Journal of Muhammad Medical College ( J Muhammad Med Coll)
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Demography and Histopathological presentations of oral and maxillo-facial region tumours in Jamshoro, Pakistan.
Full text linkIntroduction: Oral and Pharyngeal cancers are the sixth most common cancer globally. In developing countries, the annual incidence of oral cancer is around 275,000 cases while 130,300 cases of pharyngeal cancers excluding naso-pharynx. Salivary glands tumors are rare accounting for less than 5 % of tumors of head and neck region. The annual incidence of these tumors is 0.05 to 2 cases per 100,000 populations. Majority (over two third quarters) of salivary gland tumors occurs in the parotid glands of which most of them (2/3rd) of them are benign in nature. While most common parotid gland’s benign tumor is Pleomorphic Adenoma.
Objective: To assess the morphology and histopathological features of oral and maxillo-facial region tumours among the patients in Liaquat University Hospital, Jamshoro, Sindh.
Methodology: A Cross-sectional study was conducted at Liaquat University Hospital, Jamshoro. Data was collected regarding socio-demographic features, anatomical location of tumours and relevant history of patients admitted at surgical, medical and ENT units of Liaquat University Hospital, Jamshoro from January 2016 to January 2018. Histopathological diagnostic record was collected from Research and Diagnostic Laboratory of Liaquat University Hospital, Jamshoro.
Results: A total of 160 biopsies were collected from surgical, medical and ENT units of Liaquat University Hospital with maximum (43%) of biopsies were from ENT unit. Most (51%) tumours were benign and 37% were malignant in nature. These tumours of oral and maxillo-facial region were mostly (38%) located in parotid region. Histopathological findings of this study revealed that majority (51%) tumours were Pleomorphic adenoma while (20%) of malignant tumours were Mucoepidermoid Carcinoma.
Conclusion: Based on findings of the study, we conclude that the most common anatomical location of oral and faciomaxillary tumours, in either gender, is parotid region. The majority of oral and faciomaxillary tumours were benign; frequently occurring benign tumour was pleomorphic adenoma while most frequent malignant tumour was Muco-epidermoid Carcinoma.
Key Words: Faciomaxillary tumours, Salivary glands, Pleomorphic adenoma
Attitude of overseas Pakistani students towards modular examination.
Full text linkoai:mmcedupk_jmmcfinal.jmmc.mmc.edu.pk:article/8Introduction: Modularization an innovative initiative taken by educational institutes around the globe to increase the student’s productivity and efficiency.
Objective: The objective of this study was to determine the knowledge and attitude regarding modularization in overseas Pakistani students.
Methodology: A cross sectional survey was conducted at the International Medical College of one of the public sector university during December 2012 till February 2014. A total of 425 undergraduate students were approached through non-probability convenience sampling technique and requested to fill a semi structured questionnaire after taking written consent.
Result: According to the outset of this paper a total of 425 students were questioned. Among the total 189 students were male (44.47%) and 236 were female (55.52%) out of which the majority belonged from North America/Canada (79.06%). A vast percentage (48.94) invested of about 2 hours of study daily. 63.06% of students believed modular examination to be a fair system and 32.94% of students thought it to be a failure to affect any educational standards. 36% of students blame stress/load for their poor result and 31.06% agrees with the lengthy syllabus being responsible for their down showing GPA’s. 43.06% of students face hardships because of irregular attendance. The major complaint of students (39%) was their teaching style. 46.12% of students prefer to study from lecture notes. Thus, this study completely clears all the aspects of student’s performance in modular system of examinations and its flow and shortcomings. It is important that more effort should be put into cater to student’s stress, loads and make it an effective system to improve a student’s capability and efficiency.
Conclusion: The findings of this study can guide us to revise and reshape the assessment system practiced at various medical colleges in Karachi
Procedures for Obesity by Plastic Surgeons.
Full text linkTreatment of Obesity is always indirect because there is a generalized fat collection. Many surgeons have devised different methods which are either direct or indirect.Indirect methods: Are abdominal procedures where the size of stomach is reduced by different surgical methods and hence the size of stomach, so the absorption of food becomes limited.Direct Methods: Are insufficient to control the obesity; an attempt is made to show some of the procedures which can be used for not the generalized obesity but for localized collection of fat volume
An Audit of 138 Patients Admitted with Lump in the Neck in Surgical Department of Services Hospital Lahore, (SIMS)
Full text linkIntroduction: Neck swellings are very common problem in head and neck region. Causes are highly variable, ranging from simple treatable disease to a metastatic incurable carcinoma. The common causes may differ depending upon the different geographical location, gender and age of the patients. Therefore, the knowledge of local causative factors is important to avoid diagnostic delay. Commonly presenting head and neck masses are due to lymph node, thyroid and salivary gland enlargement. In third world countries, infective causes are most common. Malignant neoplasms were the second most common group. Therefore, frequent audit is necessary for prompt diagnosis and further work up.
