Journal of Rawalpindi Medical College

Prophylactic Theophyline reduces birth asphyxia related renal injury in term neonates

2023-01-02

BACKGROUND

INTRODUCTION: Birth Asphyxia (Perinatal Asphyxia) in newborn is a condition caused by the inadequate supply of oxygen before, during, or just after birth. Kidney is the most damaged organ in asphyxiated full-term infants. Theophylline is considered to be effective as adenosine antagonist in reducing renal injury related to birth asphyxia

OBJECTIVE: To determine mean serum creatinine and glomerular filtration rate in term neonates with perinatal asphyxia after prophylactic dose of theophylline as compared with that of control.

MATERIALS AND METHODS: In this randomized controlled trial, a total of 60 neonates fulfilling inclusion criteria were included in study,--removed for blind review--. After taking written informed consent, all neonates were randomized into either A (Theophylline group) or B (Placebo group). Theophylline group received single dose of intravenous aminophylline (5 mg/kg, 0.25 ml/kg) while 0.25 ml/kg of normal saline was administered to placebo group over five-minute period within the first hour of presentation. Each patient was evaluated using the predesigned proforma. The 24-hour fluid intake and the urine output were recorded during the first 5 days of life. To assess the infant’s renal function, their serum creatinine, creatinine clearance (GFR) was determined on days one, three and five and compared between both groups.

RESULTS: The mean age cases in Theophylline group was 10.73 ± 8.11 hours and in control group the mean age of cases was 14.33 ± 7.52 hours. In Theophylline group there were 17(56.67%) male and 13(43.33%) female cases while in control group there were 17(56.67%) male and 13(43.33%) female cases. The mean creatinine level in Theophylline group was 0.78 ± 0.29 and in control group was 1.15 ± 0.51 with statistically lower mean level in Theophylline group, p-value < 0.05. The mean Glomerular filtration rate in Theophylline group was 31.59 ± 6.35 and in control group was 21.17 ± 7.38 3with statistically lower mean Glomerular filtration rate in Theophylline group, p-value < 0.05.

CONCLUSION: Through the findings of this study, the therapeutic efficacy of theophylline is confirmed in terms of maintaining serum creatinine and glomerular filtration rate. So, in future renal function can be protected by introducing theophylline and by maintaining renal function we can reduce risk of mortality.

KEY WORDS: birth asphyxia, Sarnat grading system, theophylline, mean glomerular filtration rate

Transfusion Related transmission of infections among blood donors of South Punjab

Samiullah, Ammara Rasheed, Umera Saleem Samiullah, Ammara Rasheed, Umera Saleem — 2022-12-31

Objective: To investigate the frequency of blood transmissible infections in the region of South Punjab.

Study design: Descriptive cross-sectional

Place and duration: Study was carried out from February 2019 to February 2021 over a period of 2 years at—removed for blind review--.

Methodology: All voluntary and replacement donors who arrived at the hospital between the included time period were considered for the analysis. Total two blood samples were taken from each blood donor. For blood grouping and malarial parasite screening, Ethylene diamine tetra acetic acid (EDTA) sample was collected. Clotted sample was used for screening of Anti-HCV, HBsAg, HIV and syphilis and analyzed by ELISA.

Results: Our study showed cumulative frequency of 0.8 %, 0.5% and 1% for hepatitis B, syphilis and C virus respectively, and only one case of HIV and malarial parasite observed during screening for blood transfusion among blood donors.

Conclusion: Increasing transmission prevalence of hepatitis as well as syphilis in our region.

Keywords: blood transfusion, infection, HBsAG, HCV.

Effect of Oral intake of Stevia Leaf Powder on Body Weight – An Experimental study

2022-12-31

Introduction:

The steviol glycosides are found in the stevia leaf. These glycosides possess sweetening properties as well as they have antioxidant, anti-microbial, anti-inflammatory, antihyperglycemic, and anti-hypertensive effects. This study was conducted to find out the effect of Stevia leaf on body weight in obese Sprague Dawley male rats.

Materials and Methods:

This experimental study was carried out on 90 Sprague Dawley male rats. Group1(normal control) was given a standard diet for the entire study period, while the remaining sixty rats were given a high-fat diet (HFD) for 8 weeks to induce obesity. The obese rats were randomly assigned to group 2 (Obese Control) and Group 3 (obese + Stevia) and given HFD for another 6 weeks. The stevia leaf powder was added to the diet of group 3. Diet intake was noted for all the groups. Rats were weighed on the first day of every week, for six weeks, and then at the end of the study period.

Results:

Body weights of rats in each group, at the start and end of the 6-week intervention period, when compared, showed a significant increase in group 1 (p=0.001), and group 2 (p = 0.001), while group 3 showed a non-significant increase (p = 0.248). The percentage increase in body weight for groups 1, 2, and 3 was 4.8, 9.3, and 1.1, respectively. Graphically, the weekly increase in average body weights of the three experimental groups showed maximum values for group 2.

Conclusions:

Stevia leaf possesses weight-reducing effects which may be due to inhibition of appetite, reduction in food intake, and consequent weight loss.

Keywords:

Obesity, weight loss, Natural non-nutritive sweeteners, Stevia

Comparison of pain observed with sodium hypochlorite and chlorhexidine based root canal irrigant 24 hours post appointment

2022-12-31

Objective: To compare the effectiveness of 2.5% sodium hypochlorite and 2% chlorhexidine, in reduction of frequency in pain 24 hours after endodontic treatment of teeth with chronic apical periodontitis

Study design and Setting: Randomized Clinical Trial conducted –removed for blind review--from July 2018 to December 2018.

Methodology: A total of 60 patients requiring management of chronic apical periodontitis and pulp necrosis were randomly allocated by lottery method to two groups of 30 each according to the irrigating solution employed: Group A (2.5% sodium hypochlorite) or Group B (2% chlorhexidine gluconate). To assess inter-appointment pain, a questionnaire with visual analogue scale was filled out by the patient at 24 hours after the procedure. The Chi-square test was used to compare the effectiveness between the two irrigation solutions.

Results: Group A (2.5% sodium hypochlorite) was effective in 83.3% cases i.e. no or mild pain compared to 76.7% in group B (2% chlorhexidine). In group A, 5(16.7%) patients suffered pain compared to 7(23.3%) in group B. This difference in pain was statistically insignificant. (p-value 0.519).

Conclusion: Both 2.5% sodium hypochlorite and 2% chlorhexidine were equally effective in minimizing pain 24 hours post endodontic treatment.

Keywords: Chlorhexidine gluconate, Sodium hypochlorite, Flare up

Hemodynamic Comparison between modified saddle block and subarachnoid block for Transurethral Resection of Prostate

2023-01-02

BACKGROUND:

Spinal anesthesia is often the mode of anesthesia in transurethral resection of prostate (TURP) albeit with risk of hypotension. However, hemodynamic derangement is often less pronounced in saddle block. This study was conducted to compare the mean fall in Mean arterial Pressure (MAP) and Heart rate (HR) between modified saddle block and subarachnoid block for TURP.

