Journal of Gandhara Medical and Dental Science
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Intradialytic Hypotension During Heamodyalysis
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Haemodialysis (HD) is a form of renal replacement therapy commonly prescribed for chronic kidney disease (CKD) patients. However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. The objective of this study was to determine the frequency of intradialytic blood pressure changes in chronic kidney disease patients on maintenance hemodialysis.METHODOLOGY
Patients with chronic kidney disease on maintenance hemodialysis were enrolled. Predialysis and immediate post dialysis blood pressure was recorded. Increase in postdialysis blood pressure by >20mmHg was called intradialytic hypertension and decrease by >20mmHg was called intradialytic hypotension.RESULTSA total of 203 patients on maintenance hemodialysis were enrolled. Age of the patients ranged from 18 to 50 years. Mean age of the patients was 39.80 ± 5.245 years. Male to female ratio was 1.8:1. Intradialytic hypotension was observed in 36 patients (17.7%) while intradialytic hypertension was observed in 22 patients (10.8%).CONCLUSIONIntradialysis blood pressure fluctuations such as hypotension and hypertension are common complications during hemodialysis. Intradialytic hypotension is more frequent
Culture-Based Identification of Causative Organisms in Ascitic Fluids of Patients with Spontaneous Bacterial Peritonitis Secondary to Decompensated Liver Disease and their Sensitivities to Ceftriaxone as an Empiric Therapy
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To identify the pathogens in the ascitic fluids of patients with spontaneous bacterial peritonitis and then to determine their sensitivity pattern to ceftriaxone.
METHODOLOGY
The cross-sectional study was conducted at the Medical Unit-A, Department of Medicine, Hayatabad Medical Complex, Peshawar, from November 2021 to April 2022. Before ceftriaxone treatment was started, a minimum of 10 ml of ascitic fluid was introduced into a blood culture vial. Only patients with a positive culture were registered, and their information was gathered using a proforma. For statistical analysis, SPSS version 23 was used.
RESULTSA total of 96 patients were enrolled in our study. There were 62 (59.52%) male and 34 (40.48%) female patients. Based on the isolation and identification of bacteria, the most prevalent bacteria isolated was Escherichia coli in 36 (37.5%) patients, followed by Acinetobacter Spp in 13 (13.54%) patients, Streptococcus spp in 14 (14.58%), Enterococcus spp in 11 (11.45%), Staphylococcus aureus in 9 (9.39%), MRSA in 8(8.33%) and K. Pneumonia in 5(5.21%) patients. The overall sensitivity of ceftriaxone to gram-positive bacteria was observed in 12 (42.85%) isolates, whereas the overall sensitivity of ceftriaxone to gram-negative bacteria was observed in 25 (36.76%) isolates. (p=0.091) (Figure 6).
CONCLUSION
Our study concludes that gram-negative bacteria were more prevalent than gram-positive bacteria in ascitic fluids of patients with spontaneous bacterial peritonitis. The most common isolated pathogen was E.coli. Gram-negative was more resistant to ceftriaxone as compared to gram-positive bacteria
Effect of Empagliflozin On Liver Enzymes of Patients In Non-Alcoholic Steatohepatitis In Type 2 Diabetes Mellitus
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To assess the effect of 10 mg and 25 mg once daily Empagliflozin on liver enzymes of patients of non-alcoholic steatohepatitis in patients of type 2 diabetes mellitus (T2DM).
