ISSN(Print) 2076-2860 ISSN(Online) 2958-5945 Email: Editorial@jaimc.org Phone: +924299231453 PMDC & UHS (IP-0043)
VOL. 20, ISSUE NO.1
EDITORIAL
PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG
Sana Iftikhar, Shahid Mahmood Sethi
DOI: https://doi.org/10.59058/jaimc.v20i1.16
ORIGINAL ARTICLES
OUTCOME OF CROSSED K-WIRES WITH LATERAL K-WIRES FOR TYPE-III SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDEN
Zafar Iqbal, Waqas Ali,Tanveer Haider,Asim Islam,Muhammad Khalid, Mudassar Siddique
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.5
Background and Objectives: Elbow is the most common site of fractures in children. It accounts for approximately 60% of all injuries in children. These fractures are caused by direct or indirect low energy trauma. Immediate & late complications are common in fracture of this region. The objective of this study was to compare the outcome of two different modes of treatment i.e. crossed K-wires versus lateral wires for displaced type-III supracondylar fracture of Humerus in children. Methods: A total of 80 patients having age between 2-13 years with type-III supracondylar fracture of Humerus type III those fulfilling the inclusion criteria were admitted through emergency department of this hospital. All these patients underwent x-rays of the elbow joint both AP & Lat views before the surgery. Patients were randomly divided into 2 equal groups. In group A, all fractures were fixed with crossed K-wires after reduction of these fractures, one wire from the medial condyle and one from the lateral condyle while in group B all fractures were fixed from the lateral condyle with 2 parallel K-wires of 2mm size in a divergent way after reduction of these fractures. In both of these groups, all these fractures were reduced closely under G/A with the help of image intensifier. Results: In group A 62.5% patients presented with type-III A while 37.5% presented with type-III B fractures. In group B 70.0% patients had type-III A fractures while 30.0% patients type-III B fractures. Functional & radiological assessment was done with Baumann's angles & modified Flynn's criteria. At the final follow up the Baumann's angle was equal in both of these groups (78.15 + 3.32 in Group A) & (79.1 + 4.21 in Group B p>0.45). Conclusion: This study concluded that there is no statistical significant difference in both modes of treatment regarding the stability of fixation and in terms of functional outcomes. However there are more chances of ulnar nerve injury with crossed k-wires fixation.
A Retrospective Study of Antibiogram in One of the Largest Burn Center in Pakistan
Junaid Ahmad, Farrukh Aslam Khalid, Imran Shahzad, Ghazala Tabassum, Qurat ul ain khan, Shamila Ashraf, Moazzam Nazeer Tarar
ABSTRACT
DOI:https://doi.org/10.59058/jaimc.v20i1.6
Background and Objective: Jinnah Burn and Reconstructive Surgery Center, Lahore, Pakistan is one of the largest burn patients management center in country. We evaluated our latest antibiogram of burn wounds to help patients and improve the healthcare. Methods: Retrospective observational study of burn patients. Our study included all kinds of burns and all admitted patients with all ages, total burn surface area 01-80%. Wound cultures and sensitivity done on wounds swabs by culture and disc diffusion methods. Results: There were 175 cases. Total six bacteria were found in all 175 cases. The Acinetobacter species were 9 (5.1%), Klebsiella species were 110 (62.8%) and these were most common ones, Proteus species were 12 (6.8%), Pseudomonas species were 30 (17.1%), Staphylococcus aureus were 12 (6.8%) and staphylococcus coagulase negative were 2 (1.1%). Klebsiella was most sensitive to Colistin. All 105 out of 105 were sensitive (100.0%), followed by Tigercyclin; 39 out of 65 were sensitive (60.0%) and then Meropenum 47 out of 88 were sensitive (53.4%). Conclusion: Klebsiella is the most common organism found in cultures of burn wounds and Colistin shows best sensitivity results against all bacteria found in our reports including Klebsiella.
