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ISSN: 1025-9589
Publisher: Ayub Medical College
Country: Pakistan
Language: English
Subject Areas: Medicine (miscellaneous)
Frequency: Monthly
Homepage: Visit Journal Website
Abstract: The lower spread of COVID-19 in malaria endemic regions of world has been concluded in recent global COVID-19 data analysis. Scientists have compiled hypotheses about the relationships of these two infectious diseases; while some of those seem that have fully failed as malaria medications like Hydroxychloroquine were not effective in COVID-19 prevention. Our analysis of competition between ACE2 binding proteins as well as neutulizing SARS-Cov-2 antibodies revealed a similar structure to SARS-CoV-2 spike S1 protein in Plasmodium falciparum. Surprisingly, in an In-silico protein-protein interaction analysis, 20S proteasome alpha-4 subunit of Plasmodium falciparum had a better or equal binding affinity to ACE2 protein than SARS-CoV-2, based on a computational docking and MM/GBSA analysis. We hypothesized that prior encounter with Plasmodium falciparum in malaria endemic areas and the presence of asymptomatic variants of malaria in the body may render the human body to a competitive environment for SARS-CoV-2, as both infectious agents of malaria and SARS-Cov-2 may have a strong binding affinity to ACE2 protein. Keywords: malaria; COVID-19; Protein-Protein Interaction; vaccination
Authors: Afshin Avazpour, Ahmad Abolghazi, Alireza Doroudchi, Alireza Sadeghinikoo, Farshid Javdani, Mehdi Forouzesh, Mohammad Zarenezhad, Naser Hatami, Navid Kalani, Pouyan Keshavarz, Seyyed Abbas Hashemi, Shima Parsa
Abstract: Background: Justicia adhatoda is widely used in traditional medicine for treatment of menorrhagia, piles and bleeding disorders. Oral antiplatelet and anticoagulant drugs are routinely prescribed to patients with cardiovascular diseases. These drugs have one major adverse effect that they can cause spontaneous haemorrhage, which can be fatal. Development of a haemostatic agent can help in effective management of drug-induced haemorrhages. This study was devised to observe the effect of leaf extract of Justicia adhatoda on coagulation profile in mice and to evaluate its effect on in-vitro platelet aggregation. Methods: The study was divided into two parts. First part was designed to evaluate the effect of J. adhatoda leaf extract on coagulation parameters. Three drugs were used to induce coagulopathy viz., warfarin, aspirin and dabigatran. Bleeding time, platelet count, PT and APTT were estimated. Second part of this study was devised to observe the effect of J. adhatoda leaf extract on in vitro platelet aggregation of human. Percent aggregation was recorded by light transmission aggregometer for three minutes. Results Leaf extract of Justicia adhatoda decreased bleeding time from 6.1±2.36 minutes in normal control to 1.9±1.03 minutes in extract treated mice. There was no effect on the coagulation parameters. Platelet count increased significantly only in the aspirin treated group that received the extract to 540±46.8x103 /µl from 436.9±37.9x103 /µl of aspirin treated group. Platelet aggregation in vitro increased in a dose dependent manner. Conclusion: Justicia adhatoda leaf extract is effective in controlling excessive bleeding in vivo, in mice with acquired platelet defect produced by aspirin. This haemostatic effect is probably due to increased platelet aggregation as indicated by the in vitro results. Keywords: Haemostasis; Justicia adhatoda; platelet aggregation; coagulation; coagulopathy
Authors: Abdul Mudabbir Rehan, Kamran Zaman, Mahwash Malik, Nazia Rashid, Sadia Chiragh, Sehrish Zaffar
Abstract: Background: The most common complication of SLE is lupus nephritis (LN) causing high morbidity and mortality. The routine biomarkers used for the diagnosis of LN do not have the ability to predict the worsening in renal disease activity. Thus, there is need of a new biomarker leading to detection of flare in LN. The objective of this study was to assess the role of urinary neutrophil gelatinase associated lipocalin (uNGAL) as a predictor of renal flare in patients with lupus nephritis. Methods: Including a total of 84 subjects, 42 cases were lupus patients without renal involvement and 42 cases were lupus patients with nephritis (24 active nephritis and 18 inactive nephritis). The diagnosis of lupus nephritis was established on the basis of renal biopsy. uNGAL was estimated in both groups. Results: This study revealed that the nephritis group had increased levels of uNGAL as compared to systemic erythematosus patients without having lupus nephritis (p-value <0.05). Patients with active nephritis had increased uNGAL levels as compared to patients with inactive nephritis. Conclusion: From the findings in our study, it can be stated that uNGAL can prove to be a noninvasive, reliable and sensitive biomarker to predict flare in cases of lupus nephritis. Keywords: Neutrophil Gelatinase Associated Lipocalin; systemic lupus erythematosus; Lupus nephritis; Biomarker; Renal Disease Activity; Flare
Authors: Hijab Batool, Marium Shoukat, Tahira Naseem
Abstract: Background: Hepatopulmonary syndrome is severe pulmonary vascular complication of chronic liver disease requiring liver transplant. This study was conducted to evaluate different indicators of HPS in patients with portal hypertension, its varied aetiologies, clinical features & outcome. Methods: Hospital based descriptive study, 203 patients were enrolled, divided in to 2 groups positive and negative on the basis of presence or absence of HPS as per diagnostic criteria. Results: It included 203 patients with portal Hypertension of varied aetiologies. Age range was 8.76±3.69 years. 54.7% were male & 45.3% female. Commonest diagnosis for portal hypertension was portal vein thrombosis in 48 (23.6%) while Least common was biliary atresia seen in 6 (3%) of cases. Fifteen patients were included in Positive group and 188 in negative group. Clinical & laboratory parameters in order of frequency in positive group were hypoxia & cyanosis in 100% & 93.3% followed by dyspnoea & grade 4 clubbing in 86.6% patients (p<0.001). Child scoring was also done in all patients. In negative group 7 (3.7%) had dyspnoea, I (0.53%) had grade 4 clubbing while none showed evidence of hypoxia or cyanosis (p<0.001). Three patients underwent a successful liver transplant. One patient of biliary atresia & another of CHF expired. Conclusion: In All children with CLD and/or PHT with unexplained dyspnoea, cyanosis and grade 4 clubbing, HPS should be suspected. It is an indication for early LT even in absence of liver failure. Keywords: Hepatopulmonary syndrome; Arterial oxygen tension; PaO2; Alveolar-arterial oxygen gradient O2 gradient; contrast-enhanced echocardiography; CEE; technetium-99m Macro aggregated Albumin; 99 mTc-MAA, Liver Transplant
Authors: Hassan Suleman Malik, Huma Arshad Cheema, Iqra Mushtaq, Nadia Waheed
Abstract: Background: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)-ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. Methods: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. Results: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. Conclusion: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start. Keywords: COVID-19; SARS-CoV-2; Risk factors; Mortality; Clinical Laboratory Tests
Authors: Ayesha Zahid, Fatima Qayyum, Muhammad Zeeshan Haroon, Nasir Ahmed, Rashid Ali, Rizwana Hussain, Romana Irshad, Sabeen Sajjad, Sania Saleem, Sidra Qayyum Malik, Umer Farooq
