Journal of Gandhara Medical and Dental Science
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Diagnostic Yield of Blood Cultures among Patients Admitted with Non-Focal Pyrexias
Full text linkOBJECTIVES
To establish the diagnostic yield of blood cultures among patients admitted with non-focal pyrexias.
METHODOLOGY
This descriptive cross-sectional study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar, from August 2020 to April 2021. One hundred ninety-seven patients with non-focal pyrexia were recruited. Data about age, gender, presence of other illnesses like diabetes and hypertension, history of smoking and duration of fever were noted. A thorough clinical evaluation was done. Under aseptic conditions, 2 blood culture sets were taken. The final blood culture report was collected after 5 days of incubation in culture media. The culture was labelled positive if any organism was isolated from the sample. All data was entered in specially designed proforma. Patients with positive blood cultures were managed as per hospital protocols. Confidentiality of data was ensured.
RESULTSOur study shows that among 197 patients, 18(9%) had positive cultures, while 179(91%) did not yield any pathogen on blood culture. Escherichia coli was the most commonly grown organism among the positive blood cultures.
CONCLUSION
The yield of blood culture was 9% in febrile patients admitted to the medical ward of a tertiary care hospital
Assessment of Metered-Dose Inhalers with Spacer Technique among Postgraduate Trainees
Full text linkOBJECTIVES
Most obstructive airway disease medications are used via inhalers, and their proper use is significant for effectively treating these diseases. Most patients misuse it. However, some studies showed that many physicians also do not know the proper meter dose inhaler with the spacer technique. This study aimed to assess metered-dose inhalers with spacer technique among postgraduate trainee doctors.
METHODOLOGY
This cross-sectional study was carried out in the Khyber Teaching Hospital Peshawar. The total time was six months, from Dec 6 2020, to Jun 5 2021. Postgraduate trainee (PGT) doctors of either gender with an age range of 25 to 35 years were included in the study from different departments. Those with every use of inhalers were excluded from the study. Demographic details of PGTs, like age and gender, were recorded.
RESULTS
Among 96 patients, males were 85 (88.54%), and females were 11 (11.46%). The mean age was 30.02±1.84 years, and the mean training experience was 2.0521 ±0.89. Inhaler technique was Proper in 20 (20.83%), Improper in 51 (53.13%) and Poor in 25 (26.04%) doctors. Those with more training periods, pulmonology rotation, attended workshops on inhaler techniques and with relatives using inhalers were more acknowledged of proper meter dose inhalers (MDIs) with spacer technique.
CONCLUSION
Only one-fifth of the postgraduate trainees know proper MDIs techniques. The attendance of workshops and pulmonology rotation is encouraged to enhance the knowledge of physicians regarding MDIs techniques
To Determine the Decision to Delivery Interval in Category I Emergency Caesarean Sections in A Tertiary Care Hospital of Peshawar
Full text linkOBJECTIVES
The aim of our study is to determine the exact timing of the decision to the delivery interval in grade I caesarean sections, the factors contributing to the delays and the indications of those caesarean sections.
METHODOLOGY
This descriptive(cross-sectional) study is conducted in the Gynae B unit of Khyber Teaching Hospital, Peshawar from 1st April 2020 to 30th September 2020 over a span of 6 months. It is a consecutive non-purposive sampling. All women of any age or parity who underwent an emergency grade I caesarean section were included in the study. Age, gestational age, booking status, obstetrical history, the decision to delivery interval, an indication of caesarean, and mode of anesthesia was noted and entered in predesigned proforma.
RESULTS
114 patients underwent grade I caesarean in the study period.61(54%) were 21-30 years age group and 48(42%) were in the 31-40 years age group.26(23%) patients were not delayed.31(27%) got delayed as Operation Theatre table was not available,18(16%) could not arrange Caesarean medication and consumables in time,17(15%) could not provide preop investigations in time, in 13(11%) cases patient’s attendants were not available. Fetal distress was the most common cause (33%) of delayed caesarean sections, followed by previous scars in labour (20%), placenta previa with APH (13%), obstructed labour (12%), placental abruption and CPD in labour in 8% each. Spinal anaesthesia was given in 79% and General anaesthesia was given in 21% of cases.
CONCLUSION
26(23%) patients were not delayed and their decision to deliver interval was less than 30 minutes. The decision to the delivery interval in Khyber Teaching Hospital was far longer than recommended. The leading causes are delayed arrangement of the OT table, OT stuff and investigations
Mucocutaneous Manifestations of Covid-19 in an Isolation Unit of Peshawar, Khyber Pakhtunkhwa
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This study aimed to determine the frequency of mucocutaneous manifestations in patients with COVID-19.
