Journal of Muhammad Medical College ( J Muhammad Med Coll)
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Knowledge and Awareness of Forensic Odontology among Dental Professionals of Karachi, Pakistan.
Full text linkIntroduction: Forensic dentistry is a challenging and fascinating branch of forensic science that involves the application of dental sciences in the identification of deceased individuals through the comparison of ante and postmortem records. (1)
Objective: The research will not only highlight the need of implementing Forensic Odontology training in undergraduate and postgraduate curriculum in the country by investigating knowledge and awareness of dental professionals towards Forensic Odontology specially related to identification, age, mass disasters and child abuse
Methods:A cross-sectional descriptive study was conducted in 8 private and public dental colleges after approval from institutional authorities to assess knowledge and awareness of forensic Odontology among dental professionals in Karachi
Results: Most of the research participants (84.9%) denied having any experience related to medico-legal cases. For both genders of respondents, 69% thought their knowledge was not sufficient to give medico-legal opinion. In addition, approximately 79.3% of them did not receive any formal training for collecting and preserving dental evidence. However, a vast majority of respondents (75 %) dentists want Forensic Odontology to be included as a separate subject in the undergraduate curriculum
Conclusion:By including Forensic Odontology as a separate subject in the undergraduate curriculum and as a speciality in postgraduate curriculum, dentists will gain knowledge of theoretical and practical aspects of analysis and preservation of dental evidence.
Key words: Forensic Odontology, Medicolegal, Under & Postgraduate Studie
Effects of Hepatitis C on Hematological Parameters in local areas of Mirpurkhas
Full text linkIntroduction: Various diseases have emerged as a major cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HCV) confection, now that antiretroviral therapies become more effective e and has prolonged life expectancy in HIV-infected patients1. One of the most frequently identified extra-hepatic abnormalities often seen at the time of diagnosis of HIV is the hematological abnormalityObjective: To determine possible effects of Hepatitis C in local Population of MirpurkhasMethodology:140 diagnosed patients of Hepatitis C were selected from OPD/Ward MMCH and Civil Hospital Mirpurkhas, Patients of Hypertension, Heart Failure, Renal diseases and respiratory disease were excluded Their ALT, GGT, Alk Sodium was determined by kit method. Their RBC count, TLC, Platelet Count was counted and ESR was determinedResults: It was a prospective study and out of 140 hepatitis C patients 86 were male and 54 were female. The mean age was 54.77 ± 14.046 years. The mean height was 159.42 ± 11.188 cm and the mean weight was 53.69±10.604 Kgs. The mean BMI was calculated as 21.235 ± 5.0607 kgs/m2 (Table.1). The mean Hemoglobin was estimated as 10.639± 2.6924 gm% the mean RBC count was found 3.832 ± .8460 millions/cmm. The mean total leukocyte count was 9111.63 ± 4612.845 per cmm and the mean Platelet count was 160447.67 ± 93788.194 /dl. the mean ESR was 51.70 ± 26.320 (Table.2) The mean Alkaline phosphatase was 273.76± 96.818 IU, the mean GGT was 83.40 ± 102.650 IU and the mean ALT was 74.98 ± 58.614 IU. (Table.3.) The Correlation of hepatitis C was estimated by Pearson’s correlation using SPSS 15 and found that hepatitis has a significant correlation with Hemoglobin, RBC count, TLC and Platelet count (r=.167, .165, .181, 238 and p=.092̽*, .031*, 018* and .002** respectively) and it has an inverse correlation with ESR (r=-.213, p=.005**)Conclusion: Our data shows that hepatitis C has positive correlation with Hb, RBC Count, TLC and Platelet count while the hepatitis has a significant inverse correlation with ESR. More work is required to establish criteria regarding correlation between Hepatitis C and Hematological parameter
To Determine the Frequency of the Common Causes of Lower Gastrointestinal Bleeding after Colonoscopy
Full text linkIntroduction: Lower Gastrointestinal Bleeding (LGIB) is defined as bleeding from distal to the ligament of Treitz at the duodeno-jejunal flexure and it accounts for 30-40% of all gastrointestinal bleeding. Although it is less common than the upper gastrointestinal bleeding yet considered as medical and surgical emergency particularly when massive. The leading causes of LGIB are hemorrhoids, rectal ulcers, rectal polyps and colitis; while less frequent causes include ulcerative colitis, Crohn's disease and diverticulitis. This is apparently in contrast to the western literature where inflammatory bowel diseases and diverticulitis are the common cause of LGIB. Presently Colonoscopy is the diagnostic and therapeutic procedure of choice in LGIB.
