Journal of Islamabad Medical & Dental College
Not a member yet
636 research outputs found
Sort by
Evaluation of Distal Humerus Intercondylar Fractures Using Mayo Elbow Performance Score Following Elbow Reconstruction with Two Plates in Inverted Y Configuration
Full text linkObjective: Distal humerus fractures are common in elbow injuries. The objective of this study was to evaluate the clinical result following elbow reconstruction for distal humeral intercondylar fractures utilizing two plates applied in an inverted Y configuration using the Mayo Elbow Performance Score (MEPS)
Methodology: This descriptive case series was conducted from June 2019 to July 2023 in the department of Orthopedics at Akbar Medical Center, Peshawar and Maqsood Medical Center Peshawar. Patients were chosen using a non-probability, sequential sampling procedure. The study included all patients between the age of 20 and 50 years with distal humeral intercondylar fractures, regardless of gender, and whose fractures lasted less than a week. Data was analyzed using SPSS version 20.
Results: Out of 88 patients 53 (60.23%) were males and 35 (39.22%) females. The mean fracture duration was 4.19 ± 1.44 days. The clinical prognosis was excellent in 27 cases (30.68%), good in 37 cases (42.05%), fair in 16 cases (18.18%), and bad in 8 cases (9.09%) following elbow reconstruction utilizing two plates in an inverted Y configuration for distal humeral intercondylar fracture based on the MEPS.
Conclusion: A considerable percentage of patients had a satisfactory clinical outcome following elbow reconstruction with two plates arranged in an inverted Y configuration for distal humeral intercondylar fractures
Keywords: Elbow, Fracture, Humerus, Performance Score, Supracondylar
 
The Impact of Syrinx on Clinical Outcomes in Arnold-Chiari Malformation: A Retrospective Study
Full text linkObjective: Arnold-Chiari malformation is congenital or acquired anomaly of the hindbrain that leads to crowding of the cerebellum and brainstem in the posterior cranial fossa. There is an interplay between syringomyelia and Arnold-Chiari malformation. The objective of this study was to analyse the incidence trends, morphological patterns, and clinical outcomes of Arnold-Chiari malformation with and without syringomyelia, focusing on patients treated at Hayatabad Medical Complex, Peshawar.
Methodology: This retrospective study was conducted on 150 patients from January 2023 to December 2023. Patients were divided into two groups: 75 with syringomyelia and 75 without syringomyelia. Key variables included tonsillar herniation, syrinx length, and surgical outcomes. Statistical analyses were done using t-test and chi-square test to assess relationship between variables, with a significance threshold of p<0.05.
Results: Patients with syringomyelia exhibited significantly higher tonsillar herniation (mean: 10.8 ± 2.3 mm) compared to those without syringomyelia (mean: 7.4 ± 1.9 mm) with p<0.001. Syrinx presence was significantly associated with surgical outcomes (p<0.05). Among patients with syrinx, those with improved surgical outcomes had a mean syrinx length of 18.6 ± 7.5 mm, while stable or unimproved cases exhibited larger syrinx lengths. A significant difference in surgical outcomes was noted between the groups, emphasizing the clinical impact of syrinx presence.
Conclusion: A strong association was found between syrinx presence and clinical outcomes in Arnold-Chiari malformation. Early diagnosis and timely intervention are critical for improved patient outcomes.
Keywords: Arnold-Chiari malformation, Surgical outcomes, Syringomyelia, Tonsillar herniatio
The Effectiveness of Progestogens in Reducing Preterm Birth Risk
Full text linkObjective: The study aims to evaluate the effectiveness of prophylactic vaginal progesterone in preventing preterm birth among women with a history of spontaneous preterm birth.
Methodology: The study was conducted at the department of gynae & Obs, Ayub teaching hospital Abbottabad, from February 2022 to August 2022. IRB approved the study. This study investigated 125 women who had previously given birth prematurely. Demographic, medical, and obstetric data were collected before treatment initiation. Participants self-administered the study drug daily and returned to the study center every 2 weeks for monitoring. The study drug was continued until 36 weeks of delivery. Standard preterm labor treatment was provided as needed. All information was recorded on a standardized form.