OBJECTIVE:

To compare the mean fall in MAP and HR between modified saddle block and subarachnoid block for TURP.

METHODS:

In this randomized controlled trial 120 patients undergoing elective TURP were included and divided into two groups. Group A Patients received subarachnoid block and Group B received modified saddle block. Baseline hemodynamics were recorded before and then at 5 minutes after anesthesia. All the collected data was entered into SPSS version 22 and analyzed. Quantitative data like age, BMI, ASA-PS score, duration of surgery and baseline hemodynamics were presented as means and standard deviations. The fall of mean arterial pressure (MAP) & heart rate (HR) were compared among groups by independent t test and P value < 0.05 was considered as statistically significant.

RESULTS:

Mean fall in MAP was 8.98±1.28 mmHg and 3.13±0.68 mmHg (p<0.001) in group A and B, respectively. Mean fall in HR was 7.17±0.98 and 2.78±0.59 (p<0.001) in group A and group B, respectively.

CONCLUSION:

Modified saddle block resulted in significantly decreased fall in MAP and HR as compared with subarachnoid block for TURP.

KEY WORDS:

Modified Saddle Block; Subarachnoid Block; Mean Arterial Pressure

Feto-maternal Outcome of Reverse Breech Extraction versus Dis-impaction of Fetal Head in Caesarean Section for Obstructed Labour

2022-12-31

Objectives:

Obstructed labour is an obstetrical emergency with adverse feto-maternal consequences and caesarean delivery in such cases requires skillful handling of impacted fetal head. Objective of our study was to guide clinician about caesarean technique that facilitates the delivery with least complications for mother and baby.

Methods:

It was a randomized clinical trial with non-probability consecutive sampling conducted at –removed for blind review---from 1^st july 2018 – 30^th june 2020. Patients who underwent emergency cesarean section were randomized to undergo either push technique for delivery of impacted fetal head (Group A) or reverse breech extraction method (Group B) via lottery method. The data of 60 patients who fulfilled the inclusion criteria was analyzed using SPSS version 19. Maternal outcome measured were extension of uterine incision, blood transfusion, postpartum pyrexia, wound infection, postpartum hemorrhage and length of hospital stay. Fetal outcome measured were 5 minutes Apgar score, birth weight and NICU admission.

Results:

The results of our study showed statistically significant difference between extension of uterine incision(p-value=0.015), blood transfusion during surgery (p-value=0.021) and postpartum hemorrhage (p-value=0.020) in two groups with pull technique associated with less traumatic extension of uterine incision, less intraoperative transfusion and less PPH than push technique of fetal delivery. Length of hospital stay was also significantly less in reverse breech extraction group(p-value=0.001).More patients had postpartum pyrexia, wound infection, low 5-min Apgar score and NICU admissions in cephalic delivery group but results were not statistically significant.

Conclusion:

The results of our study recommend reverse breech extraction technique to be a safe alternative to conventional vaginal pushing of fetal head especially regarding maternal outcomes during caesarean section of patients with obstructed labour for fetal delivery.

Key words: Obstructed labour, impacted fetal head, reverse breech extraction, caesarean section

Practice of standard Cross Infection Protocol in Private Dental Clinics of Khyber Pakhtunkhwa, Pakistan: A cross-sectional study

2022-12-31

Background: Infection control, which is considered to be the backbone of dentistry, has become a particularly essential piece of dental training because both the dentists and patients are at an expanded danger of cross-contamination. Dental clinical settings represent a high organic hazard of spreading a wide scope of microorganisms. The objective of this study is to gather information of different dentists regarding their practice of standard cross infection protocols and how can they improve the same in their private practices.

Materials and Methods: This cross-sectional study was conducted in dental clinics of Khyber Pakhtunkhwa, KPK from January 2020 to July 2020 by distributing a questionnaire among dentists. It was a pre-designed questionnaire that was circulated in Google forms through Whatsapp and emails. The questionnaire was divided into 2 sections. Data was compiled and statistical tests were applied using the Statistical Package for Social Sciences SPSS® ver.23.0

Results: Regarding cross infection control measures, maximum dentists seem to have knowledge of cross infection control techniques. A significant difference was found (p= 0.05) between male & female dentists in disposing dental waste from clinical set up properly. A significant difference was also found between male & female dentists about rubber dam isolation (p=0.02).

Conclusion: The result of this study showed that practice of dentists in KPK is not up to standard protocols of cross infection control. In this way, the need of great importance is to authorize and execute better proportions of infection control to improve dental practice in KPK.

Key words: Infection control, Dental practice, Sterilization

Latent iron deficiency in non-anemic children under five years of age

2023-01-02

Background: The most common nutritional deficiency in world is iron deficiency. The iron deficiency is the most common cause of anemia due to nutritional deficiency and is seen most commonly in children under five years of age.

Objective: To determine the frequency of iron deficiency in non-anemic children under five years of age.

Methods: A descriptive cross-sectional survey was conducted in pediatrics department of –removed for blind review---from August 2020 to February 2021. A total of 145 non-anemic children, ages 2-59 months were enrolled through non-probability consecutive sampling in this study. The complete blood count and C-reactive protein were sent for laboratory tests to rule out infection/inflammation. In children with normal hematocrit (30-40%) and CRP (≤ 6), serum ferritin levels were sent. Those children in whom serum ferritin levels were ≤12ng/ml was regarded as cases of latent iron deficiency. SPSS version 23 was used for data entry and analysis. Age and gender for effect modifiers were controlled by stratification. The chi square test was used for post stratification. The value of p ≤ 0.05 was considered significant.

Results: The mean age of the patients was 3.20±5.41 years. Among all children, 69 (47.6%) were boys and remaining 76 (52.4%) were girls. Out of 145 children, 62 (42.8%) were iron deficient whereas 83 (57.2%) were non-iron deficient. The male to female ratio of iron deficiency was 1:1.3. The prevalence of iron deficiency among infants was 46%, followed by toddlers 42% and preschoolers 41%. The mean serum ferritin level was 22.96±2.21 ng/ml. The mean hematocrit was 33.84±2.68. The statistical analysis showed that there was an insignificant association between iron deficiency and age groups of children (p ≥ 0.5).

Conclusion: The study concluded that the iron deficiency in children is very common, especially in infants. Screening of iron deficiency in children under five years of age seems to be a very important task for better child care.

Key words: Anemia, Iron-Deficiency; Child, Preschool; Malnutrition.

Comparison of intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation in terms of mean pain reduction using vas score

2023-01-02

INTRODUCTION:

The most common dislocation presenting to emergency department is anterior shoulder dislocation. Posterior dislocations and inferior dislocations are rare. Dislocations of the anterior shoulder mostly occur with the position of the arm is abducted and externally rotated. This results in injury of the humeral head, labrum, capsuloligamentous structures and glenoid. Such patients experience severe pain, therefore prompt reduction is necessary to ameliorate the pain. Intravenous analgesia combined with sedation or intra-articular lidocaine injection can be used for closed reduction of anterior shoulder dislocation. Due to its side effects, Intra-articular lidocaine (IAL) is recommended for use as a probable alternative to intravenous sedation-analgesia especially for patients with contraindication to intravenous sedation-analgesia.