Abstract: Background: Acute coronary syndrome (ACS) is one of the leading causes of death worldwide. It is characterized by the formation of coronary artery thrombus which can be either due to plaque rupture, plaque erosion or rupture of a calcific nodule. The aim of study was to assess the plaque morphology leading acute coronary syndrome using OCT and to guide management based on its findings. It was an observational study, conducted at Rawalpindi Institute of Cardiology from Jan to Dec 2019. Methods: Fifty patients meeting the inclusion criteria were included in the study. OCT procedure was performed following intracoronary injection of 100-150 ug of nitroglycerine. The imaging catheter (OFDI dragon view) of the OCT device (Terumo Luna wave OFDI, Tokyo, Japan) was inserted into the culprit artery. Blood clearance was achieved by injecting diluted iodinated contrast at the rate of 5 ml/sec. Imaging acquisition was obtained following automated pullback at the rate of 25 mm/sec. Pathologies like stent under deployment, mal-apposition, strut fracture, plaque erosion, plaque rupture were assessed by the operating interventionist well versed with the OCT technology and lesion assessment. Data analysis was done using the SPSS version 26. Categorical variables were presented as counts and percentages while continuous variables as mean±SD. Results: A total of 50 patients were included in the study. The mean age was 49.24±11.92. Majority of the patients were male comprising 78.0% of the cases. Plaque rupture was the most common underlying pathology seen in 32.5% of the patients and exclusively in STEMI patients which required stent deployment. Thin cap fibroatheroma was seen in 27.9% of the cases while lipid rich plaque in 23.2% of the cases; again, requiring stent deployment. 9.3% of the cases had plaque erosion while 4.6% had calcific nodule and only 2.3% had intramural hematoma which were treated conservatively. 42.8% of the stent thrombosis patients had under-deployed stents requiring balloon dilatation while 14.2% had mal-apposed stent again requiring balloon dilatation. In contrast 14.2% each had neo-atherosclerosis, stent strut fracture and uncovered stent struts as the underlying pathology for stent thrombosis each requiring stent deployment. Conclusion: OCT guided PCI in cases of acute coronary syndrome is a valuable modality that gives insight into the underlying pathology of the disease process and also guides in proper management. Keywords: Optical coherence tomography OCT; acute coronary syndrome (ACS); plaque morphology
Authors: Atif Nazir, Hamid Sharif Khan, Hazrat Ullah Khan, Iqra Ateeq Abbasi, Waleed Ahmed Abbasi
Abstract: Background: Wilson's disease is a genetically transmitted disease and has a variety of clinical manifestations. We evaluated the various clinical and biochemical presentations of Wilson's disease (WD) at different ages. Methods: This cross-sectional study was conducted in Shifa international hospital and Shifa Foundation Falahi Clinic (SFFC), Islamabad. Data from Jan 2010 to Dec 2018 was retrieved from hospital medical record on a structured proforma. All patients who had twenty-four hours urinary copper level of ‰¥100 mcg/day were included in the study. Their presenting symptoms, clinical signs and lab investigations were noted. Results: Mean age was 13±4.588 years. Male to female ratio was 1.5:1. Hepatic disease was seen in 35 (68.6%) patients mainly in <10 yrs age group. Pure neurological Wilson's was seen in 14 (27.45%) cases, which were >10 years of age while 18(35.3%) had hepato-neurological manifestations. Keyser Fleischer rings were present in 26 (51%) of total patients and 14 (100%) of neurological cases. Hepatic transaminases were elevated in 36 (70 %) patients. Low serum cerruloplasmin was seen in 37 (72.5%) cases. Mean value of haemoglobin was 10.38±2.772. Mean 24 hours urinary copper was 597.6±605.446. Consanguinity was seen among 33 (64.7%) families. Family history of WD was positive in 21 (41.2%) patients. Conclusion: Hepatic form of WD is more common, yet neurological presentation is seen in patients >10 years of age. Keywords: Hepatolenticular degeneration; Keysher Fleischer rings; Neurological; Wilson's disease (WD); Copper metabolism
Authors: Fareeha Farooqui, Munir Iqbal Malik, Naurin Ali, Sahira Aaraj
Abstract: Background: There are various implant choices to fix unstable per- trochanteric fractures.Theaim of this study was to compare the outcomes of dynamic hip screw and proximal femur nail for unstable per-trochanteric fractures including complications associated with both fixations. Methods: A retrospective analysis done on pertrochanteric fractures of femur who were treated with Dynamic hip Screw (DHS) and Proximal Femur Nail (PFN). The data was taken from our hospital hip data base for the past two years from January 2017 to January 2019. Data of 174 patients was analysed, divided in to Group A with DHS (n=122) and Group B with PFN (n=52). Follow up included X-ray (anteroposterior and lateral) views for fracture union and collapse, femur neck shortening, implant position and identification of mode of failure or collapse (cut out risk) by using tip-apex distance. The Harris hip score used to evaluate mobility status and other functional outcomes.Result: The mean age in years of patients treated with PFN and DHS were 55.9 and 59.8, ranging from 39-83 years. The mean of Harris hip score at 2 year was 69.28±9.99 in DHS group and 72.12±9.71 in PFN group with the p-value 0.31. The mean of limb shortening was 12mm in DHS and 9mm in PFN group. In DHS group, four cases had tip-apex distance of 39 mm and reported implant cut out that needs revision of surgery.Conclusion: Proximal Femur Nailgroup demonstrated no implant cut out and less mean limb length shortening whereas other parameter like functional outcomes, fracture union, rate of infection, hospital stay and postoperative pain are not significantly different in two groups. Keywords: Per trochanteric fracture;Dynamic hip screw;Proximal femur nail;Functional outcomes
Authors: Al Wardha Zahoor, Athar Muneeruddin Siddiqui, Kashif Memon, Zainab Aqeel Khan
Abstract: Background: Aspirin is one of the popular, economical, easily accessible and commonly used drugs all over the world. Injudicious use of this over-the-counter available drug is a common cause of nephrotoxicity. The aim of the present study is to assess the protective effects of Nigella Sativa (NS) on the histology of kidneys against aspirin-induced toxicity. It was an experimental study that included comparative analysis of control and experimental groups, conducted in the department of Anatomy, University of Health Sciences, Lahore, from October 2016 to December 2016. Methods: The study included thirty-two female albino rats which were equally distributed into 4 groups. Group A was run as control and given single oral dose of 1% methyl-cellulose (10mg/100gm body weight of rat). Group B and C were treated with a single oral dose of aspirin (1000mg/kg body weight) dissolved in 1% methyl-cellulose (10mg/100gm body weight). Group C animals were left untreated for 7 days. Group D was pre-treated on day 1 with oral dose of Nigella Sativa (NS) extract (250mg/kg body weight) followed one hour later by a single oral dose of aspirin (1000mg/kg body weight), subsequently NS extract was administered till day 7. Rats of group B were euthanized and dissected on 2nd day of experiment while those of groups A, C and D on 8th day. Kidneys were dissected out, weighed and fixed in 10% formalin. 5µm thick sections were yielded after tissue processing and stained with haematoxylin, eosin (H&E staining) and periodic acid Schiff's reagent (PAS staining). Histological parameters of distal convoluted tubules (DCT) were observed. Results: All histological parameters were normal in group A. Group B showed marked increase in epithelial necrosis, intraluminal protein casts and broken basement membranes of distal convoluted tubules. Group C showed no self-recovery. Statistically significant improvement was observed in the histology of distal convoluted tubules with treatment of Nigella Sativa extract in aspirin-ingested rats in group D. Conclusion: Nigella Sativa extract has shown protective effects on kidneys against aspirin-induced damage as shown by improvement in the histological parameters of distal convoluted tubules. Keywords: Kidneys; Nigella Sativa; Aspirin; Distal convoluted tubules; Methyl-cellulose