Frequency of Pregnant Females with Adequate Knowledge Regarding Gestational Diabetes Visiting Public and Private Sector Hospital of Lahore
Sariya Tul Tahira ,Iram Inam, Faisal Ashraf, Nimra Abid, Memuna Kanwal, Mizrah Mehreen
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.7
Background & Objective: Gestational diabetes mellitus (GDM) is a perfect window of opportunity for the prevention of DM in two generations, and its incidence is increasing in the world. Awareness of the condition among antenatal women may translate into prevention and early diagnosis of the disease. This study aims to assess the frequency of female with good knowledge regarding GDM during pregnancy, as only few females are aware of it. There is no local evidence available in this regard which could help us in determining the level of awareness in females belonging to local population regarding GDM. Methods: Overall 230 females fulfilling the selection criteria were enrolled in the study from OPD of Departments of Obstetrics & Gynecology of both hospitals. Informed consent was obtained. Demographic information (name, age, gestational age, parity, education level and socioeconomic status) was also noted. Then females were interviewed with researcher herself regarding their knowledge about GDM during pregnancy and adequate knowledge was noted (as per operational definition). All this information was recorded through pre-designed proforma. Results: In our study, out of 230 cases, mean age was calculated as 28.38+3.71 years; mean gestational age was 28.84+3.38 weeks, frequency of adequate knowledge regarding gestational diabetes in pregnant females was recorded in 15.65%(n=36). Conclusion: We concluded that the frequency of pregnant females with adequate knowledge regarding gestational diabetes is not high and needs some emergent steps to improve it for prevention of associated morbidities.
Patient Satisfaction Towards Outdoor Medical And Surgical Services Provided in a Public Sector Tertiary Care Teaching Hospital of an Industrial City of Pakistan: A Cross-Sectional Study
Shahid Mahmood, Imrana Aslam, Sariha Mashood, Ghazia Qasmi, Noreen Bukhari, Ayesha Khalid
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.8
Background & Objectives: Patient satisfaction is a multidimensional concept that consists of client's perceived needs, their expectations and experience of a health care system. There is no data available on patient satisfaction with outdoor (OPD) medical and surgical health care services in public sector tertiary care hospital of an industrial city of Punjab, Pakistan. This study aimed at measuring patients' satisfaction towards health care facilities provided in OPD of a public sector tertiary care level hospital of Sialkot, Pakistan Methods: This descriptive, cross-sectional study was undertaken during the month of April-June, 2020 in the medical and surgical OPDs of Allama Iqbal Memorial teaching hospital, Sialkot. Overall, 180 adult patients visiting OPD were randomly selected and interviewed in-person in OPD settings using modified O-PAHC questionnaire. Analysis was based on descriptive characterization of participants, estimating patient's satisfaction score and assessing relationship of socio-demographic factors in relation to summary satisfaction score using multiple linear regression technique. Results: Of 180 participants, 93 clients were from medical and 87 were from surgical OPD. Most clients were aged 40 years or above, with females constituted 60% of sample. Two-third participants had no formal education. More than fifty percent clients were not satisfied with OPD timings, waiting time for examination, cleanliness in toilets, and surgeons not listening their health issues attentively. Mean satisfaction score was 59% ± 6 (range: 41% -70%). No statistically significant difference was found for mean satisfaction score as regards to age, sex, education status, and frequency of visit. Conclusion: On average, 59% of the OPD Clients attending medical and surgical departments of this teaching hospital were satisfied from its working. Hospital administration needs to devise strategy to reduce waiting time for consultation, extend OPD timings, with more efforts required to improve physical ambience.