OBJECTIVE:

To compare intra-articular lidocaine versus intravenous sedative and analgesic for management of anterior shoulder dislocation in terms of mean pain using VAS during reduction of shoulder joint.

STUDT DESIGN:

Randomized controlled trial (RCT).

SETTING:

Removed for blind review

DURATION:

6 months (November 22^nd, 2017 to May 21^st, 2018)

SAMPLE SIZE:

60 patients (30 in each group)

RESULTS:

We included sixty patients in my study. 19 (31.7%) were females and 41 (68.3%) were male patients. Out of all the patients 38 (63.3%) had right sided shoulder dislocation, while the rest 22 (36.7%) patients had left sided shoulder dislocation.

Patients mean age was 33.27±10.535 years and mean pain score of all the patients was 4.966±1.930. The mean pain score in Group A was 4.200±1.648, while the mean pain score in Group B was 5.733±1.910 (p value = 0.002. Stratification was done according to gender and age group of the patients, and post-stratification t-test was applied.

CONCLUSION:

Intra-articular lidocaine is better option in pain control during reduction of anterior shoulder dislocation.

KEY WORDS: Intra venous analgesia, Intra-articular lidocaine, shoulder dislocation.

Diagnostic accuracy of leukocyte esterase in confirmed cases of urinary tract infection in children

2022-12-31

Background: Gold standard for the diagnosis of urinary tract infections (UTIs) is urine culture, but it takes longer for bacterial growth on culture media. Leukocyte esterase is a simple strip testing of urine sample, so it takes less time in diagnosing cases of UTI.

Objective: To determine the diagnostic accuracy of leukocyte esterase for detection of urinary tract infection in children taking urine culture as the gold standard.

Materials and Methods: This cross-sectional study was conducted in the Department of Pediatrics, ---removed for blond review---from April to October 2017. Children of both genders between 2-12 years of age having clinical findings consistent with the operational definition of UTI were included in this study. Clean catch, midstream urine sample was collected in a sterile container for culture and test strip was dipped in urine sample for leukocyte esterase.

Results: Total 215 Children were included in the study.The mean age of the children was 7.15±3.36 years. There were 118 (54.9%) males and 97(45.1%) females in this study.37 (17%) were culture positive. Sensitivity, specificity, positive and negative predictive value of leukocyte esterase was 69.77%, 87.79%, 58.82%, and 92.07% respectively. Diagnostic accuracy was 84.19%.

Conclusion: Leukocyte esterase is a reliable marker for the screening of urinary tract infection in children 2 years to 12 years of age.

Key words: Leukocyte esterase, urinary tract infection, urine culture

Comparison of Primary Simple Closure and Limberg Flap Technique in Pilonidal Sinus

2022-12-31

Introduction

Pilonidal sinus is a disease affecting the intergluteal region. Many surgical techniques have been described for the treatment of this condition. The objective of this study was to compare Limberg flap technique and primary simple closure in terms of postoperative discharge.

Materials and methods

It was a randomized prospective study conducted at the Department of Surgery—removed for blind review-- from December 2018 to June 2021. Sixty male patients aged 15-30 years presenting with pilonidal sinus for the first time were included in the study. Patients with comorbidities and the American Society of Anesthesiologists (ASA) class three and above were excluded from the study. Patients were divided into two groups by lottery method. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 23.0. Chi-square tests were applied. A p-value of ≤ 0.05 was considered significant.

Results

The postoperative discharge was found in just five (16.3%) of the patients in group A (Limberg flap technique), while the discharge was present in 12 (40%) of the patients in group B (primary simple closure; p = 0.045).

Conclusion

Limberg flap technique is superior to primary simple closure in terms of postoperative discharge.

Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia

2022-12-31

INTRODUCTION: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly.

OBJECTIVE: To compare the efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia

STUDY SETTING: The study was conducted at Gynecology and Obstetrics Department unit II, Holy Family Hospital, Rawalpindi, from June 20, 2020 to December 20, 2020. Study design was Randomized Controlled Trial.

SUBJECTS & METHODS: Patients were randomly distributed into two groups, group-A (IM Group) and group-B (IV Group). Group-A patients received a loading dose of 4 gm IV MgSO₄ over 5-10 minutes+10 gm MgSO₄ deep intra-muscular injection (5 gm in each buttock) and a maintenance dose of 5 gm MgSO₄ deep intramuscular injection in alternate buttock every 4 hourly. Group-B patients received MgSO₄ 4 gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO₄ per hour as continuous intravenous maintenance infusion. Clinical response to therapy for both drugs was calculated in terms of efficacy and safety. All the data were entered & analyzed by using SPSS v25.0. Both the groups were compared in terms of efficacy and safety by using Chi-Square test. A p-value less than 0.05 was taken as significant.

RESULTS: A total of 160 patients with eclampsia were enrolled for this study. Patients were divided into two groups i.e. Group-A (IM MgSO₄) and Group-B (IV MgSO₄). In group-A, there were 45(56.3%) in 18-30 years age group and 35(43.8%) in 31-40 years age group, while in group-B, there were 48(60.0%) in 18-30 years age group and 32(40.0%) in 31-40 years age group. In IM MgSO₄group, prevention from recurrence of seizure was noted in 74(92.5%) and 78(97.5%) in IV MgSO₄group, which is statistically insignificant with a p-value of 0.147.

CONCLUSION: Both IM and IV regimen are equally effective in controlling the recurrence of convulsions. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflex. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity.

KEY WORDS: Eclampsia, Intramuscular MgSO₄, Intravenous MgSO₄.

Maternal Serum Ferritin Levels and its effect on Cord Blood Hemoglobin in patients with Gestational Diabetes Mellitus

2023-01-02

Background

Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that can have harmful impacts on maternal and neonatal outcomes. Literature shows that elevated serum maternal ferritin levels may cause dysregulation in glucose metabolism in GDM. This study aims to determine the association between serum ferritin, iron and hemoglobin levels in GDM patients at the time of delivery as well as cord hemoglobin and iron levels in newborns.

Methods

In this case-control study, a total of 100 patients were included i.e., 50 cases (GDM) and 50 controls (non-GDM) having aged-matched individuals of normal pregnancy. The hemoglobin, iron and serum ferritin, and hsCRP levels of the mother were determined using maternal blood. A cord blood sample was taken to determine neonatal iron and hemoglobin levels.

Results

The study participants mean age was 29.2 ± 5.6 years. The ferritin levels of GDM mothers (42.3 ± 6.7) were significantly higher than non-GDM patients (34.4 ± 3.8) with p<0.001. Similarly, Cord hemoglobin levels of newborns of GDM mothers were significantly higher than newborns of non-GDM patients (p<0.01). In GDM mothers, maternal ferritin levels were inversely correlated to cord hemoglobin levels (r= - 0.29, p =0.004).

