Journal of Islamabad Medical & Dental College
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Pattern of Abdominal Injuries, Organ Involved and Rate of Negative Laprotomy in Tertiary Care Hospital
Full text linkObjective:
This study was designed to evaluate the pattern of abdominal injuries the value of the surgery in assisting diagnosis, laparotomy and mortality rate.
Methods:
Out of 1923 total trauma patients 886 individuals were included in the study from a tertiary care hospital. Demographic , trauma-related traits, laparotomies with their indications, etiology and the organs affected were all collected. With SPSS 23 were used to evaluate data
Results:
The mean age patients were 27.05 years mostly male. Mortality and negative laparotomy rate were 5.9 and 15.4 percent respectively. Blunt injures were more than penetrating .Spleen was the frequent organ damage.
Conclusion:
Blunt trauma with spleen mostly involved organ. Mortality and negative laparotmy rate are comparable to other studie
Neonatal Hypoglycemia How common is Hypoglycemia in Newborns Weighing Less Than 2500 gms: A Hospital Based Study
No full textObjective:To determine the frequency of hypoglycemia in neonates weighing less than 2500 grams in first 48 hours of life presented to CMH Abbottabad.
Study Design: Cross Sectional Study.
Setting: Department of Pediatrics, Combined Military Hospital, Abbottabad.
Duration of Study: This study was conducted from 1st July 2020 to 1st January 2021
Subjects and Methods:
A total of 110 neonates of both genders with birth weight less than 2500 grams using consecutive non-probability sampling technique were included in the study. Capillary blood was collected by heel prick after proper aseptic measure for blood glucose estimation by Glucometer at 0, 1, 2, 3, 6 and every 6 hours till 48 hours of birth. All hypoglycemic neonates were managed with intravenous administration of 10%glucose.
Results:
Gestational age range in this study was from 34 to 42 weeks with mean gestational age of 38.663±1.55 weeks, mean birth weight 1622.818±409.23 grams and mean blood glucose level was 54.763±9.55 mg/dl. Total 80% neonates were male. Hypoglycemia was observed in 27.3% neonates. No significant difference was seen comparing frequency of hypoglycemia among pre-term and term neonates (p-value 0.52), male vs female neonates (p-value 1.00) and different modes of delivery. (p-value 0.6). While frequency of hypoglycemia was significantly high in extremely low birth neonates as compared to low and very low birth weight. (p-value <0.01).
Conclusion:
Our study concluded that frequency of hypoglycemia was 27.3% in newborns weighing less than 2500 grams in first 48 hours of life. Extremely low birth weight (less than 1000gms) is a significant determinant for hypoglycemia.
Keywords:
First 48 hours, frequency, low birth weight, hypoglycemia, new borns
 
The Effect of Intravenous Tranexamic Acid on Reduction of Seroma After Para-Umbilical Mesh Hernioplasty
Full text linkBackground
Paraumbilical hernia is the second most common presentation in adults. It is managed surgically. Surgical management depends upon the size of the defect. Sizes of more than 2cm are surgically managed by placement of mesh after primary closure of defect. Mesh can be onlay, sublay or inlay depending upon its placement at different anatomic sites of anterior abdominal wall. Seroma formation is one of the major complication of mesh hernioplasty. Different methods are used for prevention of seroma post operatively. These methods include drain placement, proper fascial closure, fibrin glue and use of sclerosing agents. Tranexamic acid can be used for prevention of seroma formation after mesh hernioplasty.
Patients and Methods
It was a case control trail conducted in department of general surgery Gulab Devi Hospital Lahore. In our study 40 patients were included through randomized sampling having paraumbilical hernia undergoing mesh hernioplasty. These patients were divided in two groups. In group 1 patient received Injection Tranexamic acid 1gm pre operatively while in group 2 inj tranexamic acid was not given.
Results
Seroma formation after drain removal was seen in 04(10%) patients only. Out of these 04 patients 01(25%) patient belonged to group 1 while 03(75%) patient were in group 2 which was proved statistically (p-value 0.004). Patients with increased BMI had seroma (26.7 ± 2.1 kg/m2 vs 25.7 ± 1.8 kg/m2) but it was not statically proved (p-value 0.84). Patients with seroma had mean weight of 89 ± 10.7 kg while patients with no seroma had mean weight of 74 ± 11.5 kg which was statistically proved (p-value 0.018).