METHODOLOGY
This prospective cross-sectional study was conducted in the isolation ward of Hayatabad Medical Complex, Peshawar, for COVID-19-positive patients from 20th June to 30th July 2020. One hundred and twenty COVID-19-positive patients were included in our study. Patients fulfilling the inclusion criteria were subjected to a detailed clinical history and mucocutaneous and systemic examination. Relevant investigations were done. Data was recorded in predesigned proforma and analyzed for various statistical variables.
RESULTS
Among 120 patients included in our study, 87 were male and 33 female. Most patients belonged to the age group 21-40 years. A total of 17 patients showed mucocutaneous manifestations. Generalized pruritus and petechial rash were the most common, and the maculopapular rash were the least common. Mucosal involvement was seen in 2 patients.
CONCLUSION
Mucocutaneous manifestations are essential clues in the diagnosis of COVID-19. Early recognition may help in the effective management of patient
Dural Tear, a Feared Complication of Spine Surgery
Full text linkOBJECTIVES
To investigate the incidence, risk factors and clinical presentation of complications in patients undergoing spinal surgery with and without Dural Tear.
METHODOLOGY
A one-year prospective case-control study was conducted in the department of orthopaedics and spinal surgery at the Hayatabad Medical Complex (HMC) and Rahman Medical and surgical centre Dagger Buner. The spine surgeon used a discrete surgical approach. The questionnaire was used to collect patient demographic data, surgical information, and data on perioperative and postoperative complications. SPSS version 21.0 statistical software was used for all statistical analyses.
RESULTS
Dural tears were observed in 3.4% of the patients, among whom 20% experienced a Dural leak. After controlling for potentially confounding variables of age, sex, primary disease, and type of procedure, the surgery-related complications that were more likely to occur in the Dural Tear group than in the non-TD group were surgical site complications OR 2.69 and postoperative neurological defect O 3.28. The proportion of postoperative delirium OR 3.22 was significantly high in the Dural Tear group as perioperative complications
CONCLUSION
A higher proportion of surgical site infections, postoperative neurological defects and delirium in the Dural Tear group are due to direct complications, such as Dural leakage
Bacterial Profile and Antimicrobial Susceptibility Pattern in Septicemia Suspected Children and Available Treatment Options
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Septicaemia (blood poisoning) is one of the chief sources of global morbidity and mortality in pediatric patients and presents with multidrug and extensive drug resistance. This study aims to detect the major causative agents, antimicrobial susceptibility patterns and associated factors of bacteraemia among pediatric patients.METHODOLOGY
This retrospective cross-sectional study was done at National Medical Center, Karachi microbiology laboratory. Clinical specimens consist of blood. Blood samples were processed in BACTEC's automated blood culture system, and positive samples were sub-cultured on blood, Mac-Conkey. Final identification was done by API 20E and API 20NE (Biomerieux) and confirmed by MicroScan (Beckman coulter)®. The antimicrobial susceptibility was performed by using Bauer– Kirby disk diffusion method.RESULTS
A total of 395 pediatric patients were taken in the study. Out of these patients, 226 (57.2 %) were female. The children with age 1-4 years were highly affected. Almost 50% were handled in emergency and transferred for admission. 36.2% of patients were exposed to intravenous devices. 89 (22.5%) patients had a history of prolonged use of antibiotics. Most patients with pneumonia presented with septicemia as a complication, and were detected by Klebsiella pneumonia (35.4%), Acinetobacter bauminii (25.3%) and Pseudomonas aeruginosa (20.3%). CONCLUSION
The study revealed that gram-negative organisms are the predominant causative organisms of septicaemia. Antibiotic resistance to Carbapenem is gradually increased in the case of Acinetobacter bauminii and Escherichia coli. These issues can be overcome by early detection of microorganisms and establishing antibiotic stewardship
The Challenges Faced By Dental Students in Studying Oral Pathology Online During Covid-19: A Cross-Sectional Study
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The way of practising and teaching dentistry has changed significantly worldwide due to the COVID-19 pandemic, and the impact on dental education should not be neglected. Therefore, sharing experiences about online teaching from in-person education is essential to a better learning process during this period. This study aimed to assess the challenges faced by dental students in studying oral pathology online during covid-19: a cross-sectional study.
METHODOLOGY
It was a descriptive cross-sectional study in the Department of oral pathology at Altamash Institute of dental medicine to assess the challenges students faced during the COVID-19 pandemic. A total of 110 participants were approached, and among them, 105 participants responded. Of 105 participants, 78% were females, and 22% were males. Data were analyzed using SPSS version 23.RESULTSAlmost 93.3% of the students felt in-person lectures are more effective than online lectures. Fourth-year students showed higher satisfaction with the number of online tutorial / practical classes taken to provide an in-depth view of the subject than 3rd year students (8.8% vs 91.2%, p=0.045). Fourth-year students showed significantly higher satisfaction with several online theory classes to provide an in-depth view of the subject than 3rd year students (p=0.045).
CONCLUSION
The present study concluded that most students prefer in person classes over virtual learning and face a lack of online interaction with the faculty.