Frequency of Patterns and Risk Factors of Acute Accidental Poisoning Among Children of Age 5-10 Years
Kanwal Batool Raza, Sonia Zofishan, Rakhshanda Umer
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.9
Background & Objective: Poisoning in children is a leading cause of fatalities across the globe; around 2% of injury related deaths are incriminated due to accidental poisoning in the developing countries. The objective of this study was to determine the frequency of patterns and contributing factors of acute accidental poisoning among children of age 5-10 years. Methods: Across-sectional type of study was done at the Jinnah Hospital, Lahore from November 20, 2018 to May 20, 2019. All accidental poisoning patients were enrolled. General and specific management steps were carried out in all the cases. After discharge they were kept on follow up in Pediatrics Outdoor Patient Department. Information regarding their demographic data was noted in the proforma. The patterns and contributing factors of acute accidental poisoning among children were identified. SPSS v23.0 was used to assess the obtained data. Results: Age range in this study was from 5 to 10 years. Mean age of child was 7.3±1.6 years. Among 145 children, 89(61.4%) were males and 56(38.6%) were females. The result of the study were unsafe storage of household poison 94(64.8%), inadequate supervision 91(62.8%), working mother 49(33.8%), low SES 19(13.1%) and illiterate mother 13 (9.0%). Conclusion: Unsafe storage of household poison 94(64.8%) was the most common factor followed by inadequate supervision 91(62.8%), working mother 49(33.8%), low SES 19(13.1%) and illiterate mother 13(9.0%).There is a need to arrange health promotion and protection programs at various levels through projects, brochures and electronic media campaigns so that the awareness of parents can be raised regarding accidental poisoning and they can observe preventive measures in the future to reduce its incidence .
SURGICAL OUTCOMES OF VOLAR LOCKING PLATE VERSUS K-WIRES FIXATION FOR DISTAL RADIUS FRACTURES
Muhammad Zafar Iqbal Shahid, Muhammad Khalid, Tanvir Haider, Asim Aslam, Muhammad Khalid Syed, Mudassar Siddique
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.10
Background and Objective: The most common hand fractures among adult population are distal radius fractures and optimal management of these fractures remains controversial. Several surgical strategies are available to treat these Fractures. Two most commonly used procedures volar locking plates and percutaneous K-wire fixation are used to treat distal radius fractures. The objective of this study was to compare outcome in distal radius fractures in volar locking plate and in K-wire fixation and in terms of functional and clinical outcome. Methods: We conducted a randomized control trial at department of orthopedic surgery, Services Institute of Medical Sciences Lahore. After approval from the Ethical Review Board, a total number of 80 patients with distal radius fractures fulfilling the inclusion criteria were included. In Group A, distal radius fractures were fixed with volar locking plate and in Group B, K-wires were used to fix the distal radius fractures. Patients with polytrauma, head injury and spine injury were excluded from the study. Follow up was done at 2, 4, 6 weeks, 3 months and final at 6 months. Functional and clinical outcomes were measured with DASH Score and PREW Score at 3 months and 6 months. Results:- Age range was 18-80 years, mean age was 61.3 + 14.5 years. Mechanism of injury was fall on outstretched hands in 45 (56.2%) patients, fall from height in 20 (25.0%) patients, motorbike accidents in 7 (8.8%) patients, injury after fight in 4 (5.0%) patients and 4 (5.0%) patients were having machine injury. No difference in radiological outcomes was recorded in the final follow up. There was no difference in volar tilt loss. It was 0.5o in plate group and 0.7o in K-wires group (p = 0.92). Radial length loss was 1mm in Group A and 1.2mm in Group B (p = 0.55). The loss of angle of radial inclination was 1.2o in Group A and 1.5o in Group B (p = 0.35) at the final follow up. There were 04 cases of superficial infection in Group B (10%) versus 01 in Group A(2.5%, p = 0.001). Conclusion:- Our study shows that no mode of treatment in distal radius fractures is superior to other. The results of volar locking plate as compared to K-wire fixation were slightly better in the initial period but on long term bases both of these techniques have excellent and comparable results. DASH Score and PREW Score were almost equal in both of these techniques. The functional outcomes were almost equal in both of these techniques The complication rate although slightly more in K-wires group but it was insignificant from functional point of view.
Association of ABO and RH Blood Group with Type II Diabetes Mellitus
Maria Abdullah, Sana Haseeb Khan, Ayesha Bajwa, Kashaf Mustafa
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.11
Background and Objective: Much of the research has shown the link of various blood groups with different ailments. It has also been assumed that those blood groups are genetic determinants of different diseases, like diabetes.The objective of this study was to find an association between blood group and Type II diabetes (T2DM). Design: We conducted a cross-sectional study in which diagnosed diabetic patients having blood sugar fasting (BSF) greater than 125mg/dl were enrolled. We determined their blood groups by the tube method. Place and duration: The study was conducted at blood bank and medical wards (indoor and outdoor) of Gulab Devi hospital Lahore for a period of six months i-e June 2021 to December 2021. Methods: A structured questionnaire was used to collect socio-demographic and clinical data from the patients. Their blood samples were drawn and the blood grouping was determined by tube method by the researcher herself. The data was evaluated using IBM SPSS21 statistical software. Results and conclusion: The current study found no link between T2DM and ABO blood groups but shows the highest occurrence of blood group B and the least prevalence of AB-blood group in the study population.