Conclusion
Injection tranexamic acid 1gm given pre operatively significantly reduces seroma formation as incidence of seroma formation was higher in group 2 as compared to group 1 patients
Restoration of Bilateral Premolars Using Custom Made Cast Post and Core: A Case Report
Full text linkWhen grossly carious teeth need to be restored after endodontic treatment, long term success depends on the choice of the post and core systems. A custom-cast post and core is recommended when the remaining tooth structure is compromised and an insufficient ferrule is present. The following case report depicts the restoration of bilateral grossly carious premolar teeth by using custom-cast posts followed by PFM crowns. The patient presented with bilateral severely carious premolars with pulpal necrosis. The treatment plan included endodontic treatment followed by custom-cast posts and cores with PFM crowns. In this way, aesthetics and function for the patient can be achieved by using cast metal posts and metal ceramic crowns for the restoration of premolars
Frequency of Atypical AVNRT in Patients Presenting with Narrow Complex Tachycardia
Full text linkABSTRACT
Objective: To determine the frequency of atypical AVNRT in patients presenting with Narrow Complex Tachycardia.
Study Design: Descriptive Cross Sectional
Place and Duration of Study: Department of Cardiology, MTI-Hayatabad Medical Complex, Peshawar, from March, 2021 to March, 2022.
Methodology: Ninety-three patients of either aged 30 to 80 years diagnosed with narrow complex tachycardia by consultant cardiac electrophysiologist on ECG showing QRS duration of less than 120 milliseconds were included in this study. Patients were managed as per standard protocol which included comprehensive clinical evaluation such as patient history, physical examination and invasive electrophysiological study for the diagnosis and characterization of atypical Atrioventricular Nodal Reentrant Tachycardia (AVNRT).
Results: A total of ninety-three patients were studied with mean age of 43.08 years (SD = 9.07). Among the participants, 58.1% were male, while 41.9% were female. Majority of patients had Slow-Fast AVNRT (7.5%) followed by Fast-Slow AVNRT (3.2%), and Slow-Slow AVNRT in 2.2% patients.
Conclusion: This study underscored the importance of gender-specific variations in the prevalence of different AVNRT types and highlighted the impact of gender as a potential influencing factor in the manifestation of specific types of AVNRT within the study population
Event of Visual Impairment and Loss with Off-Label Administration of AVASTIN Injection
Full text linkIn the middle of September 2023, frequent cases of vision loss and impairment of diabetic patients were reported in Lahore-Pakistan. Many diabetic patients lost their precious vision. with the progression of the cases, the DRAP (Drug Regulatory Authority of Pakistan) found that patients were administered an Avastin 100mg/4ml injection (an angiogenic drug used for treating colorectal and other metastatic carcinomas)2. Up to 65 cases were reported in the province of Punjab. 
Association of HBA1C level with extent of Acute Myocardial Infarction and Short Term Mortality
Full text linkABSTRACT
Objectives: To determine the prognostic value of HBA1C level with extent of acute Myocardial Infarction (MI) and short-term mortality in patients without known Diabetes.
MATERIAL AND METHODS
The prospective cohort, department of Cardiology at Liaquat University Hospital Hyderabad during the period of one year from February 2020 January 2021. All the patients aged 20-75 years, both genders with acute MI (STEMI and NSTEMI) were included. All the patients diagnosed for MI according to ECG and serum cardiac biomarkers such as Troponin-T and Troponin-I. Blood sample were taken from all the cases for assessment of HbA1c level. Echocardiography was done and categorized according to the left ventricle ejection fraction. Short term mortality was assessed in all patients. All the data was recorded in the proforma for the purpose of analysis. After collection of data the analysis was conducted by using SPSS version 22.0.
Results: Total 377 patients of acute MI were studied; their mean age was 50.42+11.71 years. Out of all study subjects’ males were in majority 83.0% and females were 17.0%. Out of all 59.4% had HbA1c level <5.5 and 40.6% had HbA1c was <6.5. Most of the study subjects 62.9% had left ventricular ejection fraction was <40%. Majority of the cases 77.7% had STEMI and NSTEMI was seen in 22.3% of the cases. Overall short-term mortality (30 days) was found 14.3%.