Objective: An audit of 138 patients admitted with neck swelling in surgical department of a tertiary care Hospital of Lahore.
Methodology: This cross-sectional study was carried out at Department of Surgery, (unit-1) Services Institute of Medical Sciences Lahore, (SIMS) during January 2014 to July 2015. All patients who presented with neck swelling during study period were included. Diagnosis made after taking clinical history, examination and relevant laboratory work up.
Results: Out of 138 patients with lump in the neck, 93 (67.39%) were female and 45 (32.60%) were male. The commonest swelling is tuberculous lymphadenitis that is 34 (24.63%) and 9 (6.52%) were lymphoma and 4 (3%) with reactive hyperplasia. 49 (35.5%) arose from thyroid (40 benign and 9 malignant). Among the benign swellings, 15 were solitary nodular goiter, 12 were Multinodular goiter and 13 were diffuse thyroid goiter, 11 were Thyroglossal cyst. Other causes included sebaceous cyst 12 (8.69%), lipoma 19 (13.67%), thyroglossal cyst 11 (8%) and carcinoma of thyroid 9 (6.52%)
Conclusion: The most common cause of neck lump is thyroid disease and tuberculous lymphadenitis. Early diagnosis of tuberculosis and goiter is crucial for appropriate management.
Keywords: Head and Neck Swellings, Lymph Nodes, Tuberculous lymphadenitis, Goite
Assessment of Mortality and Causes after Re-bleed In Patients Having Endoscopy for Upper Gastrointestinal Bleeding
Full text linkIntroduction: Acute Upper gastrointestinal bleeding (AUGIB), with prevalence of 36 to 172/100,000 natives per year, is a common medical emergency. Mortality rate after UGIB ranges from 4–14% while re-bleeding is evident in 10–30% of these patients. Despite advances in treatment modalities of UGIB, the in-hospital mortality rate remains high and it is commonly due to re-bleeding. However, the causes and frequency of mortality among patients with re-bleeding are not well known in Pakistan.
Objective: To determine the frequency and causes of in-hospital mortality after re-bleeding among patients undergoing endoscopy for upper gastrointestinal bleeding.
Methodology: A descriptive cross-sectional study was done in Military hospital Rawalpindi from December 2014 to June 2015. A total 150 patients aged between 18 to 65 years who presented with upper gastrointestinal bleeding (UGIB) and underwent upper GI endoscopy and re-bleed were included through purposive sampling. Structured questionnaire used to record data. The patients were observed for mortality and causes after re-bleeding in the hospital for about 5 days. Patients who died, the cause of the death was assessed by 2 senior consultant physicians. SPSS version 21 was used for data entry and analysis. Variables like mortality were presented as percentage and frequencies. Effect modifiers like age and gender were controlled by stratification.
Results: The mean age of patients (n=150) was 43.97±12.28 years. Among total cases, 97 (64.7%) were males and 53 (35.7%) were females. The in-hospital mortality rate was 20% (n=30), re-bleed was cause in 12 (40%) while in 18 (60%) cause was other than re-bleed (cardiac, multi-organ failure, neurological, pulmonary, and advanced malignancy). Mortality in male patients was higher (n=18, 60.0%) as compared to female patients (n=12, 40.0%). The highest mortality (n=22, 73.3%) was observed in age group ˃43 years. The association of in-hospital mortality was statistically significant (p value = 0.02) by age but not by gender.
Conclusion: In-hospital mortality after UGIB is 20 %, frequent cause is other than the re-bleed. Male above aged 43 are more vulnerable. Management of UGIB should also focus on optimization of non-re-bleeding causes and other co-morbid related deaths instead of merely maintaining homeostasis and blood transfusions.
Keywords: Re-bleeding, Mortality, Acute Upper Gastrointestinal Bleeding, Upper GI Endoscopy
Risk Factors of Blood Transfusion during Caesarean Delivery in Rural Area of Sindh
Full text linkIntroduction: Hemorrhage is a leading cause of maternal deaths; particularly in developing countries. Bleeding in pregnant ladies is an indication of blood transfusion with all its attended risk.