Conclusions

Elevated maternal serum ferritin levels are linked to increased oxidative stress and effects fetal intrauterine and post-partum health. The placental iron transfer and fetal hemoglobin synthesis will be affected by oxidative stress.

The role playing by social media in COVID-19 to exacerbate anxiety and depression among Pakistani community

2023-01-02

Introduction: The purpose of the worldwide lockdown was to impede the spread of this virus via social distancing. WHO detected symptoms like anxiety, stress, fear which have affected people’s psychology across the globe due to loneliness, substance abuse, depression and constant fear? With the surge of information regarding COVID-19 on social media (myths and beliefs), it certainly played a major role for communities’ psychology all around the globe.

Methods: A cross sectional study design was chosen with convenient sampling size of 800 via online. Questionnaire shared through online social media platforms. Statistical analysis was done through SPSS version 21 and responses were taken as frequencies, percentages and chi-square test.

Results: there was a significant association between highly educated peoples and social media usage with p-value less than 0.000 suggestive of myths generating decline of mental health.

Conclusion: COVID-19 information available over social media was used by everyone and considered as authentic. Therefore, control measures and legislation should be applied on them to restrict the ambiguity.

Key-words: Social media; COVID-19; Myths; life worth; save humanity; Attitude;

Prognosis of Severe Covid-19 patients after treatment with Therapeutic Plasma Exchange (TPE)

2022-12-31

OBJECTIVE: To demonstrate the effective role of plasmapheresis in the treatment of Cytokine Release Syndrome associated with severe Covid 19 pneumonia.

INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study showed that in severe Covid-19 patients, a hyper-inflammatory response to initial infection could accelerate to severe hyper-cytokinaemia that could lead to an underlying endothelial dysfunction and multiple organ dysfunction. Thus, removal of these inflammatory cytokines by Therapeutic Plasma Exchange is considered to be an essential part of the treatment of critically ill patients in order to improve their survival rates.

METHODOLOGY: Retrospective observational study which included 150 RT-PCR positive patients admitted in Covid ITC, from the time period of 1^st February 2021 to 31^st July 2021 –removed for blind review---Data was analyzed using SPSS software version 16. Frequencies were calculated along with mean and standard deviation. Chi square and ANOVA test was applied to the data. P value <0.05 was considered statistically significant. Linear regression study was applied to predict the prognosis.

RESULTS: Out of 150 patients, 51 patients (34%) were of severe ARDS category of whom 13 (25.5%) developed Cytokine Release Syndrome. They received plasmapheresis therapy subsequently and 7 out of those 13 (53.8%) patients got improved. P- value was found to be significant ( <0.05). Overall, the mortality rate was low with 120/150 (80%) getting discharged successfully.

CONCLUSION: Our findings suggest that Therapeutic plasma exchange is beneficial in Cytokine storm caused by SARS-CoV2 removing the inflammatory cytokines and improving symptoms, thereby, avoiding intubation.

KEY WORDS: , Therapeutic plasma exchange, Hypercytokinaemia, Cytokine Release Syndrome

The Perceptions of Medical Students Regarding Professionalism, a qualitative study

2022-12-31

Introduction: The elements of humanity and understanding the social values is significantly important for the health care workers to ensure positive health outcomes and patient’s safety, as care and empathy during the treatments are provided innately according to the standards, preferences and values of the individual.

Aim: Our goal is to prepare finest quality physicians who will serve as role models for future medical practitioners. The aim of this study is to find out student’s perception regarding professionalism in order to design curricular contents and matching instructional strategies aiming at enhancement of professionalism, understanding, practice and behavioral change.

Method: The study has been conducted at a private medical college in Islamabad after taking ethical approval. In order to collect data, a qualitative cross-sectional study design had been used. Focus group interview was conducted on semi structured questions. Data was recorded, transcribed, themes were extracted and analyzed by manual thematic analysis.

Results: the study identified fundamental themes regarding professionalism. Students had fair knowledge regarding professionalism but lack deep understanding. It was suggested to practice role modelling in order to inculcate professionalism among medical students.

Conclusion: The findings of the study indicated that the professionalism is the core of medical education and necessary for adequate practice therefore, we cannot rely on hidden curriculum for development of professional identity. The study suggests dire requirement for incorporation of study of professionalism and it applications in medical curriculum.

Key words: Perceptions, Professionalism, Medical students

Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac sodium in post-operative pain relief after cesarean delivery in the first 24 hours

2022-12-31

Background

About 80% of the patients experience enough post-operative pain to require analgesia. Adequate pain relief is needed after caesarean section to assist ambulation , mother / baby bonding & above all, a pleasant experience of being a mother. Different analgesics with various routes of administrations are available for pain relief which include opioids and NSAIDS. Opiods are known for their undesireable side effects . Diclofenac sodium is an NSAID & acts via blocking prostaglandin production. The WHO recommends diclofenac as a first line drug in pain relief. It is available in various preparations which include injections, tablets and suppositories.

We compared the mean pain experienced by the women after use of diclofenac suppositories and intramuscular diclofenac sodium after elective cesarean section in first 24 hours.

Methodology

This RCT was done in the department of Obstetrics and Gynecology, --removed for blind review---from 1^st March 2018 till 30^th August 2018. Total of 100 antenatal women already planned for elective caesarean section ,who fulfilled inclusion criteria were selected after taking informed consent & ethical approval by employing non probability consecutive sampling . The age , parity ,gestational age, weight ,BMI & ASA status of all women was documented. 50 women were randomly assigned to the each group A & B. Group A was given 75 mg intramuscular diclofenac injection immediately & then 8 hrly for the first 24 hrs after caesarean section while group B was given 100 mg rectal diclofenac suppository immediately & then after 12 hrs post caesarean for the first 24 hrs. if needed ,50 mg tramadol I/V was given to the women as rescue analgesia, Visual analogue pain (VAS) score was used to assess the pain intensity of post operative women after 24 hrs of caesarean and poltted in the proforma. The number of women needing rescue analgesia in each group was also documented. & compared between the two groups.

RESULTS:

Data was analyzed on the SPSS version 23. In group A; mean age was 26.34 years with STD of 3.69. Mean gestational age was 37.82 weeks with STD of 1.79. In group B; mean age was 25.3 years with STD of 3.47. Mean gestational age was 37.70 weeks with STD of 1.59. In group A; mean weight was 84.62 kgs with STD of 5.76 and mean BMI was 32.18 with STD of 3.16. In group B; mean weight was 84.84 kgs with STD of 7.27 and mean BMI was 31.13 with STD of 3.57. In group A (intramuscular diclofenic injection group) the mean score of pain was 3.72 with STD of 0.57. In group B (Diclofenic Suppository Group) the mean score of pain was 1.84 with STD of 0.68. P-value was significant. 26 women (52%) in group A (I/M diclofenac group) and 20 women (40%) in group B (rectal diclofenac suppository group) needed rescue analgesia with I/V Tramadol .P value was not significant.

CONCLUSION:

Dicolofenac is an effective post caesarean analgesic . Rectal route of diclofenac is more effective than the intramuscular route as post caesarean analgesia . Almost less than half number of post caesarean women needed rescue analgesia after using diclofenac suppository .