Results: The mean age of participants was 29 years (SD±8.631), 38% were first-time mothers, and 62% had prior births. The study of 125 women with a history of spontaneous preterm birth found that prophylactic vaginal progesterone was associated with a successful pregnancy outcome in 88% of participants. The average gestational period at delivery in the study was 34 weeks (SD±3.455). While the study demonstrates a positive trend, it's important to note that without a comparison group (e.g., a placebo or no treatment group), it's impossible to calculate a precise p-value demonstrating the statistical significance of the progesterone's effect. The 88% success rate suggests a potential benefit, but further research with a control group is necessary to confirm efficacy and determine statistical significance. These findings support the existing practice of using prophylactic vaginal progesterone in women with a history of spontaneous preterm birth. The high percentage of successful pregnancies (88%) reinforces its potential benefit.
Conclusion: Prophylactic vaginal progesterone significantly reduced the risk of preterm birth by 88% in women with a prior history, demonstrating its potential to improve pregnancy outcomes for this high-risk population. However, the specific efficacy of vaginal progesterone can vary, and it is important to discuss individual risk factors and treatment options with a healthcare provider.
Keywords: Cervical Length, Drug Therapy, Progesterone, Preterm Birth, Pregnancy Complications
Maternal and Fetal Outcomes of Labour Induction at 39 vs 41 Weeks of Gestation
Full text linkObjective: To evaluate the maternal and fetal outcomes in elective induction of labour (IOL) at 39 weeks versus 41 weeks to suggest future guidelines for obstetric patients. The study compared the effects on mode of delivery (MOD), APGAR score, NICU admission and still birth rate.Methodology: A Randomized controlled trial (RCT) and a single-center prospective study was conducted from October 2019 to July 2021 at Al-Nafees Medical College and Hospital, Islamabad. Low-risk primigravida (PG) and multigravida (MG) who delivered non-anomalous singletons fetus between 39 and 41 weeks after induction of labour (IOL) were included. To measure the maternal out come in view of MOD (vaginal or caesarean section) and fetal out comes (APGAR score at 5 minutes, NICU admission and still birth (SB) rate) were assessed.Results: Two groups of 120 patients participated in the trial: group A (39 weeks) and group B (41 weeks), each group comprising of 60 patients. In group A, 85% of patients had a vaginal delivery, compared to 73% in Group B. Group A had a 15% CS rate while Group B had 27%. Group A had NICU admission rate of 3.3% while Group B had 12%. The two groups APGAR scores did not differ significantly, with APGAR > 7 being 95% in Group A and 97% in Group BConclusion: Elective IOL at 39 weeks does not increase caesarian rate, with no significance difference in APGAR score however NICU admission rate was higher in women delivered at 41 weeks of gestation.Keywords: Induction of Labour, Fetal outcomes, Maternal outcome, postdate pregnancy
Diagnostic Accuracy of Clinical Finding for the Diagnosis of Acute Peritonitis
No full textObjective: To evaluate the diagnostic accuracy of clinical findings in identifying acute peritonitis, using computedtomography (CT) and surgical results as the gold standard, among patients presenting to a surgical emergencydepartment.Methodology: Over the course of six months, this prospective cross-sectional research was conducted in theemergency ward, surgery department, Gujranwala Teaching Hospital. 240 patients presenting with acute abdominalpain were included. The patients were subjected to either surgical exploration, CT scanning, or ultrasonography. Thegold standard was considered to be CT and surgical findings. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were used to determine the diagnostic performance of the clinical examination. Independent determinants of diagnostic accuracy were found using binary logistic regression.Results: Of the 240 patients, 75% were male and the mean age was 38.8 ± 15.6 years. The most frequent presentingsymptom was abdominal pain (100%), followed by abdominal distension (66.3%) and vomiting (51.7%). Comparedwith surgical/CT confirmation, clinical diagnosis showed sensitivity 98.8%, specificity 52.5%, PPV 80.6%, and NPV95.5%. Logistic regression identified fever as the only significant independent predictor of correct diagnosis (p =0.046). Other symptoms, including vomiting and abdominal distension, were not significant predictors.Conclusion: In emergency and resource-constrained situations, clinical diagnosis of acute peritonitis is a dependabletool for initial triage and early decision-making due to its great sensitivity and NPV.Key words: Acute Abdomen; Clinical Diagnosis; Computed Tomography; Diagnostic Accuracy; Peritonitis; Sensitivity;Specificity
Seroprevalence of Rubella Antibodies among Women in Rawalpindi and Islamabad
No full textObjective: This study aimed to determine the seroprevalence of Rubella immunoglobulin G (IgG) antibodies and associated risk factors among women in the twin cities of Pakistan.