Objective: This study was conducted to identify the factors necessitate blood transfusion during cesarean section.
Methodology: A total number of 2855 of pregnant women scheduled for emergency cesarean section or elective cesarean section at Bhurgri Hospital, rural area of Sindh, between July 2014 and December 2017. Participant were followed from the date of admission to the date of discharge and then for two weeks. Preoperative Hb level and the need for blood transfusion, clinical experience of obstetrician, indication for caesarean section, primary or repeat caesarean section and status of HBsAg/HCV were assessed.
Results: A total of the numbers of 4823 patients had deliveries from July-2014 to Dec-2017.Among them, 2855 patients underwent cesarean delivery, the ratio of cesarean section was recorded as 59.19%. All pregnant women who underwent cesarean delivery selected for our study. The mean age of the women who had surgery was 26 years.
Conclusion: Preoperative anemia, increasing parity, severe blood loss at surgery and status of HBs/HCV significantly contributes to require for blood transfusion in pregnant women undergoing a surgery (cesarean section).
Keywords: Caesarean section, Blood product transfusion, Risk factors, Anemia, HBs, HCV
Risk factors associated with ectopic pregnancy: A case control study.
Full text linkIntroduction: Ectopic pregnancy (EP) accounting for 10% of all pregnancies is a major health problem for women of childbearing age and leading cause of maternal deaths. The identified risk factors are previous ectopic pregnancy, previous pelvic surgery, induction of ovulation, intrauterine device usage, history of pelvic inflammatory disease, and smoking at the time of conception.
Objective: To identify risk factor for ectopic pregnancy so that appropriate directional strategies may be developed to reduce its prevalence.
Methodology: This observational case control study was conducted with sample size of 100 (50 cases, 50 control) from January 2017 to 30 July 2017 at different hospitals of Sindh and Punjab. For this study, case was defined as a pregnant woman with a confirmed tubal ectopic gestation, while control as pregnant women with a confirmed normal intrauterine pregnancy. Information regarding demographic socio-economic status and risk factors were also collected.
Results: The case & control groups were almost similar with respect to age, education, residence, age of marriage and parity. There was a significant association between prior ectopic pregnancy (OR 15.47, CI 95% 1.92-124.3, p=0.00) , history of previous pelvic inflammatory diseases (PID) (OR 13.5, CI 95% 5.09-35.83, p=0.01), smoking (OR 15.47, CI 95% 1.92-124.3, p=0.00), history of endometriosis (OR 4.04, CI95%1.22-13.47, p=0.00), use of intrauterine contraceptive device (IUCD) (OR 5.41, CI 95% 1.66-17.65, p=0.00), and previous cesarean section(OR 2.42,CI 95%1.04-5.63, p=0.02).
Conclusion: Identification of risk factors for ectopic pregnancy may help in early detection and appropriate management. Risk factors modification, such as cigarette smoking, use of IUCD and first pregnancy interval may be effective as risk-reduction strategies.
Key Word: Ectopic pregnancy, Intrauterine contraceptive device, Pelvic inflammatory disease
Barbers’ awareness about Hepatitis B in Sindh Pakistan.
Full text linkIntroduction: Hepatitis B is the serious public health problem and a leading cause of chronic liver disease worldwide. HBV alone is responsible for 0.5-1 million annual deaths globally due to cirrhosis and hepatocellular carcinoma.Methodology: This Cross-Sectional study was carried out in 8 different union council of Khairpur Taluka/ tehsils in district KhairpurMirs district from December 2014 to April 2015. Selection of barbers was done through two staged cluster sampling. In first stage 8 different Union Councils (UCs) of Khairpur Taluka of KhairpurMirs district were randomly selected. In Second stage 25 Barbers from each selected UC practicing was included in the study after random selection.Objectives: Main purpose of the study was to assess the Knowledge, Attitude and Practice regarding Hepatitis B among barbers working in different union councils of Khairpur tehsil/ taluka of district KhairpurMirs.Results: Majority (19%) of our study participants belong to UC Shah Latif while large proportion (30%) of participants belongs to age group 26-30 years. When questions related to knowledge of Hepatitis B were asked from our participant, majority (84%) of them knew that hepatitis B is a disease, while only 9% of them said that using of already used razors or blades by barbers is the main mode of spread of hepatitis B and 27% of them said that using contaminated water the reason for spread of hepatitis B. Majority (46.6%) of participants replied that there is no any vaccine available for hepatitis B prevention. Surprisingly almost 65% of them don’t have any information about Government free hepatitis vaccination program. Half of the participants believe that changing of blades every time with every new client can also prevent spread of HBV. 76% of participants use to clean their instruments with disinfectants between the clients and 46% of them use new blades on every new client. Majority of the participants were not vaccinated for Hepatitis B.Conclusion: Findings of our study demonstrate that despite the many mass media health educational campaigns related to the awareness of Hepatitis B in Sindh, barbers in KhairpurMirs district had no detailed understanding of diseases.Keywords: knowledge, attitude, practice, Hepatitis B, Barbe
Prevalence and risk factors of Hepatitis B among pregnant women.