Effect of Remdesivir in COVID-19 in Terms of Hospital Discharge and Mortality Benefits
Anjum Hameed, Asim Mehmood, Muhammad Younus, Qamar Rafique, Rao Hashim Idrees, Maqsood Cheema, Amber Riaz
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.12
Background & Objective: There is no first line antiviral treatment for Corona Virus Disease 2019 (Covid-19). Remdesivir is used as antiviral drug for covid 19 in different parts of world with variable results.The objective of our study was to assess the effect of Remdesivir in Covid-19, in terms of time to discharge from hospital and mortality rate benefit. Methods: An interventional, single-center study conducted at Corona Wards of DHQ University teaching hospital Gujranwala. Two categories were made using simple random sampling technique. First category was marked 'Remdesivir group', to whom after Informed Consent Injection Remdesivir (200 mg on the principal day followed by 100 mg every day for the following four days) was given. Second category was the 'Control group'; they were not given the injection Remdesivir. Total 248 patients were selected for the study. The Remdesivir category included 124 patients and the Control category involved 124 patients. Collected data was analyzed using SPSS 23.0. All baseline characters and variables in history were calculated as Mean and standard deviations for quantitative variables and as percentages for frequencies of qualitative variables. Univariate comparison for binary variables was performed with Chi-Square test. A p-value of <0.05 was considered as significant. Results: In the Remdesivir category 23 (18.5%) had mild illness, 50 (40.3%) had moderate illness and 51 (41.2%) patients had severe illness. In the Control category 26 (20.9%) had mild illness, and 50 (40.3%) hadmoderate illness and 48(38.8%) patients had severe illness. The median hospital stay days in Remdesivir category was 13 (95% CI: 12 - 15) and total death rate was 36.44%. The median hospital stay days in Control category was 11 (95% CI: 10 - 12) and the death rate was 31.35%. p- value .40. Conclusion: The information showed that Remdesivir was not better than the standard of care treatment in shortening the hospital stay days in patients with proven Covid-19. No Mortality benefit was seen with Remdesivir treatment.
Factors Responsible for Severity of Infection in COVID-19 Patients: A Multicenter Study
Khalid Waheed, Munaza Javed, Muhammad Naeem Akhtar, Osama Habib, Muhammad Ijaz Bhatti, Muhammad Irfan Malik
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.13
Background & Objective: After the Spanish Flu world has seen epidemics of SARS and MERS; however, these epidemics have no comparison to the magnitude of devastation caused by COVID-19. This virus originated from Wuhan, China and spread to every nook and corner of the world within weeks. In three months World Health Organization had labeled it as a pandemic. This novel deadly virus shows no discrimination of race or age. Everyone is equally at risk of developing the infection; however, clinical severity is thought to be influenced by age and the presence of comorbids. Furthermore, an increased rate of intensive care admissions, length of stay, need for mechanical ventilation, and mortality have been reported in patients with COVID-19 infections having comorbids.The objective of this study was to evaluate the Factors responsible for clinical severity of COVID 19 infection in patients presenting to tertiary care hospitals in Lahore. Methods: This Descriptive observational study was conducted simultaneously at three tertiary care hospitals in Lahore. Atotal of 200 confirmed patients with COVID-19 infection by RT PCR were included in the study. The case records of all the inpatients in the General Corona ward, Isolation wards, HDUs and ICUs were analyzed. Data analysis was performed in SPSS 20. Age, gender, and comorbid including Diabetes, hypertension, ischemic heart disease were recorded and their relationship with the severity of COVID 19 infection was studied by applying the Spearman's rank correlation and Fisher's exact test. Results: Out of the total 200 patients 54.5% were male and 45.5% were female, with a mean age of 58.29 ± 15.20 years. Critical and severe disease was seen in 33% and 63% of patients respectively. Most frequent comorbids reported were Hypertension (HTN), Diabetes (DM), ischemic heart disease (IHD), and lung diseases. A statistically significant positive association was observed between the severity of COVID 19 infection and increased age, diabetes. Hypertension was most frequently reported comorbid but association was not statistically significant. However, patients who had HTN along with ischemic heart disease had a statistically significant positive association with the severity of the disease . Conclusion: Advanced age, diabetes Mellitus and hypertension when present in patients with ischemic heart disease have a statistically significant association with clinical severity of patients suffering from COVID 19 infection.