Methodology: This retrospective study involved the collection of 838 blood samples from women at Medicare Hospital Rawalpindi, Holy Family Hospital (HFH) Rawalpindi, and Pakistan Institute of Medical Sciences (PIMS) Islamabad and was conducted from May 2020 to April 2021. Rubella IgG antibodies were detected in the samples using the Chemiluminescent Microparticle Immunoassay (CMIA) method, and statistical analysis was performed using SPSS version 24.
Results: Of the 838 blood samples tested for Rubella IgG antibodies, seroreactivity and seropositivity was highest in the age group of 21-31 years. The prevalence of positive cases reached 96.82%, peaking in November, while negative cases were at 15.38%, peaking in May. These results indicate that many women possess antibodies against the Rubella virus.
Conclusion: The frequency of seropositivity and seroreactivity was elevated during winter. Socioeconomic factors may have contributed to the high prevalence of Rubella cases. Serosurveys should be conducted nationwide. Pakistan should include the MMR vaccine in its national Expanded Program of Immunization (EPI) as it is both effective and affordable.
Keywords: Chemiluminescent Microparticle Immunoassay (CMIA), Extended Program of Immunization (EPI), Measles Mumps Rubella (MMR), Prevalence, Rubella
Effects of Oral Retinoids on Ocular Surface, Assessment through Ocular Surface Disease Index (OSDI) Questionnaire
Full text linkObjective: Oral retinoids commonly prescribed for acne vulgaris have many side effects. The objective of this study was to determine effect of oral retinoids on ocular surface.
Methodology: This quasi-experimental study, conducted at department of ophthalmology and dermatology HBS Medical & Dental College from August 2023 to July 2024, a total of 109 acne patients who were prescribed oral retinoids were included. Tear film break up time (TBUT) and ocular surface disease index (OSDI) scores were calculated at baseline and three months after therapy to determine effect of oral retinoids on ocular surface and presence of dry eyes. Data were analyzed using SPSS 22.
Results: Mean age of patients was 28.40 ± 9.81 years. There were 23 (21.10%) males and 86 (78.90%) females. Mean baseline and three months follow up TBUT were 24.13 ± 6.31 and 10.33 ± 6.04 seconds, respectively (p < 0.001). Mean baseline and three months follow up OSDI scores were 3.03 ± 2.13 and 22.80 ± 10.32, respectively (p < 0.001). Frequency of dry eyes in acne patients treated with oral retinoids after three months of therapy was 82 (75.23%). The most common ocular complaint of the patients was gritty sensation in the eyes 33 (30.28%) followed by itching in the eyes 22 (20.18%) and burning sensation in the eyes 17 (15.61%).
Conclusion: Dry eyes occurred in 75.23% users of oral retinoids showing a major effect of these agents on ocular surface.
Key words: Acne vulgaris, Dry eye, Retinoids.
 
Paediatric Risk of Mortality III Score (Modified PRISM) – To Predict Mortality and Hospital Stay in Paediatric Intensive Care Unit
Full text linkObjective: To determine mortality and length of stay (LOS) using PRISM III score in critically ill children.
Methodology: This study included a total of 129 patients who met the inclusion criteria. The study was carried out in the Pediatric Intensive Care Unit (PICU) of the UCHS & Children Hospital Lahore, spanning from December 2023 to May 2024.