Confusion is the first step towards understanding: Fixing the problems of E-learning in COVID-19 pandemic

2022-12-31

Background:

The COVID-19 pandemic forced institutions worldwide to adopt online learning, which opened a new era of challenges. Our research was designed to explore the effect of the pandemic on teaching and learning and identify the solutions to the problems based on participants’ perspectives.

Methods:

A qualitative study of the phenomenological design was conducted at a medical institute in Pakistan. The participants were selected using the purposive sampling technique. Semi-structured interviews were done which were later audio-recorded, transcribed, and subjected to manual thematic analysis. Credibility was ensured by using multiple data collection sources.

Results:

The 20 participants selected as interviewees were faculty with more than 5 years teaching experience in the medical institute and had gone through online teaching and learning during COVID-19 pandemic. The thematic analyses of the data generated six themes which were: 1. “I see what you mean”; Re-exploration of educational psychology, 2. Reorganization of curriculum, 3. Mentoring and coaching, 4. Technology: as ubiquities as oxygen, 5. Constructive feedback: a stimulus in pearl formation and 6. Turn the tables: fixing the problem.

Conclusion:

Online education has emerged as an important mechanism in delivering medical education to undergraduate medical students. Instead of shying away, efforts are needed to restructure the curricula, incorporating various online innovative teaching, and learning tools that are at par with the changing global demands of medical education.

Keywords:

E-learning, COVID-19, Challenges

Pattern of Thrombocytopenia In Pregnancy At Teaching Hospital Of Rahim Yar Khan, Pakistan

2023-01-02

Background: Platelet count less than 150 × 10⁹ / L is referred to as thrombocytopenia, which is the second common blood disorder in pregnancy after anemia. Although pregnancy is related with physiological variations in platelet count, however, several pathological conditions also cause thrombocytopenia showing significant impact on health of mother and her baby. The prevalence of thrombocytopenia during pregnancy is 7 to 11%. The physiological thrombocytopenia is multifactorial, related to hemodilution, increased platelet consumption and increased platelet aggregation.

Objective: To determine the pattern of thrombocytopenia during third trimester of pregnancy in Rahim Yar Khan.

Methodology: This cross-sectional study was carried out at Teaching Hospital of Rahim Yar Khan with effect from May 16, 2022 to September 30, 2022. Five hundred (500) pregnant females in their third trimester were the part of this study. All the study subjects were selected from the department of gynecology and obstetrics at Sheikh Zayed Hospital, Rahim Yar Khan which is a renowned teaching hospital of the region attached with Sheikh Zayed Medical College. Data collection was done on a pre-designed questionnaire. Sample of blood was taken in EDTA and Gel containing vacutainers by convenient sampling technique.

Results: The frequency of thrombocytopenia during pregnancy was found 10.4%. Gestational thrombocytopenia was the most common type among thrombocytopenic pregnancies with frequency of 63.46% in comparison to pre-eclampsia 30.76%, HELLP Syndrome 3.80% and immune thrombocytopenic purpura 1.90%. The mean age of pregnant women was observed 27.53±5 years. There is no significant difference in number of thrombocytopenic patients from rural and urban areas (p=0.2). Conclusion: The frequency of thrombocytopenia during the third trimester of pregnancy is observed high, so the regular screening is necessary to avoid any adverse outcome. Specially the patients with Pre-eclampsia and HELLP syndrome should be monitored critically.

Key words: Platelet Count, Thrombocytopenia in Pregnancy, Types of Thrombocytopenia, Pre-Eclampsia

Clinical outcome of tetanus based on dakar tetanus severity score in paediatric intensive care unit of a tertiary care hospital

2022-12-31

Objective: To evaluate the validity of Dakar scoring system in predicting the outcome of tetanus in children of post neonatal age.

Method: A prospective single center study conducted at ICU (Intensive Care Unit) of –removed for blind review-- 131 children with diagnosis of tetanus from January 2020 to June 2021 by analyzing demographic and clinical parameters.

Results: Mean age of children was 8.11 ± 3.45 years with male predominance 91(69.5%). Major proportion of children were in range of 5-10 years comprising 65(50%). Period of onset of spasm was < 2 days in 92(70%) that correlate well with shorter incubation period (p-value <0.001). Mean duration of ICU stay was (18.81 ± 11.73) days. Only 14(10.7%) received three doses of vaccination but no one received booster dose. In majority of patients trauma due to road traffic accident 86(65.6%) was the predisposing factor followed by ear discharge 31(23.7%) and other causes 14(10.7%). Out of 131 patients 104(79.3%) received mechanical ventilation because of disease severity. Regarding outcome mild cases 2(1.5%), moderate 61(46.6%) and severe were 68(51.9%) according to Dakar scoring system and out of these severe cases 18(13.7%) expired (p-value < 0.001). However, 53(40.4%) discharged, 50(38.1%) shifted out to other wards after stabilization and 10(7.6%) left against medical advice. (p-value 0.001)

Conclusion: Dakar scoring system correlates well with disease severity and should be adopted to aid clinical triage and management as with effective and appropriate treatment patients can have good prognosis. However, preventive aspects should be emphasized regarding booster dose of tetanus.

Keywords: Tetanus, Outcome, Dakar scoring system

Common Organisms causing surgical site infection(SSI) in Postoperative patients in a tertiary care Hospital

2022-12-31

Objective:

To investigate the types and frequency of organisms causing surgical site infections in postoperative patients and their association with other factors.

Study Design:

Cross-sectional

Duration and Place of Study:

Surgical Unit-II of –removed for blind review---and from 1^st March 2021 – 31^st July 2021.

Patients and Methods:

There were 391 surgeries in this study, but only 27 patients met the inclusion criteria. A diagnosis of SSI was based on specific parameters, including the detection of two or three cardinal signs of inflammation and the surgeon's confirmation of the diagnosis. This data was analyzed using IBM SPSS 23.

Results:

Among 391 patients, 242 had elective surgeries (male:female, 1.6:1), and 149 had emergency surgeries (male:female, 1:3.4). The mean length of stay for elective surgeries was 2.19 ± 1.8 days and 4.2 ± 3.7 days for emergency procedures.

There were 98 abdominal procedures (65.77%) performed in emergency settings. Only 9 (3.71 %) elective procedures and 18 (12.08 %) emergency procedures reported surgical site infections. Escherichia coli was the most commonly isolated organism from SSI during the study. The rate of SSI in postoperative patients was 6.9%.

There was a statistically significant association between SSI and type of surgery (p=0.002). The mean length of stay (LOS) was longer for patients with SSI (mean=12.5, p=.000). Emergency cases had a longer LOS compared with elective cases (mean= 4.21 days vs 2.19 days, p=.000).

Conclusion:

According to our study, our unit's SSI were comparable to other developing countries. SSI are more frequent in emergency cases, men, and diabetics, and are the primary cause of longer hospital stays.