Authors: Areeba Haider, Rabia Sajjad Toor, Sania Asif, Sarah Khan, Sitwat Amna
Abstract: Background: Accounting for 30% cases of all lymphoid neoplasms, Diffuse large B cell lymphoma (DLBCL) is the commonest lymphoma worldwide. It occurs over a wide age range and has diverse morphology, immunophenotype and clinical outcome. Objectives of the study were to determine the frequency of Double expressor lymphoma (DEL) in a tertiary care hospital. Methods: This descriptive cross-sectional study was carried out in the Department of Histopathology, Rehman Medical Institute Peshawar from June 1st to December 1st, 2018. A total of 88 newly diagnosed cases of diffuse large B-cell lymphoma (DLBCL); diagnosed on incisional or excisional biopsies were included in the study by non-probability consecutive sampling. Statistical analysis was carried out using SPSS-23. Quantitative variables were calculated as mean±SD. Qualitative variables were computed as frequency and percentages. Post stratification chi-square test was applied keeping p value equal or less than 0.05 as significance. Results: In our 88 cases of DLBCL, 56 (63.6%) were males and 32 (36.4%) were females. Age of patients ranged from 15yrs to 84yrs. Mean age was 50.8±15.2SD. Activated B-cell like (ABC) subtype of DLBCL constitute 51 cases (58%) while 37 cases (42%) were of germinal centre B-cell like (GCB) subtype. Nineteen cases (21.6%) were of DEL. Cervical node was the commonest site of involvement (n=17, 19.3%) followed by stomach (n=10, 11.4%) and tonsil (n=6, 6.8%). Out of 19 cases of DEL, 17 cases (89.5%) were of ABC type. DEL was found to have significant correlation with ABC subtype of DLBCL (p=0.002). DEL had no correlation with gender (p=0.6), age (p=0.27), Mib-1 (p=0.36) and tumour site (p=0.42). Conclusion: The frequency of DEL in our study was 21.6% which is comparable to other studies who used similar cut-offs for c-Myc and BCL2 and similar criteria of inclusion as in our study. Significant association was found between DEL and ABC subtype of DLBCL. Keywords: Double protein lymphoma; Double expressor lymphoma; Diffuse large B cell lymphoma; Double hit lymphoma, Frequency
Authors: Maria Tasneem Khattak, Masroor Hassan, Muhammad Ashraf Qamar, Sarah Javed, Syeda Uzma Saeed
Abstract: Background: Combination of DAAs, Sofosbuvir and Ribavirin has been known as an effective treatment for HCV genotype 3. The aim of our study is to assess the efficacy of Sofosbuvir and Ribavirin in relapsed HCV genotype 3 patients. Methods: A cross-sectional retrospective analysis of hospital records between January 2015 and December 2016. Data was taken of only those patients who were followed for one year. A total of 193 cases were included in this study who were HCV genotype 3 relapsers and out of these 28 patients failed to be followed. Data was entered and analysed in IBM SPSS software package 23. Results: Out of the total 193 cases, 74.1% of cases achieved RVR at 4 weeks of therapy. ETR was achieved by 91.2% cases, while 8.8% of cases were non-responders. There was statistical significance in gender achieving ETR with a p-value of .008. 84.5% of cases achieved SVR-12. Statistical significance was noted between haemoglobin levels at presentation and 4 weeks follow-up with a p-value <0.005, and also between 4 weeks and 12 weeks follow-up with a p-value <0.005. Statistical significance was also found between age and PCR at 4 weeks (p-value of .002), age and PCR at 24 weeks (p-value of .051) and between ALT levels and PCR at 4, 12 and 24 weeks follow up (p-value <0.005). At 1-year follow-up, 79.3% of cases achieved a negative PCR, 28 patients failed to be followed, 6.2% of cases had a positive PCR. 5.5% of cases of the total 163 SVR cases had a relapse at 1 year. Conclusion: HCV genotype 3 patients can benefit from Sofosbuvir and Ribavirin. With the SVR of more than 80%, this combination is cost-effective and safe. Treatment duration should be dependent on RVR and viral load at 4 weeks follow-up. Keywords: HCV; Sofosbuvir; Ribavirin; Genotype; RVR; SVR
Authors: Ayehsa Hafiza Jawaid, Fatima Hafiza Jawaid, Hammad Muhammad Khan, Mohsin Ali Shah, Muhammad Saad, Noor Muhammad, Owais Muhammad Ali
Abstract: Background: Recently the Coronavirus pandemic presented with different manifestations in different parts of the world, both on clinical examinations and on imaging. CT Scanning (CT Scan) chest is used for detailed evaluation of the different characteristic patterns determining the depth of disease. The study is aimed to assess the variations in spectrum of Covid-19 CT findings and relating severity (CT Severity Score) with the Clinical Symptoms in Bahawal Victoria Hospital, Bahawalpur. Methods: In this cross-sectional study, patients referred to radiology department from outdoor for COVID screening were included from 1st May to 30th June 2020. Mean age range of patients was calculated, while presenting complaints and co-morbidities were tabulated in frequencies and percentages after analysis. Severity of symptoms and CT findings were correlated with biochemical and haematological tests. Results: Patients' age range from 25 to 85 years with 62% males and 38% females. Statistically no significant difference was observed in CTSS on gender basis. As sensitivity of RT PCR is about 70%, negative cases cannot be considered disease free and this is seen in this study as CT findings suggestive of COVID are seen in these patients. Using 40-point CT-SS, 11 patients had a score of >19 with severe diseases, while 14 patients had common disease with a score range of 11-18 and 35 patients had <10 score with mild or no symptoms. Conclusion: In this study, a spectrum of patchy ground glass opacities, bilateral peripheral predominantly lower lung consolidations were observed. Quantitative analysis of inflammatory process as occurring in lungs in Coronavirus Disease 2019, using 40-point CTSS scoring on Imaging could provide a timely and objective approach towards identifying patients requiring intensive care and hospitalisation. Keywords: COVID-19; Corona virus; CTSS (CT Severity Score); Ground-glass opacity
Authors: Fariha mumtaz, Khaula sidra, Lubna Sarfraz, Sarah Nisar Khan