Results: The mean age of patients was 7.55 ± 4.20 years, with a mean hospital stay of 5.18 ± 1.30 days. Male patients had a mean age of 8.18 ± 4.38 years, while females had 6.79 ± 3.88 years. PRISM score analysis showed a significant trend in discharge and mortality rates. In the 0-4 PRISM range, 84.7% were discharged, while 15.3% died. For scores of 5-9, 83.0% were discharged, and 17.0% died. In the 10-14 range, 57.1% survived, while 42.9% died. Among scores of 15-19, 40.0% were discharged, and 60.0% died. In the ≥20 range, 16.7% survived, while 83.3% died. Linear regression showed a significant association between PRISM score and length of stay (LOS), with a baseline LOS of 4.716 days. Each 1-unit PRISM increase extended LOS by approximately 5 hours (B = 0.069 days). Conclusion: It was concluded that the PRISM III score has discriminatory power in distinguishing between survival and mortality outcomes. Additionally, it proves to be predictor of the length of stay among survivors.
Key words: Length of stay, Mortality, PRISM III score
Comparison of Serum Magnesium and Zinc Levels between Pre-Eclamptic and Normotensive Pregnant Women
Full text linkObjective: To find the levels of serum magnesium and zinc in pregnant women and to compare their levels in PE and normotensive pregnant women.Methodology: This study was conducted in the outpatient & in-patient departments of the Obstetrics and Gynaecological unit of the Hayatabad medical complex, MTI, Peshawar. Pregnant female were included via non-probability convenient sampling. Informed verbal & written consent was obtained, 5ml venous blood was withdrawn for estimation of serum zinc and serum magnesium levels.Results: A total of 110 patient’s pregnant women [pre -eclamptic =46; normotensive pregnant women=64] were included in the final analysis. Mean age of study participants was 26.41±4.71 years. Obstetric characteristics of the pregnant women revealed that most 84.55% (n=93) of the women were multi-gravida and similarly more than half of the women were multipara. Low serum zinc was noted in pre-eclamptic pregnant women compared to normotensive pregnant women but the difference was statistically insignificant (68.16±20.60 Vs. 74.96±32.23, p=0.385). Similarly, comparable results were noted for serum magnesium level, with mean level of 1.68±0.39 in women in pre-eclamptic group as compared to 1.86±0.34 in normotensive females.Conclusions: Our findings suggested that there was no correlation between PE in pregnant female and the serum levels of zinc and magnesium. Clinical implication of serum zinc and magnesium in PE is questionable. However, more research into the involvement of serum levels of zinc and magnesium in PE is required since they might serve as early indicators of PE.Keywords: Hypertension, Magnesium Level, Pre-Eclampsia, Pregnancy, Zinc Level
Effects of Dietary Counseling Strategies to Improve Nutritional Status of Hemodialysis Patients: A Quasi-Experimental Study
Full text linkObjective: Malnutrition is a major concern for CKD patients. Patients on dialysis with severe malnutrition have a higher risk of mortality. The objective of this study was to explore the impact of two different nutritional strategies for improving nutritional status and dietary knowledge of hemodialysis patients.
Methodology: This quasi-experimental study was conducted at Shifa International Hospital Islamabad from Jan 2022 to July 2022. A total of 54 participants were enrolled and divided into two groups and received counseling for 2 months fortnightly. Measurement was taken on three occasions, namely, at baseline, after 2 months, and after 4 months.
Results: Moreover, this study has established there was an improvement in nutritional knowledge post-intervention, with 67% of Group A and 66% of Group B showing a good understanding of dietary restrictions. There was a rise in albumin and reduction in the levels of potassium in the two groups after counseling.
Conclusion: Dietary counseling therefore enhanced nutritional knowledge and improved nutritional status in hemodialysis patients. These findings underscore the importance of nutrition education in the management of CKD and have implications for the development of tailored nutrition counseling programs.
Keywords: Hemodialysis, Nutritional Knowledge, Restriction