Journal of Gandhara Medical and Dental Science
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Self-Esteem as a Predictor of Psychological Adjustment to Limb Loss: A Case Study of Acquired Limb Amputation
Get PDFOBJECTIVES:
To examine the psychological issues following acquired limb amputation and examine the significance of positive self-esteem in the psychological adjustment of amputation.
METHODOLOGY:
This case study was conducted in the surgical and orthopedic units of different government and private hospitals of Peshawar district. The study includes a sample of 100 acquired limb amputees,both adult males and females admitted in different hospitals of Peshawar. Patients with congenital limb loss or with preexisting psychological issues were excluded from the study. Psychological adjustment scale developed by Sabir (1999) and Self-Esteem scale developed by Rifai’s (1999) was used to determine the amputee’s level of psychological adjustment and self-esteem.
RESULTS:
Results revealed that amputation leads to number of psychological issues. It was found that males had lowered self-esteem and severe adjustment issues then females while young amputees exhibit greater signs of maladjustment as compared to older amputees. Regression analysis for selfesteem predicting psychological adjustment also displayed pronounced differences in the level of psychological adjustment due changing level of self-esteem. The model suggested a strong positive relation between self-esteem and psychological adjustment (r=0.880, B=0.867, t=18.37, p<.001) and 77.5% of the variance in the dependent variable (psychological adjustment) was caused by predictor variable i.e. self-esteem (R2=0.775, F (98)=337.6, p<.001).
CONCLUSION:
Amputation badly disturbs the psychological state of an amputee and an amputee’s self-esteem is an important coping tool and has a direct relation with better psychological adjustment to limb loss
Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications
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To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital.
METHODOLOGY:
A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee.
RESULTS:
The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively.
CONCLUSION:
Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR)
Visual Outcome of Ocular Trauma in Patients Managed at Tertiary Care Hospital
Get PDFOBJECTIVES:
To determine the visual outcome of ocular trauma in patients admitted in the ophthalmology unit.
METHODOLOGY:
This descriptive cross sectional study was conducted after approval of ethical committee, from June 2017 till June 2019 at Ophthalmology Department, Medical Teaching Institution, Mardan Medical Complex, Mardan (MTI-MMC). A total of 501 patients of either gender having ocular trauma were enrolled in study. Following informed written consent, detailed history, ocular examination and investigations the surgical procedure was carried out. A pre-designed proforma was used to record the outcome along with demographics and type of trauma, which was analyzed using SPSS V-24.0.
RESULTS:
In a total of 501 patients the mean age of sample was 30.5±2.2. Among 501, males were 408 (81.44%) and female were 93 (18.56%) with ratio of 9:1. Ocular trauma was more common in age of <15 year with 174 (34.73%) patients. Professional injuries were more common and observed in 306 (61%) patients as compared to non-professional injuries in 195 (38%). Penetrating trauma occurred in 276 (55.08%) patients, which was higher than blunt 144 (28.74%) and perforating trauma 81 (16.16%). Good visual outcome was observed in 308 (61.47%), poor in 172 (34.33%) and blindness in 21 (4.1%) patients.
CONCLUSION:
The study concludes a better visual outcome for ocular traumas after surgical procedures. Young males were found to be more prone for traumatic injuries, in which professional and penetrating trauma leads the chart.
 
Pulmonary and Cutaneous Tuberculosis: A Simultaneous Presentation
Get PDFMycobacterium tuberculosis is an aerobic organism causing a disease commonly called tuberculosis (TB). Skin involvement is rare especially in association with pulmonary TB. It involves skin in a number of ways. Most of the time they are confused with systemic disease causing involvement of both pulmonary and extra pulmonary organs. Diagnosing such cases are challenging and in almost all cases histological confirmation is necessary. We are presenting a case with erythematous nodular skin lesion on nose, cheeks and on her back near scapular area along with chest involvement.
KEYWORDS: Pulmonary, Cutaneous, Tuberculosis, Granulomatous Inflammatio
Bacterial Profile and Antimicrobial Susceptibility Pattern of Aerobic Vaginal Pathogens in Gynae Patients Visiting to Khyber Teaching Hospital Peshawar
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The aim of this study was to determine the prevalent aerobic vaginal bacteria and their antibiogram to commonly prescribed antibiotics for the treatment of aerobic vaginitis (AV).
METHODOLOGY:
A total of 200 high vaginal swabs (HVS) samples were collected from different AV suspected patients visiting Khyber Teaching Hospital (KTH) and processed for identification of bacterial isolates followed by antibiotic susceptibility patterns as per CLSI protocols.