Abstract: Background: Acne vulgaris has been a common clinical condition. Due to. high prevalence and unclear etio-pathogenesis of acne vulgaris, large number of treatment options have been available across the globe. Limited work has been done to explore the options which may manage or prevent these adverse effects and improve the adherence to the prescribed medications. We therefore conducted this trial to look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. Objective: To look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. It was a randomized control trial conducted at Department of Dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. Methods. A total of 60 patients of acne vulgaris put on oral isotretinoin by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the placebo along with oral isotretinoin while Group B received oral omega 3 in standard dose in addition to oral isotretinoin. Comparison was made in both the groups regarding common mucocutaneous side effects. Results Out of 60patients with acne vulgaris and put on isotretinoin included in the study, 26 (43.3%) received placebo in addition to isotretinoin while 34 (56.7%) received omega 3 in addition to isotretinoin. Forty (66.7%) patients were female while 20 (33.3%) were male. Cheilitis 35 (58.3%) was the commonest side effect followed by lip dryness 33 (55%). Application of chi-square test revealed that cheilitis, lip dryness and xerosis were significantly found in more patients who received placebo as compared to those who received omega 3 along with isotretinoin. Conclusion Mucocutaneous side effects were a very common finding among patients of acne vulgaris managed with isotretinoin. Cheilitis was the most reported mucocutaneous side effects among the target population. This RCT demonstrated that omega 3 was superior to placebo in order to prevent or manage cheilitis, xerosis or dry lips. Keywords: Acne vulgaris; Isotretinoin; Mucocutaneous; Omega 3
Authors: Alia Pervaiz, Kanza Aftab, Maimoona Mumtaz, Naveed Akhtar Malik, Saqib Malik, Shanza Obaid, Zainab Syed, Zarnab Zainab
Abstract: Background: The present study intended to examine the direct effects of perceived spousal support and postpartum depression on postpartum maternal bonding. Furthermore, it also explored the mediating role of postpartum depression between perceived spousal support and postpartum maternal bonding. Methods: This study was based on a cross-sectional survey research design. A purposive sample of 170 women who were already diagnosed by the doctor/psychiatrist as suffering from postpartum depression was recruited from different hospitals of Gujrat district. Urdu translated versions of The Marital Empathy Scale, Postpartum Bonding Questionnaire, and the Edinburgh Postnatal Depression Scale were used to measure the focal constructs of the study. Results: IBM Amos was used to test the proposed model of the present study. Path analysis revealed that perceived spousal support had negative significant direct effects on postpartum depression and postpartum maternal bonding. Postpartum depression had significant positive direct effect on postpartum maternal bonding. Finally, the significant indirect effect of perceived spousal support through postpartum depression on postpartum maternal bonding was negative. Conclusion: The mediation found in the present study suggested that perceived spousal support reduced the postpartum depression, which in turn, lowered the chances of dysfunctional postpartum maternal bonding with the baby. Implications of the study along with the recommendations for future studies have been reflected upon. Keywords: Postpartum depression; postpartum maternal bonding; perceived spousal support
Authors: Adnan Adil, Anam Khan, Rabia Shahbaz, Sadaf Ameer
Abstract: Background: Primary nocturnal enuresis is one of the common problems in children. Mostly parents are concern for this condition in children and also children are depressive from this condition. The main stay of treatment is the training of child. The objective of this study was to look for the outcome of conservative management of primary nocturnal enuresis. Methods: This study was done in OPD of paediatrics department. Patients aged five year or more were included in the study. Patient age, weight, sex, blood pressure, family history in siblings and parents, number of wet days/week, recorded on specific proforma along with renal function tests. Patients were advised fluid restriction after evening and micturition before sleep and after 2-3 hours of sleep. Follow up was done after six months to observe for the impact of habit change. Data has been analysed by SPSS 20 and results are taken significant with p-value <0.05. Results: Out of 81 patients, 41 were male and 40 females. Age ranged from 5 to 14 years and mean age was 8.2±2.35 years. There were 11.1% parents who had primary nocturnal enuresis during childhood and in 29.6% siblings, history was positive. Follow up at 6 months, 58% patients improved while 42% showed no improvement. There was significant relationship between evening fluid restriction, micturition before and after sleep with improvement at 6 months with p-value of 0.010, <0.001 and 0.002 respectively. Conclusion: Conservative management is the effective intervention in children as parents should be emphasized for habit change. Keywords: Primary nocturnal enuresis; Children; Conservative management
Authors: Ali Raza, Anis-ur-Rehman, Bibi Aalia, Shahzad Najeeb, Syed Sajid Hussain Shah
Abstract: Background: Perspectives of practicing medicine have rapidly changed due to global shift and interconnectedness. Doctors who do not develop their leadership skills may lack the acumen to make significant choices which enhance the quality and effectiveness of care. Pakistan is one of those countries that have not yet introduced the leadership skills training for undergraduate medical students. Aim of this study was to perform a perceived need analysis for teaching leadership skills to undergraduate medical students in Pakistan. Methods: The study was designed using phenomenological approach to gain detailed insights into what the research participants think about leadership. Qualitative methods were used for data collection and analysis. Data were collected from fourteen medial students in their 3rd, 4th and 5th year and eight staff members of medical colleges through semi-structured interviews and focus group discussion respectively. Thematic analysis was used for data analysis. Results: Participants agreed that leadership skills are necessary for successful medical practice and can be learnt with timely and proper guidance. Need to introduce a leadership curriculum for undergraduates was recognised to acquire skills for pressure handling before entering clinical practice. The view was common that doctors in Pakistan are good at clinical skills but have no or weak leadership skills, affecting their clinical practice. Transformational leadership that encompasses behaviours resulting in empowering, inspiring and challenging the followers to make them capable of reaching their full potential was recommended necessary for developing successful physician leaders. Simulated scenarios, case-based learning, lecture-based modules and peer-led case discussions were suggested as the useful methods for course delivery. Formative method of assessment with feedback was suggested rather than summative assessment. Conclusion: There is a perceived need to introduce a leadership course in early years of medical curriculum of Pakistan, as participants acknowledge the importance of clinical leadership and depicted the preparedness to have leadership education implemented in the curriculum. Keywords: Curriculum; Education, Medical; Undergraduate; Leadership; Students, Medical
Authors: Misbah Tabassum, Salman Riaz