Study of Postdatism with Respect to Fetomaternal Outcome at A Tertiary Care Hospital
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This study aims to know our setup’s fetomaternal pregnancy complications that extend beyond 40 weeks of gestation. METHODOLOGY
This is a prospective cross-sectional study of 390 patients with uncomplicated postdated pregnancies fulfilling the inclusion and exclusion criteria admitted to the department of Obstetrics and Gynecology (both in spontaneous labour and induced patient) at Hayatabad Medical Complex, a tertiary care hospital in Peshawar, KPK from July 2020 to June 2021.RESULTS
Out of 390 patients, a majority (72.30 %) were in the age group of 20 – 35 years. Most of them (50.51%) presented at gestation 40+1 – 40+6 weeks. The majority (57.69%) were multigravida, and most (93.07%) were un-booked. Most delivered vaginally (80.51%), and 19.48% had C/section (including both emergency and elective). The most common indication for C/section was fetal distress (44.73%), followed by C/section on demand (18.42%). The majority>90% had Apgar score greater than seven at 5 minutes which was gestation dependent. Overall perinatal mortality was 4.07% which was also gestation dependent ranging from 0.5% at 40+1 – 40+6 weeks to 2.30% at and beyond 42 weeks of gestation. Neonatal morbidity in the form of Birth asphyxia, Meconium Aspiration Syndrome (MAS), Shoulder Dystocia and NICU admission also showed an increasing tendency with increasing gestation beyond 40 weeks. Maternal morbidity in the form of PPH, perineal tears 3°/4° and endometritis also showed a similar increasing trend with increasing gestation beyond 40 weeks. CONCLUSION
Pregnancy continuing beyond 40 weeks has a definite risk to the fetus.
Assessment of Polycystic Ovarian Syndrome Knowledge among Unmarried Women Seeking Care at Secondary Healthcare Facilities
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This study aims to assess the level of awareness regarding polycystic ovarian syndrome (PCOS) among young, unmarried females attending secondary healthcare institutions.
METHODOLOGY
A cross-sectional study was conducted at a rural hospital between January 2022 and December 2022. Ethical clearance was obtained prior to data collection. A pre-designed proforma was employed to gather information from participants visiting the Out-patient Department (OPD). Data collection utilized a non-probability sampling technique, and subsequent analysis was performed using SPSS version 24.
RESULTSThe study’s findings pertaining to knowledge levels, participants with no formal education constituted 24.03%, while 6.20% had completed high school and 3.87% held master’s degrees. Information on PCOS was relayed by sisters/cousins (13.17%) and mothers (20.25%), and 32.55% expressed hesitancy in seeking information due to shyness. Menstrual irregularities included polymenorrhagia (24%), oligomenorrhea (33%), amenorrhea (15%), and irregular periods (28%). Clinical deviations encompassed menstrual abnormalities (37%), abnormal male hair type distribution (12%), infertility (16%), mood disorder (7%), dyslipidemia (17%), and hypertension (11%).
CONCLUSION
The study underscores the need for well-structured educational initiatives to enhance comprehensive awareness of PCOS symptoms, facilitate early diagnosis and treatment, and ultimately improve overall well-being
Incidence of Port Site Infection After Laparoscopic Cholecystectomy: Our Experience at Hayatabad Medical Complex
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This study aimed to assess the factors that affect post-laparoscopic cholecystectomies PSI and determine which characteristics can be changed to prevent PSI in a trial to maximize the benefits of laparoscopic surgery.METHODOLOGY
The study included all patients who experienced port site infection following laparoscopic cholecystectomy. All patients received Inj Ceftriaxone 1gm pre-operatively & then twice a day postoperatively for 03 days. In all operations, the gallbladder is removed from the epigastric port without using a retrieval bag by skilled surgeons employing four-port methods and reusable equipment. Most patients had the sub-hepatic tube drain placed and were discharged the day after surgery.RESULTSAcute cholecystitis was the most common operative finding with port-site infection, i.e. 6(42.8%), second being empyema that was seen in 3(21.4%) patients, 2(14.3%) patients had bad adhesions, mucocele in 2(14.3%) patients and thick walled gall bladder with stones was found in 1(7.1%) patients respectively, indicating that the relationship between infection and acute cholecystitis is significant. Regarding the spills of bile, stones, or pus, 3(21.4%) patients had infections despite there being no spillage, while 11(78.6%) patients developed an infection while the spillage happened during their procedures. The p-value was 0.0001, meaning that the spillage might be considered a risk factor for the development of port site infection.CONCLUSIONThe spilling of bile, stones, or pus, the port of gallbladder removal, and acute cholecystitis are all strongly associated with port site infection. Given that Mycobacterium tuberculosis may be the source of chronic deep surgical site infections, more care should be exercised. The majority of PSIs are superficial and more prevalent in men