ISSN(Print) 2076-2860 ISSN(Online) 2958-5945 Email: Editorial@jaimc.org Phone: +924299231453 PMDC & UHS (IP-0043)
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MBBS, MD
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CURRENT ISSUE
VOL. 22, ISSUE NO. 3
EDITORIAL
Smog in Lahore, Pakistan
Iqra Azeem, Anjum Razzaq, Shahid Mahmood Sethi
https://doi.org/10.59058/ngh75g65
ORIGINAL ARTICLES
Comparative Study of Short Segment Fixation with or Without Transpedicular Bone Graft for Surgical Treatment of Burst Fractures of Thoracic & Lumbar Spine in Adults After Trauma
Muhammad Asad Munir, Omer Farooq Tanveer, Waqas Ali, Asghar Ali, Muhammad Tahir, Naveed Ali Shair
https://doi.org/10.59058/7yenjy83
ABSTRACT
Background And Objective: Thoracolumbar fractures are among the most common fractures of the spine because of high energy trauma. A short segment fixation with two proximal & two distal screw fixation including the fractured vertebra at single level thoracolumbar fracture with or without transpedicular intracorporeal bone graft provides the adequate support & stability. The objective of this study was to assess the clinical effectiveness of short segment fixation with or without transpedicular bone grafting substitutes in patients with single level Thoracolumbar spine Burst fracture.
Methods: This Randomized Controlled Trial was conducted from December 2016 to December 2019 in the Department of Orthopedic & Spine Surgery at Lahore General Hospital, Lahore. After approval from Hospital Ethical Review Board, 64 patients having single level burst fractures of thoracolumbar Spine were divided into two equal groups A & B. In Group A, all patients were treated with short segment trans pedicle screw fixation with bone graft while in group B patients, only short segment fixation was done. All the patients were followed for one year to assess the Kyphotic angle, vertebral body height and visual analogue score (VAS) and was noted in a predesigned proforma.
Results: Group A and Group B demonstrated statistically significant differences in various measured outcomes. For the kyphotic angle, Group A recorded a mean of 18.5° ± 4.0°, while Group B had a slightly higher mean of 19.5° ± 4.2° (p = 0.03). Vertebral height measurements revealed that Group A maintained a mean height of 23.1 ± 2.8 mm, whereas Group B exhibited a lower mean height of 21.3 ± 3.3 mm (p = 0.02). Lastly, the VAS score, reflecting pain intensity, showed Group A with a mean score of 2.0 ± 0.8, slightly lower than Group B's 2.05 ± 0.7 (p = 0.01), indicating a statistically significant improvement in pain levels in both groups but more significant in Group A over the year.
Conclusion: Short Segment Fixation is an effective treatment option for maintaining the anterior vertebral height and prevention of loss of kyphotic angle at single level thoracolumbar fracture of the spine. Moreover, the VAS score was also improved where the short segment fixation with transpedicular bone graft was done. Key Words: Anterior vertebral height, Kyphotic Angle, Short segment fixation, Trans pedicle graft substitutes,
Trans pedicle screw fixation, Thoracolumbar Burst fractures
Risk Factors for Seroma Development Following Breast Cancer Surgery
Ghazia Qasmi, Muhammad Hassan, Shahrukh Muneer, Syed Qasim Ammar, Hana Nasir, Aysha Zafar, Muaz Shafique-ur-Rehman
https://doi.org/10.59058/h71fgn76
ABSTRACT
Background and Objective: Seroma formation is a common complication after modified radical mastectomy and breast conservation surgery in breast cancer patients. This study investigates the factors influencing seroma development in women undergoing breast cancer surgery at a tertiary care hospital in Lahore, Pakistan.
Methods: A retrospective analysis was conducted at a tertiary care hospital in Lahore, including 159 female breast cancer patients aged 20 years and above from 01 august 2020 to 30 September 2022. Patients who underwent modified radical mastectomy (MRM) or breast conservation surgery were included, while those with uncontrolled diabetes, advanced liver disease, or prior axillary surgery were excluded. Data were collected using a semi-structured questionnaire, covering socio-demographic characteristics, known risk factors, and disease history and was analyzed using SPSS-26.