Abstract: Background: Feedback is an essential component of the clinical skills development of dental students. The clinical training is a complex integration of knowledge, psychomotor skills, behaviour and clinical communication skills under stress for both instructor and student. This study aimed to investigate the perceptions of undergraduate dental students and their instructors on the quality of clinical feedback. Methods: The current cross-sectional observational study was conducted at the Department of Operative Dentistry and Endodontics, Riphah International University, Islamabad from August to December 2019. A self-administered questionnaire was used to collect responses from final year undergraduate dental students and faculty. The questionnaire comprised of 13 items, subdivided into six categories, targeting the various aspects of clinical feedback. SPSS 23 was utilized to analyse the data. Descriptive statistics were tabulated and data was analysed using the Mann-Whitney test (p<0.05) for differences between the two cohorts. Results: The mean age of the 64 students who responded was 24±0.8 years. Students' male to female ratio was 1:1.56, while for the 18 instructors the ratio was 1:1. Good agreement between the students and instructors was shown for items related to personal dignity and empathy. Moderate agreement was found for items covering the domains of time, understanding, comfort level, professionalism, and self-assessment. The disagreement was observed for the items associated with conflicting feedback, conflict satisfaction, and effective communication. Conclusion: Incongruousness existed between the dental students and instructors, about the quality of clinical feedback provided to the dental students. Communication between the instructors and learners must be promoted to increase the level of understanding of the feedback given by the clinical instructors. Keywords: Dental education; Dental students; Feedback; Clinical clerkship
Authors: Alia ahmed, Muhammad Qasim Javed, Rashid habib
Abstract: Background: A novel coronavirus strain, SARS-CoV-2, was identified in December 2019, causing a disease known as coronavirus disease 2019 (COVID-19). WHO declared the COVID-19 emergency as a pandemic in March 2020. Following nationwide lockdowns, it becomes pertinent that the self-quarantined medical students are able to dispense necessary knowledge regarding appropriate prevention practices related to the disease to their respective families and communities, therefore playing a positive role in sharing the economic load of the health system already overburdened by the increasing number of COVID-19 patients. This study aims to investigate the knowledge, attitudes and practices (KAP) of undergraduate medical students of the Twin Cities of Pakistan toward COVID-19, with regards to their observance of precautionary measures against the disease. Methods: Online data in this descriptive cross- sectional study was collected through self-developed questionnaires from 267 undergraduate medical students of twin cities, by convenient sampling. Results: High level of knowledge (72.7%) regarding Covid-19 infection among undergraduate medical students was consistent with their practices (70.8%) but not with their satisfactory attitude (p<0.01). Being female than male and students of private medical colleges showed more satisfactory attitude (p<0.05) and knowledge (p<0.01) towards Covid-19 infection respectively, while practices were more among the students of public sector medical college (p<0.05). Conclusion: The Knowledge of the students was satisfactory and consistent with their practices but not with their Satisfactory attitude, indicating a need to improve upon the prevailing attitude regarding infectious diseases such as Covid-19 and their prevention. Keywords: Covid-19 Pandemic; Medical Students; Knowledge, Attitude and Practices; Pakistan; Prevention
Authors: Aaiz Feroze Khan, Arshia Bilal, Laiba Shams-ul-Haq, Rukhsana Khan, Saiyid Ahmad Ali Naqvi
Abstract: Background: Respiratory tract infections are a significant cause of mortality and morbidity in paediatric age group all over the world and especially in under developed regions. The present study was conducted with an aim to assess the burden and the types of respiratory illnesses in our region. Methods: The study was a cross sectional study conducted at Paediatric A unit of Ayub teaching hospital from 1st October, 2018 to 31st March, 2019. All patients aged 1 month and above who required admission for various respiratory ailments were included in the study. Results: A total of 2255 patients were admitted in Paediatric A unit over a six months period. Of these, 603 (26.74%) patients were admitted with various respiratory problems and were included in the study. Among these, 389 (64.5%) patients were male and 214 (35.5%) were female. Mean age of the participants was 18.77±30.87 months. The major disease categories were bronchopneumonia in 189 (31.3%), bronchiolitis in 176 (29.2%), measles pneumonia in 60 (10%), lobar pneumonia in 52 (8.6%) and upper RTI in 32 (5.3%). Mean duration of stay was 3.13±2.08 days. Majority of the patients 482 (79.9%) were up to 24 months of age, followed by 77 (12.8%) patients in 25-60 months age and 44 (7.3%) patients more than 60 months of age. A total 295 (48.92%) patients were vaccinated while 308 (51.07%) patients were either partially vaccinated 116 (19.2%) or unvaccinated 192 (31.8%). A total of 576 (95.5%) patients were discharged, 17 (2.8%) patients expired and 5 (0.8%) were referred to higher specialty. Bronchopneumonia was the leading cause of mortality in this study. Conclusion: Respiratory tract infections constitute a major threat to the health of paediatric patients especially in the first two years of life. Improvement in vaccination coverage is essential in reducing the burden of a majority of respiratory ailments along with health education. Keywords: Respiratory tract infections; Pneumonia; Mortality
Authors: Afsheen Siddiqui, Hafiza Sidra, Saima Bibi, Shahzad Najeeb, Syed Yasir Hussain Gilani, Tahir Saeed Siddiqui
Abstract: Background: The incidence of gall bladder diseases is increasing day by day in developing as well as developed countries. Most common gall bladder diseases include gallstones (cholelithiasis) and cancer of gall bladder. Objective: To determine and compare the surgical incidence of gallstones on the basis of gender and age in patients undergoing elective cholecystectomy in Benazir Bhutto Shaheed Hospital (DHQ) Abbottabad. Methods: This was a descriptive study which was carried out for a period of one year from January 2017 to December 2017 in surgical unit of Benazir Bhutto Shaheed Hospital Abbottabad on patients who had cholecystectomy secondary to symptomatic gall stone disease diagnosed on the basis of history and ultrasonography. Gallstones were then analysed for bilirubin, cholesterol, calcium and phosphate. The data was analysed by using SPSS Version 16.00. Results: In our research study 88% of patients were females while 11.8% were males, the mean age being 35.81±8.12 year. The frequencies of different types of gall stones were: mixed type of stones 80.0% and cholesterol stones 20.0% Conclusion: Cholecystectomy secondary to gallstones is more common in women of forty to sixty age groups as compared to men of same age. Majority of gall stones are of mixed type. Keywords: Cholelithiasis/Gallstones; Elective cholecystectomy
Authors: Alruba Taimoor, Humaira Imtiaz, Muhammad Nawaz, Omair Jadoon, Sara Jadoon, Sumaira Javed