Objective: To determine the frequency of the common causes of lower gastrointestinal bleeding (LGIB) after Colonoscopic examination in a tertiary care hospital of Lahore.
Methodology: This cross-sectional descriptive study was conducted at Department of Gastroenterology, Services institute of Medical Sciences Lahore (SIMS) from April 2016 to March 2017.
Results: A total of 277 patients were included in this study, 181(65.34%) were males and 96(34.65%) were females. The average age oi the patients was 45.5 years. Colonoscopy showed abnormal findings in 219 (79.06%) patients. The internal hemorrhoids were the most common cause of LGIB while least common cause of LGIB after Colonoscopic examination was malignant lesions of colon and rectum.
Conclusion: In our study bleeding from internal hemorrhoids was the leading cause of lower gastrointestinal bleeding followed by rectal ulcers and polyps.
Keywords: Lower GI Bleeding, Hemorrhoids, Rectal Ulcer, Rectal polyps, Colonoscopy
Knowledge, Attitude and Practices of Health Professionals towards Nosocomial Infection
Full text linkIntroduction: A hospital-acquired infection, also known as Nosocomial Infection, is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff, that becomes clinically evident after 48 hours of hospitalization.
Objectives: To assess the knowledge, attitude and practices of Health care professionals towards Nosocomial Infection, to find the gap present between knowledge, attitude and practices and to give suggestions to remove the gap.
Methodology: This cross-sectional study was conducted among the doctors and nurses in different units of Allied Hospital Faisalabad. Out of 250 only 244 participants replied, and convenient sampling was used. It was an anonymous survey and participation was voluntary. SPSS used for data entry and analysis. Means ± SD were calculated for continuous data and tables and figures used for categorical data. All the tests were performed using alpha=0.05
Results: For this KAP study the response rate was 97.6%, majority of the participants (89.3%) were females; the mean age was 24.52 ±3.240 years, 79.50% were doctors and 20.5% were nurses, more than half were house officers (60.7%).87.7% had a good idea about nosocomial infection, and majority thought it was either respiratory tract infection (31.6%) or surgical wound infection (31.6%). Most common causative organism is thought to be all 3 of E.coli, Staphylococcus Aureus, and Pseudomonas (38.1%). Immunocompromised adults were the most important risk factor. Among practices of health care professionals, majority denied washing their hands before touching every patient (62.7%), before aseptic procedures (60.2%), after exposure to body fluids (52.5%) or after touching a patient (42.2%). Out of 244, 215 (88.1%) agreed that all equipment should be properly sterilized, while, only about 119 (48.8%) responded that they always used a newly sterilized equipment for every new patient. Only 22.1% of health care professionals kept themselves well updated with latest antibiotics prescribing information.
Conclusion: Knowledge and attitude of doctors and nurses of Allied Hospital towards nosocomial infection is good. There is lack of obligation towards practices and major factors such as hand washing, ward hygiene, and proper sterilization are frequently ignored.
Keywords: Health Professionals, Nosocomial Infection. KAP study. Methicillin-resistant Staphylococcus aureus
Seasonal variation and Seroprevalence of Dengue fever in Karachi, Pakistan
Full text linkIntroduction: Dengue fever is a rapidly emerging arthropod born viral disease becoming an international public health problem. Approximately 500,000 people suffer from dengue hemorrhagic fever and dengue shock syndrome with 20,000 deaths annually.