Results: Seroma formation was observed in 37(23.27%) patients out of 159 total patients .On bivariate analysis the findings revealed a higher incidence of seroma among patients from urban areas as compared to rural (29.9% vs 12.9%, p=0.013) and higher in lower socioeconomic backgrounds (> 32% Vs 19.2%, p=0.042). High body mass index (p=0.015) was also associated with increased seroma formation with more in higher BMI as compared to normal BMI ( 29% Vs 11.5%, p = 0.015). Surgical factors, like the number of axillary lymph nodes involved p=0.032) and postoperative wound infections (p<0.001) were also significantly associated with seroma formation. However, on multivariate analysis only body mass index with over weight patients (AOR= 4.89, 95% CI=1.29-8.79) , axillary lymph nodes involvement(AOR=2.88,95% CI=1.18-7.05) and post operative infection (AOR=6.23, 95% CI=2.54-15.28) showed significant association. However, factors such as age, education, neoadjuvant chemotherapy, diabetes, hypertension, and postoperative radiation showed no significant association with seroma formation.
Conclusion: Our study found a higher rate of seroma formation, with possible predictors including body mass index, extent of axillary nodal clearance and post operative infection. Mitigation of these factors can prevent seroma formation and better recovery of patient.
Key Words: Seroma, Mastectomy, Breast Conservation Surgery, Hypertension, Breast Neoplasms.
Functional and Radiological Outcomes of Surgical Treatment of Giant Cell Tumor of Bone Using Liquid Nitrogen as Adjuvant Therapy
Tahir Mahmood, Mubashir Farhan, Asghar Ali, Naveed Ali Shair, Hamid Siddique, Rizwan Anjum, Zafar Iqbal Shahid
ABSTRACT
https://doi.org/10.59058/dghmd392
Background and Objective: Giant Cell Tumor (GCT) is a relatively uncommon aggressive primary bone tumor. With simple curettage, the recurrence rate is high. Several adjuvants like Liquid Nitrogen, Hydrogen Peroxide, Ethanol, Polymethylmethacrylate (PMMA) and Phenol, have been used to reduce the recurrence rate of this potentially aggressive benign tumors. Liquid nitrogen is used as an adjuvant that causes controlled necrosis and intracellular destruction of tumor stromal cells. Thus, this study was conducted to determine the role of liquid nitrogen as an adjuvant therapy for the surgical treatment of GCT in term of functional outcomes, complications and reduction of recurrence with this treatment modality.
Methods: After ethical permission from institutional review board, this quasi experimental study was conducted at the Department of Orthopaedic Surgery, Services Hospital Lahore from January 2023 to December 2023. The study included 22 patients with established diagnosis of Giant Cell Tumor of bone in different bones. All these patients underwent adjuvant therapy with Liquid nitrogen after Extended Curettage. The Sub chondral bone was packed with iliac crest bone graft while the cavity was filled with Bone Cement and it was fixed with some sort of fixation device like Butress plate for Proximal Tibia, distal Femur Locking Plate for distal Femur etc., At follow up of 12 months, the recurrence rate of tumor, functional outcomes of joint in terms of MSTS scores and complications like infection, skin breakdown, implant loosening and neurological deficit were noted.
Results: Out of 22 patients, 13 (59%) were female and 9 (41%) male, with a mean age of 36 ± 11 years. The overall mean MSTS score was 88.98 ± 7.0, with higher scores for lower limb cases (92.26 ± 6.9) compared to upper limb cases (85.99 ± 7.1). Complications included recurrence in 3 (13.63%), skin breakdown in 1
(4.5%), and superficial infection in 3 (13.63%).
Conclusion: Extended curettage using Liquid Nitrogen as adjuvant therapy is associated with low recurrence rate and an effective treatment for these tumors. It also has good functional outcomes with low complications rate.