Abstract: Background: This study was conducted to explore the occurrence of aggression, disruptive behavior and nature of self-concept among internally displaced and un-displaced children. This study also examines the effectiveness of art therapy and progressive muscle relaxation (PMR) technique of behavior therapy in the treatment of psychological problems among internally displaced children. Methods: In this cross-sectional study a semi-structured interview and Beck Youth Inventory for children and adolescents (2nd edition) were used for assessment. The sample comprised 192 internally displaced and 90 un-displaced children. After taking formal permission from head of the schools, internally displaced children were assessed in their schools arranged for them at Jalozi camp, whereas un-displaced children were assessed at different schools of settled areas in Peshawar. Independent sample t-test was used to analyze mean differences, standard deviation and t-values. Results: Results supported the hypothesis. Internally displaced children showed higher levels of aggression (39.38±6.60) with t (280) = 8.57, and disruptive behavior (40.97±3.90) with t (280) = 6.76, and lower levels of self-concept (48.71±8.31) with t (280) = -15.32. Conclusion: Internally displaced children showed high levels of aggression and disruptive behavior, whereas their self-esteem was lower than the un-displaced children. This study also provides support to the idea that art therapy and technique of behavior therapy can be helpful in treatment of post trauma psychological issues in children. Keywords: Aggression; Disruptive behavior; Self-concept; Internally displaced and un-displaced; Children; Art therapy; Behavior therapy; Progressive muscle relaxation technique
Authors: Erum Irshad, Rabia Amjad, Ruqaia Gul
Abstract: Background: This study aimed to test the psychometric properties of the Urdu version of the Safety Attitudes Questionnaire for inpatient settings in Pakistan. Methods: The SAQ short form (inpatient version) was translated with the back-translation technique into Urdu. The SAQ-Urdu was administered in three teaching hospitals in Pakistan to a sample of 483 front line healthcare personnel from August 2016 through December 2017. Confirmatory factor analysis was performed to test the factor structure of the responses. Cronbach's alphas and correlation coefficients were computed. Mean and percentage agreement scores for items were reported. Results: The response rate was 75%. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit (χ2=213.27, df=125, p<0.001; CFI 0.94, RMSEA 0.044). Cronbach's alphas of survey factors (teamwork climate, safety climate, job satisfaction, perceptions of management, and working conditions) ranged from 0.71 to 0.87. In terms of mean percentage agreement scores, substantial variability was found at the clinical unit level. Conclusion: The Urdu version of the SAQ showed satisfactory internal psychometric properties. The attitudes around patient safety considerably vary and indicate a need for improvement. Keywords: Patient safety; Healthcare; Pakistan; Safety culture
Authors: Hammad Muhammad Khan, Hasnain Syed Ahmad, Mohsin Ali Shah, Muhammad Irfan, Muhammad Zeeshan Fazal, Owais Muhammad Ali, Suleman Khan Afridi
Abstract: Background: Trigeminal neuralgia is a very painful condition which is presented as severe pain corresponding to spastic shock. This is caused by trigeminal nerve's vascular compression at root entry zone. The pain is induced due to ipsilateral neurovascular conflict. in spite of the condition being known since centuries, it still continues to frustrate the clinician and its pathogenesis remains as enigma to the medical profession. It is very common for these patients to undergo unnecessary dental extraction without any relief in pain. This study was conducted to assess the association between trigeminal neuralgia and unnecessary tooth extraction. Methods: This was a cross-sectional study conducted between January 2017 and July 2019 in the Department of Dentistry of Ayub Teaching Hospital, Abbottabad. A total of fifty-three cases with Trigeminal neuralgia were included. All the patients were evaluated by history, clinical examination and local anaesthetic injection. Results: Fifty-three Trigeminal neuralgia cases were enrolled in this study; out of which 22 cases (41.5%) were males and 31cases (58.5%) were females. Mean age of all the patients was 53.90 years. Twenty-nine patients (54.7%) had their right side involved, while the left side was involved in 23 patients (43.4%). In only one case (1.9%) there was bilateral involvement. Regarding tooth extraction unnecessary extraction were reported by 25 (47.1%) patients before they were diagnosed to have trigeminal neuralgia. The Maxillary first Premolar was the most common tooth extracted. Conclusion: Trigeminal neuralgia is one of the most severe painful condition of the maxillofacial region which can confuse the patient and the Dentist with toothache. Patient should be evaluated in detail to rule out trigeminal Neuralgia before tooth extraction. Keywords: Trigeminal neuralgia; Toothache; Tooth extraction
Authors: Abdur Rehman, Alamgir, Ans Ahmad, Iram Abbas, Nofil Ahmad, Shah Muhammad Ghous
Abstract: Background: Stigma towards mental illness is among the main reasons of higher mental health burden in Pakistan, especially in women. Therefore, this study was planned to explore gender differences regarding stigma towards mental illness among medical students of Peshawar. Methods: A Cross-sectional study was conducted among the students of medical and dental institutions of Peshawar from December 2018 to March 2019. Students were asked to respond to the Community Attitude towards Mental Illness (CAMI) scale consisting of 40 questions with four subscales that assess different attitudes towards mental illness. We also asked two additional questions regarding health-seeking behaviour of the general public. Results: The mean age of the sample (n=1003) was 20.75±1.66 years and majority of the respondents were females (n=581, 57.9%). Female, as compared to male students, exhibited positive attitude on overall CAMI scale and its subscales of benevolence and community mental health ideology; while male students showed positive attitude on authoritarian and social restrictiveness subscales, as compared to female students (p<0.05). Both female and male students recognized lack of awareness (combined 34.5%), and stigma attached to mental illness (combined 24.3%) as the main barriers to health seeking behaviour of general public; and suggested that the people struggling with mental health issues should first approach their parents (combined 37.9%) and a psychiatrist/ psychologist (combined 35.0%). Conclusion: Significantly more female medical students showed less stigma towards mental illnesses. Lack of awareness and stigma associated to mental illnesses are considered as the main barriers to help seeking behaviour of general public. Keywords: Stigma; Mental illness; Medical Students
Authors: Maryum Abdullah, Mifrah Rauf Sethi, Muhammad Irfan