Objective: To identify seasonal variation and seroprevalence of dengue fever for primary and secondary dengue infections.
Methodology: The study was conducted on 4900 plus subjects with mean age of 30 years, admitted to Dow University Hospital, Karachi. Reported cases were diagnosed by immuno-chromatography kit, used to measure the presence of IgG and IgM antibodies against dengue virus.
Results: Seasonal variation of seropositive dengue patient from 2010 to 2013 showed most prominent dengue fever disease onset found in the month of October whereas least seen in the months from Jan to April. Age wise younger subjects were more prone to the infection with mean age of 21 to 30 years. 64% of the total febrile seropositive cases were male as compare to female patients noted 36%.
Conclusion: Dengue disease is a threat to Pakistani population, being a developing country there should be more focus in eradicating this debilitating disease, to reduce the economic burden. Through adapting vaccination strategies, proper sanitation and awareness programs. Special campaign for sprays and dengue control measures prior to month of October and fall season should be adopted essentially on regular basis.
Keywords: Dengue fever, haemorrhagic fever, dengue virus, dengue Prevalence, Ig
Evaluation of anxiety and depression in chronic liver disease patients.
Full text linkObjective: To evaluate the risk factors of anxiety and depression in chronic liver disease patientsMethodology: In this longitudinal study seven hundred fifty-five patients (mean age 51+ 5 years, 59% males). All the patients were suffering from chronic hepatitis B, chronic Hepatitis C, Alcoholic liver disease and non-alcoholic fatty stomach disease. Questionnaires were included anxiety, using the Hamilton depressing rating scale (HDRS) and Hamilton anxiety scale (HARS), including socio-demographic, health status and family support. The criteria for inclusion in the study were having liver disease from last 15 months. Clinical functional and psychological assessments were performed.Results: In this study patients with depression was 59.3%, with anxiety 17.4% patients and both anxiety and depression were noted in 36.7% patients. After measuring and calculating all the variables score of depression and anxiety were recorded. A higher HDRS score was noted in patients older than 46 years (p=0.024). Patients with gastrointestinal bleeding had a prominent higher score of anxiety than those without bleeding (p=0.019). A higher HARS score was present in the women (p=0.011), unemployed patients (p=0.009) and those with alcoholic liver disease (p=0.006). There was direct correlation between the duration of disease and the value of HDRA and HARS score.Conclusion: In the chronic liver disease patients’ depression and anxiety are increasingly high with passage of time, gastrointestinal bleeding and unemployment. Increased prevalence of relax by patients are more likely to be due to the low acceptance of disease prognosis
Nocebo: Three cases
Full text linkNocebo effect is due to negative expectations of the treatment. It is belief which strongly influences the outcome of disease. Three cases presented here, have an irrational response to scientific medical procedures due to lack of trust. Agnosis leads to faith in superstitions
Efficacy of Lactulose Vs Lactulose with Rifaxamin in patients with Hepatic Encephalopathy: A Randomized Control Trial
Full text linkIntroduction: Hepatic encephalopathy (HE) is one of the deadliest complications of cirrhosis. The basic underlying pathophysiology is the increased production of ammonia which can cross the blood brain barrier and can influence in multiple ways. For managing HE various therapeutic regime have been tried in the past with varying degree of success grate and side effect profiles. Neomycin, Enema, Lactulose, Metronidazole, Vancomycin, Rifaxamin etc. are the various modalities used. Lactulose is the most widely used and Rifaxamin; an antibiotic is recently used with good success rate.
Objective: To compare the outcome of lactulose alone versus lactulose with Rifaxamin in cases with hepatic encephalopathy.
Methodology: A randomized control trial was conducted on indoor patients of medical departments, Mayo Hospital. Lahore from June 2017 to December 2017. The cases of hepatic encephalopathy of any grade within last 7 days of its onset with age range of 20-60 years were included. The cases with end stage cardiac or renal failure were excluded. The cases were divided into two groups; A and B. The group A was treated with lactulose alone in a dose to 20 to 100 ml per day to maintain stool frequency of at least 2 per day and the group B was treated with same amount of lactulose along with Rifaxamin in a dose of 550 mg thrice a day. The efficacy was assessed daily till there were no signs and symptoms of hepatic encephalopathy till day 7 where final outcome was seen to label efficacy or mortality as Yes or No.