Key Words: Giant cell tumor, Cryotherapy, Liquid nitrogen, proximal tibia, distal femur, distal Radius
Frequency of Neurological Complications in Children Presenting with Meningitis to a Tertiary Care Hospital
Muhammad Sarwar,Nighat Sultana, Muhammad Shafqat
https://doi.org/10.59058/6p548x57
ABSTRACT
Background and Objective: Meningitis can be defined as infection of brain covering, protecting the brain and spinal cord, resulting in inflammation. There is much gap in literature regarding frequency, complications and predictive factors in children with meningitis. The purpose of this study was to assess frequency of neurological complications in children presenting with meningitis.
Methods: This prospective longitudinal study was conducted at Pediatric Intensive Care Unit, The Children Hospital, University of child's Health Sciences from 1st Dec 2021 to 30th November 2022. Patients of both gender with meningitis were included in the study through non probability consecutive sampling. Sample size of 92 was calculated using confidence level as 95%, 8% margin of error with expected frequency of hydrocephalus as 18.8% in children with meningitis. All patients were sent to radiology department and neurological complications (Subdural effusion, Ventriculomegaly, Subdural empyema and Hydrocephalus) was recorded as per CT-scan and MRI findings and all this data was documented on pre-designed questionnaire. Data were entered and examined with SPSS version 23. Cross tabulation was done between age, gender and duration of meningitis with the complications and chi square test was applied, p ≤ 0.05 was considered statistically significant.
Results: Male patients were 52.2% and females were 47.8%. Frequency of Post Meningitis complications were studied and results showed that seizure was observed in 57.6%, subdural effusion 42.4%, ventriculomegaly 29.3%, subdural empyema 17.4% and hydrocephalus in 10.9%. On cross tabulation, only age was found to be significantly related with subdural effusion, with a p value 0.021.
Conclusion: Neurological complications in pediatric meningitis are frequent, with seizures being most common. Age significantly correlates with subdural effusion. Timely and proper management of these neurological complications can improve the outcomes in these children.
Keywords: meningitis, infection, neurological, frequency, seizure, complications, subdural effusion
Effects of Spearmint (Peppermint) on Morphological, Histological and Biochemical Aspects of Ovaries
Uzma Ali,Amber Salman, Momna Riaz, Shireen Hamid, Faiza Hanif, Saqib Mansoor
https://doi.org/10.59058/bbnxgy14
ABSTRACT
Background and Objective: Spearmint (Peppermint), known for its aromatic and medicinal properties, is used in various products globally, including food, confectionaries, chewing gum, and toothpaste. While it has been known for its potential therapeutic benefits, this study aimed to investigate the effects of spearmint on the morphology, histology, and biochemistry of ovaries in Wistar albino rats.
Methods: This Experimental animal study involved 30 adult female albino mice (200–250 g), divided into three equal groups. Group A (Control) received 15 ml/kg distilled water, Group B (Low Dose) received 0.3 g/kg body weight ethanol extract of peppermint leaves, and Group C (High Dose) received 0.6 g/kg body weight. Treatments were administered via gastric infusion for 30 days. Ovaries were dissected, weighed, and histological slides were prepared using H&E staining. Parameters, including capsule thickness, follicle diameter, and corpus luteum, were analyzed with ImageJ® software. Data were processed using SPSS 20.0, with significance level as p < 0.05.
Results: Final ovarian weights (Group A: 0.19±0.02 g, Group B: 0.36±0.09 g, Group C: 0.49±0.05 g; p<0.001) and Relative Tissue Weight Index (RTWI; Group A: 0.08, Group B: 0.17, Group C: 0.27; p<0.001) increased significantly in experimental groups. Histological analysis revealed decrease in follicle diameters with higher doses of spearmint in both secondary and graafian follicle (secondary follicle; Group A 29.10±4.11 µm, Group B 22.31±5.51 µm, Group C 15.20±2.94 µm and Graafian follicle; Group A 53.75±8.01 µm, Group B 35.87±4.97 µm, group C 23.64±4.96 µm). Decreased corpus luteum size, along side significant reductions in serum progesterone levels post-experiment (Group A: 55.29±5.94 ng/ml, Group B: 23.01±8.89 ng/ml, Group C: 4.12±0.70 ng/ml; p<0.001) were also observed.