Abstract: Background: Hemorrhoids are one of the most common anal pathology affecting millions of people around the world. Milligan-Morgan open hemorrhoidectomy is the most effective hemorrhoidectomy method used as gold standard procedure. Post-operative pain is recognized as a distressing complication of hemorrhoidectomy leading to increase hospital stay and psychological stress to both patient and surgeon. This study is designed to determine the efficacy of diltiazem gel in relieving pain after hemorrhoidectomy caused by anal muscle spasm. This will lead to decreased hospital stay and save both patient and surgeon from stress in postoperative period. Objective: To compare mean post-operative pain in patients undergoing hemorrhoidectomy with vs. without topical application of diltiazem gel. Methods: Total 80 patients who were diagnosed with third- and fourth-degree hemorrhoids and undergo hemorrhoidectomy were included in the study. Patients were randomly allocated to two groups using opaque sealed envelope method. Group A and B both have 40 patients in each group. Pain score was measured on visual analogue scale (VAS) by asking the patients to fill a questionnaire or by the help of the doctor. Results: The patient's average age was 39.98±7.98 years. At 24 hours, mean pain score was significantly high in group B than group A [7.23±0.95 vs. 5.38±1.06; p=0.0005]. At 3rd post-operative day, mean pain score was significantly high in group B than group A [5±0.78 vs. 3.08±0.99; p=0.0005]. Seventy percent cases were observed in group B which required rescue analgesia. Conclusion: It is concluded that application of diltiazem ointment at perianal area with standard treatment considerably decreases pain after haemorrhoidectomy. Keywords: Hemorrhoids; Hemorrhoidectomy; Diltiazem gel
Authors: Asad Ali Kerawala, Nighat Bakhtiar, Saima Awan, Syeda Sakina Abidi
Abstract: Background: Undergraduate (UG) research is new but important concept in modern science. It is considered as an effective educational tool for enhancing the undergraduate medical experience. The objectives of the study were to know the perceptions of UG medical students towards research, main motivating factors and barriers faced by the students. Methods: It was Cross-sectional study with both quantitative and qualitative portions conducted in Ayub Medical College (AMC) from November 2018 to April 2019. The quantitative portion of the study was based on a simple questionnaire with 9 closed ended questions completed by 215 participants selected using stratified random sampling technique. Data was analysed using SPSS 20.0. The Qualitative portion of the study was based on 8 Focused Group Discussions (FGDs), two from each year, with 6-10 participants. The interviews were recorded and reported by obtaining informed consent from each participant. The audio recording of the FGDs was transcribed verbatim and content analysis was done by conventional content analysis. Results: Out of 215, 128 (59.5%) had a previous research experience mostly as a compulsory requirement of undergraduate curriculum; 134 (62.3%) were aware that research is a part of their curriculum. Lack of resources and lack of interest of students was main barrier, i.e., 152 (70.7%). For 133 (61.8%) participants, the main motivating factor was learning research methodology. Conclusions: Students were aware about research and their awareness about research increased with increasing year in medical school. Hardly any student had a research experience beforehand they took part in mandatory research in 4th year. Keywords: Medical undergraduates; Undergraduate research
Authors: Junaid Khan Toori, Mohammad Mustafa, Mustafeez Waheed, Naveed Ahmad, Nayab Riaz, Nayha Nadeem, Noor ul Huda, Saamia Arshad, Saeed Anwar, Sobia Ali
Abstract: Background: The adrenal gland is one of the major endocrine glands involved not only in different physiological functions, but also in response to stress This study was done to asses the effects of L-arginine and insulin on streptozotocin (STZ) induced adrenal gland damage in albino rats. Method: This laboratory based experimental study on animals was undertaken in the Anatomy department of Basic Medical Sciences Institute (BMSI), Jinnah postgraduate Medical Center (JPMC), Karachi, from February to March 2018. Forty adult, healthy male albino rats were placed into 4 groups (10 each). Group A was taken as control. Group B was given STZ. Group C and D were given STZ as in group B with insulin and L-arginine respectively. Absolute and relative weight of adrenal glands was measured at the end of the study. Tissues from adrenal glands were processed and stained with Haematoxylin and Eosin for the morphometric study. Results: The absolute as well as relative adrenal weight of animals was significantly raised in group B in comparison to control, although showed a significant recovery in group C and D animals when insulin and L-arginine were added to STZ. Haematoxylin and Eosin (H&E) stained sections of adrenal cortex of STZ treated Group B showed reduced width of zona glomerulosa, with increased width of zona fasciculata and zona reticularis when compared to control. The width of these zones of adrenal cortex recovered to a significant extent when group C and D tissue sections were compared with STZ- treated group B tissue sections. Conclusion: This study highlighted the protective effect of L-arginine on adrenal gland weight and histology in streptozotocin induced adrenal gland damage, which was comparable to insulin. Keywords: Streptozotocin; L-arginine; Adrenal gland; Insulin
Authors: Aisha Qamar, Mariyah Hidayat, Muhammad Fawad Saeeduddin, Sahal Salman, Shire Chaudhry, Yasmeen Mahar
Abstract: Background: Sharing of information through health education training of mothers on child vaccination has proved an effective intervention for better outcome and increased immunization coverage. This study aimed to examine the effect of interpersonal communication (IPC) training program on mothers' knowledge of child's vaccination and routine childhood immunization uptake in local government areas (LGAs) of Kebbi State, Nigeria. Methods: A quasi-experimental study was conducted in two local government areas in Kebbi State, from October 2016 to March 2017. Four hundred twenty mothers participated in the study and were allocated equally (210) in both intervention and control group (n=210) and data were collected on vaccination status of the children after intervention from children's vaccination cards and mother's verbal reports. Independent t test and Chi-square were used to test the effect of intervention on mother's knowledge of child's vaccination and routine childhood immunization uptake between intervention and control group. Study was ethically approved from the review board of Ministry of Health, Nigeria. Results: Mean knowledge scores has improved in the intervention group (M = 5.42, SD = 3.35) and control group (M=1.96, SD=2.37) after intervention with p<0.001. Routine childhood immunization uptake fully immunized (53.8% vs. 9.5%), partially immunized (16.6% vs. 32.8%) and un-immunized (29.5% vs. 57.6%) in both group after intervention with p<0.001. Approximately fifty-four percentages of children in the intervention group were fully immunized after intervention. However, there was minimal change of 2% has been observed in control group. Percentage of unimmunized children was high in both groups at pre-intervention (66%) but this decreased to 29.5% in the intervention group and 57.6% in the control group. Conclusion: This study concludes that, IPC skill is an effective intervention and a sustainable service for improving the knowledge and uptake of mother's face-to-face education, social mobilization and reminder services about routine childhood immunization within entire population. Keywords: Immunization; Effectiveness; Knowledge; interpersonal communication skills and training
Authors: Muhammad Basheer Yaha, Pramon Viwattanakulvanid, Ramesh Kumar, Ratana Somrongthong, Saudat Abdullahi Basheer
