groups (p=0.16). Patients pre-treated with Ketamine significantly experienced lesser shivering episodes than Ondansetron group (2 (1.6%) vs. 9 (7%), p=0.03). Conclusion: The findings of our study suggest that the prophylactic administration of low dose Ketamine (0.25 mg kg-1) and Ondansetron (4mg) produces anti-shivering effect in patients undergoing spinal anaesthesia. Ketamine (0.25 mg/kg) is significantly more effective than Ondansetron (4mg) during spinal anaesthesi
In-Vitro Toxicology Approach to Explore Nicotine Effects in Oral Mucosal Culture
Get PDFObjective: To measure the effect of in vitro nicotine on reconstituted oral mucosal culture and to study its effect after 5 minutes and 24 hours in normal healthy uninflammed oral mucosa. Material and Methods: This observational study was conducted at Department of Oral Pathology, Barts and London Queen Mary University London to measure the effect of in vitro nicotine on reconstituted oral mucosal model. The reconstituted human epithelium model was used and was supplied by Skin Ethic Laboratories, Nice, France. Cells viability was assessed by MTT assay. Working solutions (10μM, 100µM, 1mM, and 10mM) of nicotine were primed from 2.5M stock solution (Sigma,UK). The effect of nicotine was studied after 5 minutes and 24 hours in normal healthy uninflamed oral mucosa. Results: It was found that that application of nicotine after 5 minutes and 24 hours’ treatment on uninflamed oral mucosal model and did not significantly affect the viability at all concentrations used. Conclusion: Nicotine did not show any effect on uninflamed mucosa and also had no momentous effect after 5 minutes and 24 hours respectively. Further workup on proteomics and genomics is suggested to confirm our observations
Primary Musculoskeletal Hydatid Cyst of Thigh
Get PDFPrimary musculoskeletal hydatid disease means that there is no primary focus of hydatid disease in body. It is a rare disease and present in approximately 3% of the patients. We present a case of primary hydatid cyst of thigh in 40-year female with history of swelling in left thigh for 2-years and referred for MRI at CT & MRI Centre, at Radiology Department, Dow University of Health Sciences/Civil Hospital Karachi. This case highlights that hydatid disease should be considered in the differential diagnosis of every soft tissue cystic mass in any anatomical location. Preoperative diagnosis of hydatid cyst is important for proper management and to avoid the long-term complication of recurrenc
Determination of Reference Range of Glycosylated Haemoglobin (HbA1c) for Different Age Groups
Get PDFObjective: To determine the reference interval of glycosylated haemoglobin for different age groups in our local Pakistani population. Subjects & methods: Total number of 164 healthy adults (91 females and 73 males), were selected through nonprobability consecutive sampling. After informed consent, venous blood sample (3-4 ml) from each subject was collected in EDTA vial under aseptic conditions. Haemolysed blood was used for estimation of HbA1c by Fast Ion-Exchange Resin Separation method on Microlab 300. The participants of the study were divided into three groups according to their age distribution. All data was analysed using Microsoft Excel and statistical software Minitab15. Mean and SDs were calculated for each group. Reference range of HbA1c was calculated for each group by using the formula Mean ± 2SD. Results: One hundred and sixty-four healthy individuals were included in the study. Mean age of the individuals was 32±11.6 years and mean HbA1c level was 4.17±0.93%. The reference range of HbA1c for age group 20-30 years was 2.09-5.57% with the mean value of 3.83±0.87%. The reference range of HbA1c for age group 31-40 years was 2.63-5.99% with the mean value of 4.31±0.84%.The reference range of HbA1c for individuals > 40 years of age was 2.8-6.4% with the mean value of 4.31±0.9%. Conclusion: For proper assessment of the diabetic status, it is mandatory that every lab should establish its own reference range of HbA1c for both genders and different age groups representing its patient population. 