Keywords:

Surgical Site Infection; E.Coli; Length of stay;

Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed

2023-01-02

Introduction:

Upper gastrointestinal bleeding is a common reason for hospitalisation across the world, with a UK frequency of 10% and a death rate of 8-14 percent. [1] Several risk assessment scores have been created to predict clinically relevant outcomes like death, the requirement for hospital-based care, rebleeding, and hospital stay length

Objective: To determine frequency of mortality in patients with high AIMS65 score presenting with upper gastrointestinal bleeding.

Setting: Gastroenterology Department –removed for blind review---

Material & Methods: It was a cross-sectional, prospective, observational research study. Patients having a high AIMS score were recruited in the study. The patient's medical history, physical examination, and biochemical data were all properly recorded. Patients were observed for the outcome variable, which was hospital mortality.

Results: 119 patients fulfilling the inclusion criteria were included. There were 77 (64.7%) males and 42 (35.3%) females. The mean age was 43.10 ± 14.213 years On analysis of demographic data, it was observed that 61 (51.3%) patients were below 40 years of age. On analysis of organ dysfunction 79 (66.4%) had cardiovascular dysfunction, 55 (46.2%) had respiratory dysfunction, 39 (32.8%) had renal dysfunction. On outcome variable, It was observed that 81 (68.1%) of the people had died.

Conclusion: Majority of the patients with high AIMS had mortality. Majority of the patients were males and had cardiovascular dysfunction.

Key words: GERD, endoscopy, gastroduedonal disease, carcinoma, gastritis.

Evaluation of Impact of Prescribing Safety Assessment Workshop on Medical Doctors Using Kirkpatrick Model

2023-01-02

Background

Clinical pharmacology training is a prerequisite for all medical graduates. Prescription writing errors are not infrequent at primary health care level leading to threat to patient safety. Prescribers lacks uniform structured training and assessment which is one of the major factors for this situation across the country. In lots of institutions despite proper curriculum, learners lack interest because the subject importance is insignificant. Hence to bring more interest in pharmacology for prescribers there is a dire need for innovative and interesting methods of teaching and assessment, one of which is prescribing safety assessment (PSA).

Objectives

To assess if the PSA is superior method of training prescription writing than CPW
To evaluate the workshop on prescription writing using guidelines of Kirkpatrick Model

Methods

It was an experimental study. 44 medical doctors participated; a pre-test was taken 01 week before the workshop. Afterwards, they were randomized into 02 groups, group A went through PSA and group B followed conventional prescription writing (CPW) 01-day workshop. At the end, post-test was taken from both groups. The qualitative data was also collected from participants on feedback proforma consisting of few closed ended questions on Likert scale.

Results

The independent t-test was used to compare the data as it was in normal distribution. Posttest performance of PSA group significantly increased P ˂ 0.001 as compared to CPW. Reaction to closed ended 13 questions on Likert scale showed high satisfaction from 4.32 to 4.84 on 5 points Likert scale on workshop satisfaction.

Conclusion

PSA is an effective teaching and assessment strategy for learning clinical pharmacology. The study objectively proves its effectiveness in comparison to CPW and provides a guideline to implement this innovative and useful tool for teaching and assessment.

Keywords

Prescribing safety assessment, conventional prescription writing, Faculty development, Workshop, Impact, Kirkpatrick model.

Frequency of congenital hypothyroidism in new born admitted with neonatal jaundice at tertiary care hospital peshawar

2023-01-02

Neonatal jaundice is a common disorder worldwide affecting 30-70% of newborn infants. Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries.

OBJECTIVES:

To determine the frequency of congenital hypothyroidism in new born admitted with neonatal jaundice at tertiary care hospital Peshawar.

METHODOLOGY:

Settings: removed for blind review

Duration: Period of 1 year from January 2020- January 2021.

Study Design: Descriptive (cross sectional) study.

Results:

In our study 489 mothers 386(79%) mothers were in age range 18-30 years while 103(21%) mothers were in age range 31-40 years. 279(57%) babies were male and 210(43%) babies were female. 303(62%) newborns had maternal gestation age ≤38 weeks and 186(38%) neonates had gestation age >38 weeks. 352(72%) newborns had duration of jaundice ≤14 days and 137(28%) newborns had duration of jaundice >14 days. Birth weight was analyzed as 200(41%) newborns had birth weight ≤2.5 kg and 289(59%) newborns had birth weight >2.5 kg. 15(3%) Mothers had positive history of hypothyroidism while 474(97%) mothers had negative history of hypothyroidism . 24(5%) mother had positive history of anti-thyroid drug intake while 465(95%) mothers had negative history of anti-thyroid drug intake. 5(1%) newborn had congenital hypothyroidism while 484(99%) newborn didn’t had congenital hypothyroidism.

Conclusion:

Our study concludes that the frequency of congenital hypothyroidism was 1% in new born admitted with neonatal jaundice at tertiary care hospital Peshawar.

Key words:

Hypothyroidism, Jaundice, kernicterus, bilirubin, morbidity, anti-thyroid drugs.

Comparison of open vs Plastibell techniques of circumcision for surgical outcomes and cosmetic satisfaction;A randomized control trial

2022-12-31

Objective of the study: To compare the results of circumcision by open technique and the Plastibell

technique in male babies.

Methods: In this randomized controlled interventional study, 1440 babies whose circumcision

was done as religious rite were divided into two groups. Group A underwent circumcision by open

technique whereas group B underwent circumcision by Plastibell method.

Results: Majority 720 (50%) were in age group 6-8 weeks. Compared with open method,

significantly less number of patients in plastibel method experienced moderate pain (47.91% versus 35% p value .00001 and severe pain 31.94% versus 9.02% p value .00001.Rate of wound infection was significantly less in plastibell method 2.77% versus 4.86% p value .020. However more patients in plastibell technique needed re-do circumcision 4.02% versus 1.94% p value .0202. Overall greater parent’s satisfaction was attained with plastibel method.

Conclusion: Plastibell technique has many advantages over open method in terms less post op pain, wound infection, and greater cosmetic satisfaction however more patients will need re-do circumcision in this technique compared with conventional method.

Keywords: Circumcision, open technique, Plastibell, post-op complications

Association of hyperglycaemia at admission with in-hospital mortality and severity of illness among patients with COVID-19.

2022-12-31

Objectives

The association between hyperglycemia at admission and COVID-19 severity and in-hospital mortality is an area of active medical research. Our study aims to explore this association across diabetics and hyperglycemic patients while keeping normoglycemic patients as control.

Methods

This retrospective cohort study involved a total of 90 patients with confirmed diagnosis of COVID-19 infection. Patients were divided into three equal groups based on their history and BSR levels (diabetics, hyperglycemic, normoglycemic). Various laboratory parameters and inflammatory markers were compared across the study groups using Kruskal Wallis test. Finally, chi-square test was use to assess the association of severity and mortality across the study groups.

Results

Out of 90 patients, 38 (42.2%) were males with a mean age of 57.1 ± 14.7 years. Serum ferritin, LDH and lymphocyte levels were significantly higher in diabetics and hyperglycemic patients than in normal COVID-19 patients (p<0.05). hyperglycemia at admission was significantly associated with disease severity (p=0.03) but not with in-hospital morality (p=0.07).