Abstract: Background: Operative notes are the most important account of a surgical procedure containing all details that may have been encountered during the surgery. Summary: Below par quality of these notes remains a challenge for the healthcare system and guidelines from the Royal College of Surgeons should be made use of to ensure efficient recording. Operative notes need to be legible with clear and concise instructions for the nursing staff for postoperative care. Key messages: Relevant details of surgery, additional procedures and complications should be thoroughly documented as well to avoid losses in terms of financial remuneration and for medicolegal purposes. Residents in training should be taught about their importance and inclusion in surgical curriculum should be sought. Keywords: Documentation; Guidance; Note writing; Operation note; Surgery
Authors: Muhammad Umar Younis
Abstract: Angiosarcoma is a rare mesenchymal neoplasm that may arise from vascular or lymphatic tissue. Angiosarcoma of bone is a rare high-grade malignant vascular tumour, representing less than 1% of all angiosarcomas. The most common locations of unifocal tumour are the long and short tubular bones, followed by the pelvis, and trunk. The literature regarding treatment and outcome of patients with this tumour is limited. We performed a retrospective study to analyse treatment and survival of four patients with angiosarcoma of bone. Keywords: Angiosarcoma of bone; Angiosarcoma; Bone tumour
Authors: İsmail Burak Atalay, Recep Öztürk, Selçuk Yılmaz
Abstract: Shprintzen-Goldberg syndrome is a relatively rare congenital connective tissue type of disorder with a constellation of dysmorphic features including craniosynostosis, craniofacial, skeletal, cardiovascular and neurological abnormalities. We present the case-report of a 5-year-old boy with Shprintzen-Goldberg syndrome and a brief review of literature pertaining to this condition. The patients with Shprintzen-Goldberg syndrome show a considerable phenotypic overlap with other craniosynostosis syndromes. So, a meticulous evaluation of these patients should be performed for a prudent diagnosis. Since these patients present with multiple systemic conditions,a multidisciplinary approach should be planned for their management. Keywords: Brachycephaly; Cleftpalate; Craniosynostosis; Cryptorchidism; Hypertelorism; Uvula
Authors: Parvathy Chitran, Philips Mathew, Sreela L.S, Twinkle S Prasad
Abstract: Congenital maxillomandibular syngnathia is characterized by fusion of jaws. Depending on the severity, it has a wide range of clinical presentations. It can be complete /incomplete and may be unilateral or bilateral. Primary concern in such patients is maintenance of airway and feeding difficulties. Therefore, early recognition and management is important to reduce nutritional, feeding, airway difficulties and growth-related problems in such new-borns. This case report presents a case of syngnathia in a 4-day infant with bilateral fusion of maxilla and mandible, leaving a small anterior portion. Early intervention was planned and the fusion was released to facilitate feeding. Good mouth opening was seen on 1week follow-up. Keywords: Congenital; Maxillomandibular fusion; Syngnathia; Synechiae
Authors: Abul Khair Zalan, Anika Gul, Anser Maxood, Hira Zaman, Khadeejah Khalil Zubairy, Manahil Niazi
Abstract: Emphysematous pyelonephritis (EPN) is a type of critical renal infection having dire consequences at times. It is said to be result of gases produced inside renal parenchymal tissue or pelvicalyceal system. Rarely coexistence of emphysematous pyelonephritis and emphysematous cystitis (EC) may lead to an intimidating condition in case it is not dealt with swiftly. The resent case report narrates the management of a 45-year-old female patient who suffered from EPN with concomitant EC. Right-sided emergency percutaneous nephrostomy was passed. Afterwards, Double J stent was passed under general anaesthesia. Although she had an initial improvement clinically but later on due to recurrent urinary tract infections and non-resolving right kidney abscess and fever right sided nephrectomy was done. This is a very rare presentation and has not previously reported much in literature. Keywords: Emphysematous pyelonephritis; Emphysematous cystitis; Nephrectomy
Authors: Aminah Abdul Razzack, Anab Rehan Taseer, Faheemullah Khan, Nadeem Iqbal, Nayal Ahsan, Priyanka Kumari, Saeed Akhter, Tania Platero Portillo
Abstract: The calcifying epithelial odontogenic tumour (CEOT) is a rare but well recognized benign odontogenic tumour for any Pathologist. Histologically, it shows sheets of polyhedral epithelial cells with prominent intercellular bridges, hyperchromatic nuclei and globules of amyloid-like material among tumour cells which undergoes calcification. We present a case of CEOT with classical histopathological picture in a 37-year-old HIV positive patient with long evolution history. Its association with HIV positivity, long clinical history and delay in surgical treatment make it a challenging case to report. Keywords: Calcifying Epithelial Odontogenic Tumour, HIV
Authors: Akshay Bhargava, Bharat Sankhla, Chandni Shekhawat, Krishna Sireesha Sundaragiri, Sankalp Mittal, Shikha Saxena
Abstract: Background: Lower back pain is a common complaint in pregnancy which often impacts quality of life. An uncommon aetiology of lower back pain is Osteitis Condensans Ilii (OCI), a condition characterized by a triangular area of sclerosis of ilium adjacent to the sacroiliac joint. It is thought to be associated with pregnancy, but also affects non-pregnant women and men. We discuss a case of a 23-year-old woman, who presented during the 8th month of her first pregnancy with debilitating pain in her lower back. Several differential diagnoses were explored, including autoimmune aetiologies and pregnancy associated osteoporosis, before OCI was diagnosed via an MRI. The patient was managed conservatively with intravenous analgesics and physiotherapy, after which her pain abated gradually. On her 3rd day of admission, the patient went into premature labour and gave birth to a healthy child via vaginal delivery. Her pain resolved completely within days of delivering her baby. Keywords: Pregnancy; Low Back Pain; Osteitis; Sacroiliac Joint
Authors: Ahmed Ayaz, Ainan Arshad, Raisa Saleh
Abstract: A 43-year-old housewife with no prior medical illness presented with progressive right neck swelling for 3 months' duration, associated with dysphagia and trismus. She reported no history of fever, hoarseness of voice, constitutional symptoms, or contact with pulmonary tuberculosis. Physical examination revealed a large right neck swelling that was tender and fluctuant. CT of the neck and thorax showed a collection within the right carotid space, measuring 1.0×3.1×5.3 cm with resultant anterior displacement of the right submandibular gland, right common carotid artery and internal jugular vein (Figure-1). There were also multiple enlarged and necrotic lymph nodes in the right cervical region. She subsequently underwent incision and drainage of the right neck abscess in which 20 cc of purulent material was drained. Cultures of the purulent material, as well as the intraoperative tissue, grew Morganella morganii, susceptible to cefepime and carbapenems. The histopathological examination findings of the sampled lymph node were negative for both tuberculosis and malignancies. The patient was treated with intravenous cefepime 2 g twice daily for a total of 14 days. The neck swelling reduced in size, and she made a full recovery.
Authors: Chee Yik Chang, Edmund LC Ong, Mahaletchumi Rajappan, Masliza Zaid