Results: In the present study, 100 cases of hepatic encephalopathy were included. Out of these 50 were in each group. The maximum cases were in Child Pugh class in both groups comprising 26 (52%) and 25 (50%) in group A and B respectively. The mean age at presentation was 46.73± 9.13 years in A as compared to 51.25± 9.04 years in group B with p= 0.54. The efficacy in group A was seen in 28 (56%) of cases and in group B as 38 (76%) of cases with p= 0.01. This difference was also statistically significant in terms of mortality which was seen I n 22 (44%) of cases in group A and 12 (24%) in group B (p=0.01).
Conclusion: Combination of lactulose plus Rifaxamin is significantly better as compared to lactulose alone for the treatment as well as to reduce mortality in cases of hepatic encephalopathy.
Key words: Lactulose, Rifaxamin, Cirrhosis, Encephalopath
Outcome of everted end-to-end urethroplasty in traumatic bulbar and membranous urethra.
Full text linkIntroduction: Numerous options are available for the surgical management of urethral strictures. Everted End-to-end anastomosis is the utmost effective management for bulbar and membranous urethral strictures with a documented high success rate with low postoperative morbidity.
Methodology: This study was conducted at department of Urology, Lahore General hospital, Lahore from May 2012 till May 2014. Total 30 patients were included in the study. Procedure was done by a single surgical team and Uroflowmetry and subjective evaluation was done on 2nd week, 1st month and 4th month and 12th month post operatively.
Results: Mean age of patients was 24.43±12.39 years. Mean stricture length preoperatively was 1.83±0.63 cm. On follow up 50% of patients were in each grade whose subjective grading were 1 and 2 at 2 week post operatively. After 1-month post operatively 76.67% patients had Grade-1 and 6.67% patients had Grade-2. After 1 month follow up 63.34% patients presented with grade-1, 20% with Grade-2 and 6.67% presented with Grade-3. Only 80% of the patients at 4th month and 1-year post operatively presented with grade-1 subjective improvement. 10% of the patients had stricture recurrence at 1-month follow up and another 10% had recurrence at 4 months of follow up.
Conclusion: Everted End-to-end urethroplasty is treatment of choice for short traumatic bulbar and membranous urethral strictures with a high success rate.
Key Words: Urethral Strictures, Everted End-to-end Urethroplasty, Bulbar Urethra, Membranous Urethr
Determining the future direction of Curriculum reform process at a Public-Sector University in Saudi Arabia.
Full text linkIntroduction: Educational institutions have recognised the importance of evaluating academic curricula to keep up with dynamic changes in the field of medical education. The college of medicine at King Khalid University has acknowledged this trend and embarked on reviewing its curriculum.
Objectives: To evaluate the undergraduate medical curriculum using SPICES model of curriculum evaluation as a tool with the view to plan and shape future curriculum reforms at the college of medicine, King Khalid University.
Methodology: A questionnaire-based survey was conducted eliciting the responses of faculty members and the departmental chairmen regarding the practice of student centred, integrated and non-traditional teaching methods as well as a separate questionnaire for the quality of problem-based learning in practice. The compiled responses from all the respective departments were statistically analysed subsequently.
Results: An average of 43.5% of student-centred learning (SCL), 41% of Integrated teaching (IT) and 19% of Non-traditional teaching (NTT) is being employed in different departments of the college of medicine.
Conclusion: The results suggest that the college of medicine is currently carrying out traditional teacher centred, discipline based and information-oriented teaching along with small chunks of student centred, integrated and problem-based teaching methods. Although the problem-based learning is proportionately very small in practice but in general, its quality is better in the clinical departments as compared to the basic sciences departments.
Key words: Curriculum evaluation, curriculum review, medical education, educational strategie