Effect of Tocilizumab in Terms of Hospital Stay and Mortality Pattern Among Patients with Severe Versus Critically-ill COVID-19 Patients: A Comparative Analytic Study
Anjum Hameed, Asif mehmood, Muhammad Younus, Shahid Mahmood, Qamar Rafique, Maqsood Cheema, Rao Hashim Idress, Amber Riaz
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.14
Background and Objectives: Most patients with mild and moderate COVID-19 infection recover with standard care therapy. Mortality in patients with severe illness and those critically ill is high. Tocilizumab acts by blocking interleukin-6 receptors and shows promising results in severe disease. Aim of this study was to assess the effect of Tocilizumab in severe and critically ill COVID-19 patients in terms hospital stay and reducing the risk of death. Methods: In this comparative analytical, single-center study undertaken in DHQ university teaching hospital Gujranwala, forty-four patients were enrolled after an informed consent through non-probability consecutive sampling. The patients were categorized based on oxygen requirement as severe (oxygen requirement 10 L/min) and critically ill patients (oxygen requirement 15 L/min). All patients were treated with injection Tocilizumab (8mg per kg body weight) using criteria based on oxygen requirement (10L/min or more) and increased levels of any two of the laboratory investigations including CRP, D-Dimers, serum ferritin and LDH. Sociodemographic and clinical profile were collected using a semi-structured proforma. Outcome of interest was hospital stay and mortality. Comparison of effect of Tocilizumab was analyzed in regards to age, sex, laboratory investigations and stated outcome using Pearson's Chi-squared test. P-value of ≤0.05 was considered statistically significant. Data were analyzed using SPSS version 24.0. Results: Of 44 COVID-19 patients, 26 (59.1%) had severe disease and 18 (40.9%) were critically ill. We did not observe any statistical difference between these two categories as regards age, sex, hospital stay or presence of co-morbid conditions. However, there were 17 (94%) deaths observed among critically ill patients, whileonepatientdiedwithseveredisease.Thismortalitydifferencewasfoundstatisticallysignificant(p<0.001). Conclusion: Tocillizumab has shown significant effect to reduce mortality and minimizing hospital stay amongst COVID-19 patients with severe disease only with minimal effect in critically ill patients. Tocilizumab may be introduced early in treatment plan for severe COVID-19 patients.
CASE REPORT
GIANT TUBULAR ADENOMA OF BREAST IN A YOUNG NULLIPAROUS FEMALE: A CASE REPORT
Ghazia Qasmi, Amina Rizwan, Shahid Mahmood, Maryam Hameed, Rajia Ejaz
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i1.15
Background: Tubular adenoma of breast is an uncommon benign condition in young females, with only few growing to a very large size. Triple assessment tools shows similar presentation as a fibroadenoma, however, only excision biopsy can differentiate tubular adenoma from fibroadenoma. Methods: A case of giant lump in 18 years young, unmarried, nulliparous female presented in outdoor patient department of a medium size trust hospital of Lahore, Pakistan and was preoperatively diagnosed as a case of fibroadenoma. Results: Postoperative excision biopsy report showed a rare pathology of giant tubular adenoma of breast. Conclusions: Giant tubular adenomas are rare clinically in nulliparous young females and should be considered in differential diagnosis of breast lumps among young, nulliparous females and a long-term follow-up of patients is required to observe its potential for recurrence and malignancy.