Conclusion: This study reveals detrimental effects of excessive spearmint leaf consumption on rat ovarian histology, body weight, and progesterone levels. Caution, particularly during pregnancy, is advised due to potential risks to hormonal and ovarian function. Further research is essential to understand the mechanisms and assess the implications for human health.
Key words: spearmint, ovarian morphology, progesterone level
Reasons of Patient-Related Delay in Diagnosis of Breast Cancer Among Women From a Developing Country: A Multi-centre Comparative Cross-Sectional Study
Hana Nasir, Ghazia Qasmi, Ammara Afzal, Laiba Anwar, Muhammad Waleed Imran, Sanwal Sardar Nawaz, Aysha Zafar, Maria Arshad
https://doi.org/10.59058/v8gkax56
ABSTRACT
Background and Objective: Breast cancer (BC) is the most commonly diagnosed cancer among women globally, with developing countries like Pakistan facing significant challenges related to late diagnosis and high mortality rates. A large proportion of Pakistani women present with late-stage BC due to a lack of awareness, cultural barriers, and healthcare accessibility issues. This study aimed to identify patient-related factors contributing to delays in BC diagnosis among women in Lahore, Pakistan.
Methods: A multi-centre comparative cross-sectional study was conducted at two hospitals in Lahore,
including public and private healthcare facilities. A total of 208 female BC patients were enrolled using non- probability convenience sampling from June 2023 to December 2023. Data were collected through structured interviews assessing socio-demographic factors, medical history, and healthcare-seeking behaviors. Statistical analyses, including binary logistic regression, were performed to identify predictors of delayed diagnosis, with a p-value of <0.05 considered statistically significant.
Results: The study found that 58.2% of participants experienced a delay in diagnosis of more than three
months. Significant predictors of delayed diagnosis included a preference for alternative therapies (AOR=2.49, 95% CI: 1.17–5.29, p=0.018), fear of biopsy spreading cancer (AOR=5.99, 95% CI: 2.70–13.32, p<0.001), and social stigma associated with cancer (AOR=3.67, 95% CI: 1.58–8.48, p=0.002). Additionally, lack of awareness regarding breast self-examinations and screening programs was prevalent among delayed cases.
Conclusion: Patient-related factors such as fear, misconceptions, and cultural stigma play a significant role
in delayed BC diagnosis in Pakistan. Targeted public health interventions, awareness campaigns, and culturally sensitive educational programs are critical to promoting early detection and improving BC outcomes in developing countries.
Key Words: Breast Cancer, Diagnostic Delay, Predictors of Delay, Cultural stigma, Misconceptions.
CASE REPORT
Gastric Mucormycosis Mimicking Gastric Carcinoma in a 51-Year-Old Male: A Case Report From a Tertiary Care Hospital
Raana Akhtar, Sadia Shareef, Sadaf Ali Jaffari, Anam Ilyas, Sobia Anwar, Tahir Naeem, Sobia Ashraf
https://doi.org/10.59058/ar29gd02
ABSTRACT
Mucormycosis is a rare opportunistic fungal infection which is usually diagnosed in immunocompromised individuals. Here we are reporting a 51 years male patient who was a known diabetic with chronic renal failure, presented with gastric bleeding and was clinically suspected as a case of Gastric Carcinoma. He underwent endoscopy for gastric mucosal biopsy and histopathological evaluation was done. Microscopic examination of the sections revealed partially ulcerated gastric mucosa which has dense mixed inflammation in the lamina propria. There were multiple areas of necrosis and many variable sized fungal hyphae showing branching at right angles. The histopathological diagnosis of Mucormycosis was made.
Keywords: Mucormycosis, Immunocompromised, Gastric carcinoma
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