Efficacy of Spot Urinary Albumin Excretion Test for the Detection of Early Nephropathy
Get PDFObjective: To compare the effectiveness of spot urinary microalbumin excretion for detection of early diabetic nephropathy in comparison with 24 hours urinary proteins in patients with diabetes mellitus. Materials and Methods: The study was conducted at Nephrology Department of Pakistan Institute of medical Sciences, Islamabad. It included diagnosed cases of type 1 or 2 diabetes mellitus, (with type 2 diabetes of any duration and type 1 diabetes of more than 5 years duration) who tested negative for overt albuminuria on standard urinary dipstick done on two occasions. Each patient was provided a plastic container with capacity of 4000 ml for 24 hours collection of urine. The study group subjects were requested to provide early morning urine sample for spot urine test. Urinary microalbumin was determined by the immunoturbidimetric method. 24-hour urinary albumin excretion was determined by photometric test according to biuret method. SPSS version 12 was used to record and analyze the gathered data. Descriptive statistic and frequencies of the spot urine albumin and 24 hours urinary albumin were measured. The sensitivity, specificity, negative predictive value, positive predictive value, accuracy and efficacy of spot urine microalbumin test was calculated in comparison to 24-hour urine protein test. Results: Out of 289 patients of Diabetes mellitus included in the study, 39 (13.5%) had type 1 Diabetes mellitus and 250 (86.5%) had type 2 Diabetes mellitus. The mean age of the patients was 54.079.5 years. Among total patients 113 (39.1%) patients had positive 24-hour urine protein and 98 (33.9%) had positive spot urine microalbumin test. The sensitivity, specificity, positive predictive value and negative predictive value of the spot urinary microalbumin test in comparison to 24-hour urine protein test was 83%, 97.7%, 96% and 90% respectively. In total spot urinary microalbumin test was accurate in 92% cases. When the results of spot urine microalbumin test and 24-hour urinary protein test were compared using the chi-square test, it was found that patients with a positive spot urine microalbumin test had a statistically significant probability of having a confirmed diabetic nephropathy on 24-hour urinary protein test; p= 0.00. Conclusion: Spot urine microalbumin test is a highly sensitive and specific tool in the diagnosis of early diabetic nephropathy with high positive predictive value. Spot urine microalbumin test offers the advantage of speed, simplicity and early diagnosis. Spot urine microalbumin test has acceptable accuracy as compared to 24-hour urine protein test. 
Microalbuminuria: A Urinary Biomarker of Diabetic Kidney Disease
Get PDFDiabetes Mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia and disorders of carbohydrate, protein and lipid metabolism.1 It is expected that by the year 2030, about 552 million people globally will be affected from diabetes mellitus.2 If not well controlled, diabetes mellitus leads to both microvascular and macrovascular complications.2 Diabetic mellitus is the most common cause of diabetes nephropathy that has a momentous impact on quality of life and survival of the patient.1 It is estimated that about 40 % of type I and type II diabetes mellitus develop diabetic kidney disease.2 If not timely diagnosed and properly treated, diabetic nephropathy eventually leads to End stage renal disease that requires dialysis or renal transplantation. Multiple serum and urinary biomarkers are used to diagnose diabetic nephropathy before it is clinically evident.2 Urinary microalbumin has been used as a clinical biomarker of diabetic kidney disease since 1982.4 It is used to screen both type I and type II diabetes mellitus.5 Microalbuminuria results when albumin crosses glomerular filtration barrier due to ultrastructural changes in endothelial glycocalyx.6 Microalbuminuria also represents a marker of systemic endothelial dysfunction with increased risk of cardiovascular and cerebral insults in patients with diabetes mellitus.
School Health Services
Get PDFSchool health service is defined as ‘a service concerned with the early detection of health and social problems in school children and their subsequent treatment and surveillance’1 or ‘coordinated system that ensures a continuum of care from school to home to community health care provider and back’.2 Historically, the concept of school health services evolved in colonial American era by Benjamin Franklin who advocated a ‘healthful situation’ and promoted the primary subject of physical education in schools. Later, this concept gained major attention as a mean to promote public health and prevent disease after the report of the ‘Sanitary commission of Massachusetts’, headed by Lemuel Shattuck in 1850.3 Soon after Shattuck report, the medical and public health sectors began to recognize the role that schools could play in controlling communicable diseases with their captive audience of children and young people. On realization of school’s role in the prevention of public health problems, in 1995 WHO launched ‘Global School Health initiative’. The aim of this program was to mobilize and strengthen health promotion and education activities at the local, national, regional and global levels4. This initiative was designed to improve the health of students, school personnel, families and other members of the community through ‘health promoting schools’.
Frequency of Dry Eye Disease in Elderly Population and their Associated Risk Factors
Get PDFObjective: To know the pattern of dry eye disease (DED) in a tertiary care hospital and its association with various clinicoepidemiological factors. Patients and Methods: This one-year cross sectional study was conducted at Federal Government Services Hospital from 1st January 2012 to 31st Dec 2012. About 1600 patients above 40 years of age were screened randomly for DED and included in the study. A 5-item standardized questionnaire (DEQ 5), Schirmer's test (ST), Tear film breakup time (TBUT), corneal fluorescein staining (CFS) for the presence of conjunctival injection, punctate epithelial erosions (PEE), and meibomian gland dysfunction (MGD) were used. The diagnosis was made on the presence of three out of five parameters. SPSS 17 was used to analysed the data. Results: About 1600 willing patients were screened for DED. Among them four hundred and eighty-six (486) (30.37%) patients were diagnosed on the basis of symptoms and signs as DED. Out of them, 261(53.7%) were males and 225(46.25%) were females, 288(59.2%) were urban and 198(40.7%] belong to rural areas. Conclusion: DED constitutes a major proportion of patients attending the ophthalmology department in a tertiary care hospital. It is a multifactorial disease, is frequent in an elderly male who are using drugs like an antihistamine, anti-BPH, antidepressant, and in postmenopausal women.