Conclusion

Patients with diabetes and stress hyperglycemia have increased levels of inflammatory markers than normoglycemic patients. Hyperglycemia at admission is associated with poor COVID-19 severity. More studies a required to validate and further explore this relationship.

Post Covid-19 Syndromes, The Time line of Covid

2023-01-02

BACKGROUND & OBJECTIVES: Novel corona virus has claimed significant mortality and morbidity. Timeline of long-term complications and effects on humanity are yet to be explored. Current study aims to evaluate the spectrum of post Covid syndromes in our Covid survivors.

METHODOLOGY: This observational study was conducted at Medicine Dept. RIHS Islamabad after ethical approval. 195 recovered COVID cases were selected and followed 3 monthly over a year. Inclusion criteria: Age >12 years, both genders, Covid PCR+ve >4 weeks earlier. Exclusion criteria: Malignancies, pregnancy, recurrent Covid and that lost follow-up. Patients were evaluated for new onset generalized symptoms, respiratory, cardiovascular, neurological, hematological, gastrointestinal, dermatological and genitourinary supported by relevant investigations. Data analyzed by SPSS-22 with significant p<0.05.

RESULTS: Amongst 195 cases, 102(52.3%) males and 93(47.7%) females, mean age was 42.35+14.31 years, mean duration since Covid recovery 32+24.47 weeks. There was history of mild COVID in 89(45.6%), moderate 71(36.4%), severe 32(16.4%) and life threatening 02(01%) having significant association with increased mean age and female gender (p<0.05). ninety four (48.2%) cases had post COVID syndromes. persistent fatigue (58), fever (29), myalgia’s (27), dyspnea (26), persistent cough (19), weight loss/gain (18), smear positive TB (2), bronchitis (7), asthma exacerbations (3) and pleural effusion (1). X-ray findings showed lung fibrosis in 12, ground glass appearance 10. Spirometry showed reduced exercise capacity in 11. Anemia in 11, leukopenia 02, thrombocytopenia 02, pancytopenia 01 case. In CVS, retrosternal chest pain in 11, orthopnea/PND 05, myocarditis/myocardial fibrosis 04, pericardial effusion 01, new onset hypertension 03, worsened hypertensive control 02, palpitations 10 and POTS 03. Regarding ENT, sinusitis in 12 and mucor-mycosis 03. Reduced GFR 05 and COVAN 01. New onset diabetes 05, worsened diabetic control 06, bone-demineralization 03 and thyroiditis 01. Persistent diarrhea 06, IBS 04, gastritis 08, esophagitis 06, GERD 11. Seven of 93 females reported menstrual irregularities. Hair loss 15, rash 07. headache in 23, anxiety 17, disturbed sleep 14, depression 09, peripheral neuropathy 03, CVA 03, amnesia and PTSD 03 each. 03 cases expired with cardiopulmonary arrest.

CONCLUSION: Post COVID syndrome observed in half of Covid survivors. The respiratory, cardiovascular, dermatological, neuropsychiatric and generalized symptoms were frequent. Authors suggest follow-up of Covid survivors. The clinical evaluation and timely management may improve quality of life and morbidity amongst survivors.

KEY WORDS: COVID-19. Post Covid Syndromes. Long Covid syndrome. Covid complications. Persistent post-Covid syndrome (PPCS), Myocarditis. Lung Fibrosis.

A Comparative study of online and traditional (face to face) learning

2022-12-31

Introduction:

Ever since the advent of usage of internet as a medium of teaching in late 1980s, the method of distanced teaching using online methods has been on the rise.We did a comparative study of online vs. Traditional learning in order to assess student’s viewpoint about the different ways of learning and to assess various aspects of online classes when compared with physical classes

Materials and Methods:

A cross sectional, descriptive study was conducted in may-june 2021 in –removed for blind review---in order to analyse the response of students towards the online mode of learning, and compare it with the traditional learning. The target population were the students of 1^st, 2^nd and 3 year MBBS at the Rawalpindi Medical University. Self structured questionnaires were disributed among a total of 600 students, 200 students from each year. The data collected was analysed using SPSS v 22 and using chi square test.

Results:

87% (522 out of 600) students responded that traditional learning is more effective as compared to online learning. It was shown that there is no association between year of study and mode of learning also no association between gender and mode of learning. Weak internet connection is the biggest hurdle to online learning.

Discussion and Conclusions:

Majority of the participants, acknowledging the positive aspects of online learning; like making management of assignments easier,promoting creativity, easier access to contents and facilitation of giving feedback, still favoured traditional, face-to-face learning, for it ensures a better study environment, allows adequate clinical practice, and improves interaction with the teacher and the fellow students. The biggest hurdles to online learning were connectivity issues, lack of technical expertise, and the need for stricter self-discipline. In short,with removal of the problems associated with online learning, it can evolve into an efficient mode of learning in the near future.

Key words:

Educational technology; Higher education, Online learning, traditional learning, interaction

Word Count Of Abstract : 299

Hamstring Shortness among Undergraduate Students, Using Knee Extension Angle Test

2022-12-31

Objective: To examine the causes and incidence of hamstring tightness/shortness among undergraduate physical therapy students. Cross-sectional study. Institute of Physical Medicine & Rehabilitation, DUHS during the period of Jan 2019 to Jun, 2019.

Material and Methods: The subjects sample size (n=248) was estimated by open EPI software. Male and female both are included. Hamstring muscle shortness was assessed by a gold standard assessment tool i.e. passive knee extension angle test. Descriptive statistical analysis was done by using SPSS version 24.

Results: The hamstring muscle tightness was measured by using knee extension angle test. It results conclude that among (248) students (62.90%) had hamstring muscle tightness / shortness and (37.10%) did not show any muscle shortness. Out of (216) females participants (136) have hamstring shortness. On the other hand out of (32) male participants (20) had hamstring shortness/tightness out of total (248) students. It was also evident from the study that 27% of physiotherapy students having low back pain was because of clinical exposure and tight hamstrings muscles.

Conclusion: Hamstring tightness/shortness is very much prevalent among the undergraduate physiotherapy students. The reason might be the prolong study durations and lack of physical activities. The result showed statistically significant difference between hamstring muscle extensibility in both male and female

Key words: Extension Angle, Flexion, Contracture, Fascitis

Correlation of international prostatic symptom score with prostate volume

2023-01-02

Objective: To evaluate the correlation of International Prostatic Symptom Score with Prostate Volume of Benign Prostatic Hyperplasia patients.

Study Design: A Cross- out sectional study was done. Qualitative variables measured by Chi square test and quantitative by ANOVA. Pearson correlation & multinominal regression were applied. P value considered significant at <0.05. It was conducted in a tertiary care hospital, Ziauddin University Hospital Karachi.

Methodology: The data was collected from 103 Benign prostatic hyperplasia patients. Prostate Volume of BPH patient were recorded by transabdominal ultrasonography in Radiology department. Severity of symptoms were assessed by IPSS questionnaire.