RESULTS:
Out of 200 clinical samples, 70 (35%) HVS isolates yielded bacterial growth. Of the isolates, E.coli was the common pathogen 36 (51.4%) followed by S.aureus 20 (28.5%), Enterobacter spp 08 (11.4%), Pseudomonas spp 04 (5.7%) and Citrobacter spp 02 (2.8%). The highest prevalence was observed in the age group of 21-35 years (31.4%) followed by age groups 16-20 years (25.7%) and 26-30 years. S.aureus isolates (n=20) were resistant to ciprofloxacin (90%), cephradine (70%), erythromycin (70%), gentamicin (50%) and cefotaxime (40%) while 1 (5%) of each isolate was resistant to methicillin and vancomycin. Majority of the gram-negative isolates (n=50) were resistant to cotrimoxazole, cephalosporins, quinolones, aminoglycosides and susceptible to carbapenems, tigecycline, sulbactam and tazobactam.
CONCLUSION:
Aerobic vaginitis should be treated very selectively in order not to kill the beneficial bacteria. Before treating AV, the causative agents should be accurately identified and tested for drug susceptibility patterns and empirical antibiotic therapy should be avoided
Postnatal Depression: Frequency, Demographic Characteristics and Risk Factors
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The iobjective iof ithe istudy iwas ito iestimate ithe iprevalence iof postpartum idepression iand iits iassociated irisk ifactors iamong imothers.
METHODOLOGY:
This icross-sectional istudy iwas icarried iout iin ithe iDepartment of iObstetrics i& iGynecology,iand iDepartment iof iPsychiatry, iKhyber Teaching Hospital iPeshawar 1st April 2018 till 31st March 2019. iA itotal i750 ipost-natal imothers iwere iscreened irandomly ifor ipostnatal idepression ifor ifirst i1-2 weeks ifollowing idelivery iby iusing iEdinburgh iPostnatal iDepression iScale (EPDS). 680 iaccepted ito iparticipate, i70 irefused ito iparticipate iand i504 ifulfill ithe inclusion icriteria. iA iscore iof i≥13 iwas iconsidered ihaving Ipostpartum depression.
RESULTS:
A itotal iof i168 iwomen ihad ian iEPDS iscore i10, iyielding ia icrude prevalence irate iof i34%. iThe iprevalence iof isuicidal iideation iwas i14 iout iof 504 (3%), iamong iwhich i11 i(79%) ihad iEPDS iscore iof i10. iWe ifitted multiple ilinear iregression imodels ito ievaluate ithe ipredictors iof ivariables measured ion ithe iEPDS. iThis imodel iwas istatistically isignificant p<0.0001 iin ipredicting ithe itotal iEPDS iscore. iWomen's iemployment istatus, domestic iviolence iand imarital iconflict iwere istatistically isignificant predictors.
CONCLUSION:
Thisistudy ireflected ithe ifacts ithat imany iof ithe ipostnatal mothers iof iour icircumstances isuffer ifrom ipostpartum idepression iand ineeds medical iattention. iScreening iof ipostpartum idepression ishould ibe iconsidered as ia iroutine ipart iof ipostpartum icare.
KEYWORDS: IPostpartum IDepression, Risk IFactors, Socio-Demographic IFactors, Pakista
Factors Influencing the Participation and Engagement of Dental Students in E-Learning During Covid-19 Pandemic
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To assess the factors that influences the participation and engagement of dental students in online classes.
METHODOLOGY:
A descriptive cross-sectional study was conducted using a pre-validated questionnaire with 45 barriers items used. The Cronbach Alpha value after removing certain items in our study was calculated to be 0.934, which resulted in 35 barrier items. Recorded data were coded and entered using SPSS version 23.0. Nominal data were presented as frequency and percentage, whereas all numerical data was entered as mean and standard deviation. Factor analysis on questions pertaining to barriers to e-learning was done.
RESULTS:
The underlying construct of the data was identified using principal component factor analysis. The type of rotation used was Varimax. The value of Kaiser-Meyer-Olkin measure for sampling adequacy (MSA) was 0.880. The criteria used for identifying factors were the latent root criteria. A total of six factors were identified. The overall variance explained by these factors was 61.9%. The barriers ranked the highest were those pertaining to motivational problems and time interruptions (2.8667±0.88524). The barriers that were ranked the lowest were those pertaining to instructors and personal problems (2.3894±0.81059).
CONCLUSION:
The biggest barrier was found to be motivational problems in attending online classes. The second-highest ranked barrier was social problems. The third barrier included a lack of support services. Technical barriers were ranked fourth. The barrier that was ranked fifth was a lack of pre-requisite skills. The barriers that were reported to be the least were problems pertaining to the instructor and personal problems.
KEYWORDS: Motivational Barrier, Social Barrier, Technical Barrier, Instructor and Personal Barrier, Pre-requisite Skill, Kaiser-Meyer-Olkin (KM
Diagnostic Accuracy of Clinical Tests in Knee Joint Injuries: A Single Centered Experience
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The accuracy of clinical tests (Lachman, McMurray, Anterior Drawer) in the diagnosis of knee joint injuries in comparison to arthroscopy taken as gold standard.