METHODOLOGY
The study design was Quasi Experimental. Thirty three adult patients of Type 2 diabetes mellitus (T2DM) who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycemic control (HBA1C > 7% <12%), had elevated Alanine Transaminase (ALT) levels and had ultrasonographic features consistent with non-alcoholic fatty liver disease (NAFLD) were divided into three groups, one group receiving 10 mg Empagliglozin as add-on treatment (Group A), the second group receiving 25 mg of Empagliflozin (Group B) as an additional treatment, and the third group continued with previous medications without any additional treatment (Group C). HbA1C levels and ALT levels of all the three groups were taken at baseline and at 12 weeks. RESULTS
Total patients and their mean ages in group A, B and C were 10, 12 and 11 and 52.40 ±4.24 years, 52.42 ± 5.27 years and 52.34 ± 4.37 years, respectively. There was a statistically significant (p > 0.05) decrease mean ALT levels in Group A pre-treatment and 12 weeks post-treatment. Similarly, there was a statistically significant (p > 0.05) decrease mean ALT levels in Group B pre-treatment and 12 weeks post-treatment.CONCLUSION
Empagliflozin in both 10mg and 25 mg once daily doses cause statistically significant reduction in ALT levels in patients with NASH associated with T2D
Effectiveness of Foleys Intrauterine Balloon Tamponade in Management of Postpartum Haemorrhage and Factors Associated With its Failure; A Tertiary Care Experience
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To evaluate the effectiveness and factors associated with the failure of intrauterine balloon tamponade (IUBT) in managing postpartum hemorrhage (PPH). METHODOLOGY
We conducted a retrospective observational study including data from 160 patients aged 21-30 years at the Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, managed for PPH with IUBT, after failed medical treatment from Jan 2020 to December 2021. Data were collected retrospectively in three months, from January to March 2022. IUBT was successful if, after 24 hours of insertion, no or less than 100ml bleeding occurred.RESULTS
Among the patients managed by IUBT, the majority had uterine atony (81.25%), 17.5% had lower segment hemorrhage, and 1.25% of cases had a placental abruption. The mean estimated blood loss was 1263.7±398.7 ml. The procedure was successful in 89.3% of cases. Sixteen patients underwent a hysterectomy for failed IUBT. There were six maternal deaths, mainly due to acute renal failure and disseminated intravascular coagulation (DIC). Between the successful and unsuccessful cases of IUBT, there was a statistically significant difference in the gravidity, mode of delivery, gestations, booking, peripartum BP, pulse rate, hemoglobin, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), blood loss during the procedure, DIC, and intensive care unit admissions (p<0.00). The median hemoglobin, hematocrit, platelets count, and lymphocytes were significantly higher before IUBT insertion (p<0.00).CONCLUSION
IUBT is an effective, easy-to-use, inexpensive, and safe tool in the management of PPH. Low hemoglobin, thrombocytopenia, high PT, aPTT, and DIC are associated with low success rate
Positivity of Lumbar Puncture for Acute Bacterial Meningitis among Children Presenting with First Febrile Seizure
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To determine the frequency of lumber puncture-proven acute bacterial meningitis among children with fever and seizures of first onset.METHODOLOGY
From March 2020 to March 2021, a hospital-based descriptive cross-sectional study was conducted at the paediatrics department of Hayatabad Medical Complex Peshawar. The sample size for a total of 342 people was estimated using WHO software. The study included all children who had first-onset febrile seizures through OPD and the emergency department. All children underwent lumber punctures using a stringent aseptic procedure, and the hospital laboratory received the samples to look for bacterial meningitis. On a pre-made Proforma, details including name, age, and gender were entered. The gathered data were input into the computer for additional SPSS analysis (version 23).RESULTS
Most individuals were male and were lies in the 21-40 months of age group. Mean weight and length/height were evaluated, respectively. The majority had a history of 6-10 days of disease duration. Bacterial meningitis was found significantly (p<0.05) associated with age, gender and neurological deficit, while non-significantly (p>0.05) associated with the duration of diseases.CONCLUSION
All children between the ages of 6 months and 60 months who presented with episodes of fever and seizures were found to have a statistically significant (p<0.05) association found among bacterial meningitis and age groups
Frenectomy Using Diode Lasers: A Case Report
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Lasers are used in almost every aspect of dentistry, be it surgeries, restorations, periodontal procedures, and even aesthetic dentistry. One certain area that requires extra emphasis and importance is the laser-assisted frenectomy. Frenectomy, as the name suggests, is the excision of frenum attachment to the underlying bone. Frenectomy is carried out in the mandible as well as the maxilla. This is a case of a patient undergoing orthodontic treatment who also required a frenectomy, and to minimize the postoperative pain and swelling, the procedure was carried out using a diode laser rather than the conventional surgical procedure
Smart Phones and Personal Listening Devices - Tinnitus & Hearing Impairment in Adolescent and Young Adult Earphone Users
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To determine the frequency of tinnitus & hearing impairment in adolescent and young adult earphone users with smartphones and other personal listening devices.METHODOLOGY
This prospective & descriptive study involving children with glue ears was conducted in the ENT Department of Medical Teaching Institute, Hayatabad Medical Complex, Peshawar, from Jan 1, 2022, to Sep 30, 2022. Personal listening device (PLD) users aged 12-25 years with complaints of tinnitus and hearing impairment were examined. Conductive hearing loss was excluded by audiological testing. The frequency of resultant hearing loss and tinnitus was calculated. The information obtained was analyzed using SPSS v 26.0 for windows. A Chi square test was performed to determine the significance of tinnitus & hearing impairment in earphones and other PLD users.RESULTS
A total of 163 patients were included in the study. The patient’s age range was 12-25 years, with a mean age of 18.03 years and a standard deviation of ± 3.575. There were 117 males and 46 females. The male: female ratio was of 2.54:1.Tinnitus was present in 73% and Hearing impairment in 54.4% of the patients. The chi-square test and p-values determined showed that both tinnitus and hearing loss occurred in many patients using personal listening devices.CONCLUSION
Tinnitus and hearing impairment occurs in a significant number of those who use personal listening devices. Their inappropriate use can lead to auditory system damage. It is recommended that PLD users undergo periodic audiological testing to detect early hearing loss and tinnitus to minimize damage to the ear
Assessment of Oral Stereognosis and Denture Satisfaction in Old Denture Wearers: A Retrospective Study
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Stereognosis has been investigated occasionally to predict the prognosis of treatment with complete dentures. This study evaluated oral stereognosis and satisfaction levels in completely edentate patients wearing prostheses for at least three months.