Full text linkIntroduction: Globally Hep C virus (HBV) a public health problem account for 2 billion infection and 400 million of them were chronically infected1,2,3. In Pakistan prevalence among general population is 4.3 % with carrier rate 3-5% (7-9 million) 4. The prevalence of HBV among pregnant women 5% (range 0.6% to >20%) worldwide, leading mother to child transmission causing fetal and neonatal hepatitis, attributed for 30% to 50% of chronic carriers.
Methodology: A cross-sectional study was conducted among randomly selected 140pregnantwomen attended the antenatal clinic of the District hospital of Rahim-Yar-Khan in June-July 2013. Rapid diagnostic tests kits were used to access for HB surface antigen (HBsAg). A face to face interview was carried out by using structured pre-tested questionnaire to obtain demographic and other information.
Results: 16(9.3%) out of 140 pregnant women were found to be positive for HBsAg, higher risk age group was 20-29 years 10(62.5%) , 16(100%) out of 16 infected women and 6(4.83%) out of 124 non-infected women had Negative history of HBV in Husband. Blood transfusion in last pregnancy was 14(87.5%) out of 16 infected women and 52(41.93%) out of 124 non-infected women. 10(62.5%) out of 16 infected women and 5(4.03%) out of 124 non-infected women has passed through dental procedures. Therefore, negative history of HBV in Husband, blood transfusion and dental procedures in last pregnancy were the most prevalent risk factors among infected women. Among the total 124, 76(61.29%) were vaccinated against HBV, while 0(0%) out of 16 infected women were not vaccinated.
Conclusion: Prevalence of the HBV among pregnant women in Rahim-Yar-Khan is of intermediate endemicity (11.4%). Past history of blood transfusion and HBV infected Husband was the most prevalent risk factor. Health education regarding risk factors, preventive measures should be given to pregnant women with the involvement of Lady Health Worker and mass media. Free screening and immunization of pregnant women should be incorporated in antenatal and postnatal program of hospital
Role of Beta Blockers and Band Ligation in upper gastrointestinal tract bleeding.
Full text linkObjective: To sort out the combine role of beta blockers and band ligation in upper gastrointestinal bleeding
Methodology: In this prospective observational study 563 patients were included, (mean age 47 ±6 years, males 69%) with liver cirrhosis and deterioration from Medical ward Mayo hospital Lahore. All the patients had cirrhosis and esophageal varices confirmed by endoscopy. In hospital cirrhotic patients with hypertension and liver cell deteriorations. All the record of betablocker use and band ligation was carefully recorded. Data regarding patient presentation and characteristics were keenly monitored and observe with treatment and improvement as major variables. Mortality was taken as major influential factor. Linear regression model was used.
Results: Overall, there were 426 patients getting pharmacological treatment and have band ligation treatment simultaneously. One Hundred and thirty-seven had gastrointestinal bleeding during study time. Standard deviation of patients who had no recurrence of bleeding from last two years was 67±4. Low level of serum albumin, presence of ascites, and treatment with betablockers were the only independent variables that directly influenced the bleeding. The percentage of patients who had only once bleeding during study period was 23±2 percent. The major effects by be ta blockers were preserving after band ligation of source of bleeding.
Conclusion: This study demonstrates that best treatment of bleeding in upper gastrointestinal tract is beta blockers, with the use of b and ligation where it is needed. Strict monitoring and guidelines should be under consideration before stop the beta blockers upper gastrointestinal bleeding patients.
Keywords: Beta blockers, Band Ligation, Upper Gastrointestinal Trac