In this study short term mortality (30 days) was statistically significant according to the gender, HbA1c, left ventricular ejection fraction and types of the MI, P-<0.05).
Conclusion: As pers study conclusion overall short-term mortality (30 days) was 14.3%. Higher HbA1c was observed to be a potential indicator for short term mortality among patients of acute coronary syndrome (ACS) and a predictor for short-term mortality in ACS patients without known DM and without DM
Key words: Acute MI, 30 days mortality, Hba1
Prevalence of Ischemic Versus Hemorrhagic Stroke in Patients Taking Anti-Coagulation Therapy
Full text linkOBJECTIVE: To evaluate the prevalence of ischemic versus hemorrhagic stroke in patients taking anti-coagulation therapy.
PATIENTS AND METHODS: This cross-sectional prospective study was conducted at medicine Departments of Peoples University of Medical & Health Sciences (PUMHS), for a period of 18 months from September 2021 to January 2023. All the patients taking anti-thrombotic therapy (warfarin, rivaroxaban, dabigatran, or apixaban) were included in this study and their baseline and clinical data were collected. Statistical package for the social sciences version (SPSS v. 26) was used for data entry and data analysis. Chi-square test/fisher’s exact and independent t-test test was used for determination of risk factors associated with hemorrhagic or ischemic strokes. A p value of <0.05 was considered as statistically significant.
RESULTS: A total of 296 patients were enrolled for final analysis. The overall mean age, BMI, and duration of anticoagulation therapy was 62.14±8.44 years, 25.38±3.19 kg/m2, and 8.34±12.51 months. Among all study participants, 57.43% (n = 170) were taking NOACs while 42.56% (n = 126) were taking warfarin. The overall prevalence of stroke was 14.18% (n = 42) and among them hemorrhagic stroke was more common (57.14%, n = 27) than ischemic stroke (35.71%, n = 15). Patients taking NOACs were more likely to have hemorrhagic stroke as compared to ischemic stroke, 74.07% (n = 20/27) and 40.0% (n = 7), respectively, p value <0.001.
CONCLUSION: The risk of stroke is quite high in patients receiving anti-thrombotic therapies. Hemorrhagic stroke is higher in patients receiving NOACs
KEYWORDS: Anti-thrombotic therapy, ischemic stroke, hemorrhagic stroke, Pakista
Identification and Susceptibility Pattern of Various Candida Species Isolated from Different Clinical Samples in Rahim Yar Khan
Full text linkObjective: To isolate distinct Candida species from various clinical samples and examine their patterns of antifungal susceptibility.
Methodology: This prospective, cross-sectional study was carried out from January 2023 to December 2023 on 210 clinical samples positive for Candida, conducted in Pathology Laboratory of Sheikh Zayed Hospital, Rahim Yar Khan. The VITEK 2 compact system was utilized to identify the isolates and determine their antifungal susceptibility pattern.
Results: Candida isolates were analyzed, with Candida albicans being the most prevalent species at 64.8%. Antifungal sensitivity was highest for amphotericin, followed by caspofungin, fluconazole, flucytosine, and micafungin. Voriconazole was the least sensitive drug.
Conclusion: The study found that Candida albicans as most prevalent, followed by Candida Guilliermondii. Rare non-albicans included Candida Glabrata, Candida Krusei, Candida Tropicalis, Candida Sake and Candida Intermedia. Amphotericin has a strong antifungal sensitivity.
 
Head Injury Management in Road Traffic Accident Patients: A Case Report
Full text linkObjective: To examine recovery outcomes for patients with head injuries from road traffic accidents (RTAs), focusing on neurosurgical care.
Methodology: We studied patients admitted to our hospital with head injuries from RTAs. This included a case study of a 55-year-old man severely injured in a road accident, highlighting neuropsychological assessments and treatment outcomes.
Results:
The case report presents the successful recovery of a 55-year-old patient who sustained severe head injuries from a road traffic accident. Following neurosurgical intervention to remove blood clots and comprehensive neuropsychological therapy, the patient showed significant improvement in memory and cognitive functions. The outcomes demonstrate a positive response to the integrated treatment approach, with the patient regaining substantial normalcy in life over the course of three months.
Conclusion: The case of a 55-year-old patient highlights the challenges and outcomes of treating severe head injuries resulting from RTAs. Key findings include the importance of immediate and appropriate neurosurgical care and neuropsychological support.