METHODOLOGY
From November 2014 and January 2016, data from 322 patients' follow-up visits were collected from records of the Prosthodontics department at Liaquat University of Medical and Health Sciences, Jamshoro. Denture satisfaction was assessed using a self-structured proforma, and oral stereognosis was measured using different-shaped objects made from self-cure acrylic resin, kept in the oral cavity without showing them to the patient. The frequency of qualitative variables was determined for data analysis, and a chi-square test was applied. Significant P-values were defined as those less than 0.
RESULTSThe male-to-female ratio was 1.2:1, with 50.9% wearing a prosthesis for less than a year and the minimum range being 3-6 years (13.66 %). Only 31 had stereognosis positive but were completely satisfied with their prosthesis, while 85 who were unsatisfied were found to have positive sensory perception. Statistical analysis for all groups shows a p-value of 0.000 for patient satisfaction with denture wear which is statistically significant. Most patients with the least duration of wear found their stereognosis positive and were unsatisfied with the prosthesis and vice versa. The chi-square test shows a statistically significant value for both groups of stereognosis i-e 0.0001..
CONCLUSION
Patients with the shortest period of wear were found to be more dissatisfied, but their oral perception remained intact, while those with more experience complained less but had reduced stereognosis
Nosocomial Transmission of SARS CoV-2 in a Tertiary Care Hospital in Peshawar, Pakistan
Full text linkObjective
The study aimed to determine the frequency of nosocomial transmission of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) in a tertiary care hospital in Peshawar, Pakistan.
Methodology
This cross sectional, analytical study was carried out in Hayatabad Medical Complex, Peshawar, Pakistan from 1st June 2021 to 31st August 2021. Consecutive patients aged 18 years and above admitted for conditions other than COVID-19 with a negative rapid antigen test for COVID-19 at admission were included. Patients with respiratory symptoms or those who were hospitalized for any reason in the preceding six weeks in any health care facility were excluded. The study protocol was completed by 90.9% of participants. The rapid antigen test was repeated for participants at the time of discharge or symptoms suggestive of COVID-19. Patients with a positive rapid antigen test for COVID-19 either at the time of discharge or symptom onset were considered to have acquired nosocomial SARS-CoV-2 infection. Statistical Package for the Social Sciences version 21 for Windows was used for data analysis.
Results
The frequency of nosocomial transmission of SARS-CoV-2 was 2.7% (13/482). Patients with nosocomial COVID-19 stayed longer in the hospital than those who tested negative (7.5±4.0 versus 4.8±3.6 days; p=0.006). Age (p=0.796), gender (p=0.453), department of inpatient stay (p=0.943), major surgery (p=0.678), minor surgery (p=0.576), and visit to the radiology department (p=0.707) did not affect nosocomial spread of SARS-CoV-2.
Conclusion
Nosocomial transmission of COVID-19 was infrequent, accounting for 2.7% of participants in this study
Effects of Exposure Time to Sun on Hair Fall During Lockdown in Covid Pandemic
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The study aimed to assess the effects of quarantine on non-scarring hair fall and to determine the relationship between sun exposure and hair fall.
METHODOLOGY
This cross-sectional study was conducted in Karachi from January to June 2022
. Ethical approval was taken from the institutional ethical review committee. Participants were recruited by non-probability convenience sampling technique after obtaining informed consent. Those with dermatologic diseases of the scalp (cicatricial alopecia, alopecia areata, seborrheic dermatitis, infections), high-stress levels, post-pregnancy, thyroid disorders, hormonal disorders and COVID-19 were excluded from the study. Hair loss was assessed using a self-filled questionnaire regarding the history of comorbidities, demographics, education, institute status during quarantine, hair fall experience and personal habits.
RESULTSThe study consisted of 137 participants after exclusion criteria were applied. Among these, 95.6% complained of increased hair fall during quarantine. Most participants were women (63.4%) compared to men (36.6%). The average age of the hair fall group was 20 years. Only 15.3% of participants spent more than 1-2 hours in the sun, and the majority had their hair covered when going out during quarantine.
CONCLUSION
Hair fall is high during quarantine, particularly among women of young age group. Personal habits and exposure to the sun for a short time at noon can affect hair fall in quarantine, although no direct correlation was found. Hair fall during lockdown is inversely related to certain comorbidities