Result: Mean IPSS was found out to be ±13.7. Clinical presentation showed hesitancy & nocturia as most frequently occurring symptoms in benign prostatic hyperplasia patient, these symptoms were found to be statistically significant with prostatic volume.

Conclusion: IPSS strongly correlated with prostate volume. Irritative voiding symptoms have shown more association with increasing prostate volume.

Keywords: Benign Prostatic Hyperplasia, Prostate Volume, International Prostatic Symptom Score, Lower Urinary Tract Symptoms.

Assessment of derangement in biochemical profile in primary open angle glaucoma patients presenting at a tertiary care hospital

2022-12-31

Objective: To assess the changes in high sensitivity C Reactive protein (hs-CRP), serum cholesterol, uric acid, creatinine, bilirubin and ALT in patients of primary open angle glaucoma.

Material and methods: Comparative cross-sectional study conducted between April 2021 and October 2021 at departments of Ophthalmology and Pathology, --removed for blind review----44 POAG patients and 54 healthy controls volunteered to participate in the study. POAG was diagnosed as per criteria. Venous blood was drawn for analysis of serum cholesterol, uric acid, creatinine, bilirubin, ALT and hs-CRP. hs-CRP was performed on ELISA plate reader Platos R496 while spectrophotometric analysis of serum uric acid, creatinine, and cholesterol was carried on Beckman Coulter AU-700.

Results: Mean hemoglobin (Hb), Total leukocyte count (TLC), serum urea, creatinine, uric acid, ALT, bilirubin, cholesterol and HbA1c were 12.80 ±1.50g, 8.88±1.92 mm³, 5.95±5.47 µmol/l, 92.19±21.81 µmol/l, 305.85±79.92 mmol/l, 34.31±18.26 IU/L, 9.26±3.11 µmol/l, 5.18±0.96 mmol/l,6.70±1.28 %respectively whereas the Mean IOP in POAG patients was 28mmHg, mean CCT was 516.6 µm, and mean vertical CDR was 0.6.

High frequency of hs-CRP positivity (50 percent) was reported in our patients. Significantly lower uric acid levels were observed in primary open angle glaucoma patients versus controls ie 305.85±79.92 mmol/l vs 344.36±37.24 mmol/l (P value < 0.05). Serum creatinine was significantly different between mild and severe groups i.e. 88±14.7 vs 113.1±32.4. (p value <0.001*)

Conclusion: High frequency of hs-CRP positivity and low uric acid levels suggest the presence of para inflammation in patients of POAG.

Key words:

Primary open angle glaucoma (POAG), intraocular pressure (IOP), high sensitivity CRP (hs-CRP), uric acid (UA)

Maxillary Impacted Second Premolar; A Surgical Intervention in an Orthodontic Case

2022-12-31

In clinical settings, impacted teeth are a typical occurrence. Because of their proximity to the nasal and oral cavity, impacted teeth have the potential to create more severe and catastrophic difficulties, such as the formation of dentigerous cysts and other disorders. The goal of this report is to look into the fundamentals of treating maxillary premolars that have been palatally impacted. A case report of a palatally impacted right maxillary second premolar is presented in this case report.

Medical Jousting: Going for the kill!

Dr.Fuad Ahmed Khan Niazi — 2023-01-03

He stood determined, focused on the target, his grip on the lance tightening just the right amount, aimed toward the enemy warrior with the precision of an excellent marksman. All set to joust, he leaped gallantly toward his opponent. So sure, of himself, he wanted the win and victorious he was. The triumphant doctor, our knight in shining armor stood tall beside his trophy. Was he dead? he didn’t really care; he had won. The crowd cheered for him as he waived proudly and then stooped forward to reach for the helmet; he wanted to see his face! Who was he? Prince Covid, Sir Typhoid or the Lord Dengue? He was dying and a bare murmur could be heard over his last breath: “I am your brother!!”

Through the evolution of medicine, from medieval times to the modern day, medical jousting has kept haunting us. It is essentially a term meant to describe the use of derogatory comments or gestures in front of a patient or attendant, concerning previous medical care provided by a fellow healthcare professional, without complete or accurate knowledge about real facts.¹

“I do not even consider her a doctor; who told you to get operated by her?” A comment which might have touched a sensitive wire somewhere in your emotional memory, is an actual recollection of what I myself overheard once.

Or, maybe, remembering someone who used to grin, rather peculiarly, when a patient mentioned another colleague’s name, just enough to create sufficient doubt in their minds, will jolt up some sensitive recollections.

Although, this unfortunate practice can be unintentional, sadly, it is more often than not, intentional. It emanates from the deep-rooted instinct of us humans to survive and feel jealous or intimidated by an equal or someone who shares the same goals and targets. This fear leads to insecurity and creates competition out of friends. These complexes tend to flourish more in private healthcare sector where money and high patient turnover matters. However, it is not uncommon even in public sector, where fame and career are the ultimate objective. Unintentional jousting may happen when someone tries to project oneself so much that eventually ends up denigrating others. For example:

“It’s good that you have come to me; all your problems will now be cured, at last.”

Medical Jousting may also be due to a lack of knowledge about other specialties in the context of multidisciplinary patient care or, it may just be a defensive mechanism to bail out of a complication; why not just blame it on someone else!!²

A far less common, albeit, a much more dangerous way is to write incriminating statements against other health professionals.

“This complication has developed because of the stubborn attitude of the anesthetist who kept refusing to intubate our patient without any justifiable reason.”

In these times of medical litigation, such notes can be suicidal as well as being murderous. More recently, the most disparaging and scornful form of jousting has been through the use of social media, given its endless scope and lethal repercussions.^3,4

In trying to develop an understanding of the phenomenon of medical jousting, it needs to be remembered that it is the right of the patient and their families to know the truth. However, truth needs to be discovered through a proper trail of medical record and a well-intended chat with the previous attending doctor. Also, the truth needs to be delivered in its entirety in a neutral manner without compromising the integrity, or safety, of a fellow professional.

It also needs to be emphasized, that, any medical error or unethical behavior should be reported through proper channels to relevant bodies with the motive to ensure benefit to the patient, and, improvement and development of the involved colleague. Under no circumstances should such discussion be carried out in front of patients, their attendants or any unrelated person.⁵

Medical jousting is a real-life problem that genuinely exists and threatens our profession. In a study it was shown that among all the comments that were made about another doctor during patient consultation, 67% were accusing or critical while only 29% were supportive.⁶ This unnecessary evil, encompassing our ‘noble profession,’ can result in, not only the loss of confidence and faith in the medical professionals, but also, respect in the eyes of the common man. This may potentiate a surge in an already alarming tendency of violence, among a certain segment of our population, against hospitals and healthcare workers. It can, however, be avoided with the collective effort of all the professionals. Jousting should be categorically denounced as professionally unethical and efforts for its elimination should be encouraged at all levels.

“Speak truth in such a way that it should be pleasing to others. Never speak truth which is unpleasant to others. Never speak untruth which might be pleasant.” (Anonymous)