METHODOLOGY:
This cross-sectional study was conducted at the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar for 3 years. Total of 48 patients were recruited in the study. Data was collected after ethical approval from the hospital ethical committee using consecutive non-probability sampling techniques. Written informed consent was obtained from the patients. Arthroscopy examination was taken as a gold standard. Data analysis was performed using statistical software SPSS 21 and MEDCALC online software for calculating sensitivity and specificities of the clinical tests.
RESULTS:
Mean age was 26.4+6.5 years. Lachman and Anterior Drawer tests were noted to have 91.67% and 66.67% sensitivity for anterior cruciate ligament while McMurray test was noted only 66.67% sensitive for both meniscal injuries. On the other hand, Lachman was 95.8% specific, McMurray was 77.78%, and Anterior Drawer was 79.2% specific. Regarding accuracy, Lachman was 93.7%, McMurray 70.8% and Anterior Drawer was 72.9% accurate.
CONCLUSION:
Among clinical examination and specific examination tests, Lachman has high sensitivity, specificity and accuracy followed by Anterior Drawer test and MacMurray for diagnosing anterior cruciate ligament and meniscal injuries of knee joint
Pyogenic Granuloma: A Case Report
Get PDFPyogenic granuloma is a type of inflammatory hyperplasia of the oral mucosa and skin that occurs commonly. Histopathologically, it mimics an angiomatous lesion instead of granulomatous disease. These lesions generally appear as a sessile papule or solitary nodule and may have a smooth or lobulated surface clinically. These granulomas present in a variety of sizes, ranging from a few millimeters to several centimeters. About 75% of the pyogenic granulomas of the oral cavity are associated with the gingiva. In this case report a 31 years old female presented in the department of oral and maxillofacial surgery with the complaint of abnormal growth of gingiva in maxillary anterior region. The patient was diagnosed with the pyogenic granuloma (pregnancy tumor), which had developed in the second trimester of her pregnancy. Surgical excision was done to remove the lesion
COVID-19-A CHALLENGE FOR THE HEALTHCARE SYSTEM
No full textUntil the last century, coronavirus have been associated with non-severe respiratory infections in humans'. In December 2019, a new coronavirus was isolated in patients related to the Wet market in the city of Wuhan (China)². It rapidly spread across the world and has become the largest pandemic since the Spanish Flu in 1918. More than half a million people worldwide were infected by the end of March 2020 with an increasing number of deaths being reported³ The first COVID-19 case in Pakistan was reported in the end of February, since than the total confirmed cases of COVID- 19 are 261,914 and reported deaths of 5,522 and recovered cases are 198,509⁴. By now we are all aware of the symptoms of the still evolving disease, which can include cough, fever and chills, muscle pain, sore throat, shortness of breath and loss of taste and smell. It can also include gastrointestinal symptoms and headaches.
The year 2020 has proved to be a nightmare for the economy and health care; creating a panic situation across the world⁵. It is a three-fold challenge for the health care professionals: one concerning health care of the general population and prevention and control of infection in the community, secondly providing health care facilities for combating this critical situation, and thirdly safety and protection of the front-liners³. This is an uphill task for developing countries like Pakistan due to low socioeconomic reasons⁵. The virus is transmitted from human to human droplets putting the medical personnel at greater risk and requiring the use of full personal protective equipment (PPE) as they are in close contact with such patients. The shortage of PPE is a worldwide problem. Proper triage systems should be established at different health care centers for screening of suspected COVID-19 patients. Infected patients require critical care and assisted ventilation which needs professional training of staff who are involved in care of virus infected patients. High demand for ventilators and establishment of high dependency units on emergency basis is also a challenge. The emerging need for experienced frontline health care professionals is putting our skeletal health care system under a lot of pressure. As we are eagerly waiting for drugs and vaccines to combat this pandemic, the only option we have is to take precautions. However, health care professionals cannot stay away from the patients nor can they avoid contact with suspected cases of COVID-19. They are the frontline warriors fighting with full strength. They are under tremendous physical and mental stress. Many doctors across the world have lost their lives mainly in China and Italy, and several deaths have been reported in Pakistan. Apart from their health, they are at a high risk of transmitting the disease to family and friends. Many queries still need to be answered in research for best scientific evidence in order to prevent and control spread of COVID-19 and clinical management of infected patients. COVID-19 pandemic is a challenge for health care system globally, which should be combated with improvement in acquiring knowledge about the disease, spreading that knowledge to the common man and getting acclimatized with the new normal by changing our practice guidelines for providing best medical care. Public awareness and strict adherence to standard operational procedures cannot be stressed enough to control the spread of the novel coronavirus