ISSN(Print) 2076-2860 ISSN(Online) 2958-5945 Email: Editorial@jaimc.org Phone: +924299231453 PMDC & UHS (IP-0043)
VOL. 20, ISSUE NO.3
EDITORIAL
DOES MEDICAL EDUCATION IN PAKISTAN NEED REORIENTATION?
Shazia Saaqib, Shahid Mahmood
DOI: https://doi.org/10.59058/jaimc.v20i3.62
ORIGINAL ARTICLES
Aysha Rashid, Syed Kumail Abdi, Maahin Rizwan, Momina Rasheed
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.63
Background & Objective: Screen time has now become a most concerned issue around the world due its negative effects on children' health. COVID-19 was declared as a pandemic by World Health Organization (WHO) during March 2022 and lockdown was one of the strategy to control disease transmission. This study aims to investigate whether this lockdown caused an increase in screen time and what are its effects on physical, emotional, and behavioral functioning of children. Methods: It was a cross-sectional study including a sample of 260 mothers of children aged 5–13 years from Karachi, Lahore and Islamabad, during March to June 2021. A google survey form was developed and participants were invited using a google link on social media, parents' groups, Whats app groups and school facebook pages. Screen time was measured in number of screen hours per day. Physical health was evaluated through body mass index (BMI) reports. Children's Emotional Adjustment Scale (CEAS) and Strengths & Difficulties Questionnaire (SDQ) were used for behavioral and emotional problems. Coefficient of correlation and t-test was used for examining the difference of means. Results: About 244 (94%) mothers reported that screen time of their children is significantly increased during COVID-19 lockdown. There was a negative relationship observed between screen time with temper and anxiety control (r= -0.13; p= 0.04). However, a positive relationship was found for hyperactivity (r= 0.74; p<0.001) and conduct problems (r= 0.18; p= 0.003). We found a gender difference for screen time (t= 4.39; p=0.001) and hyperactivity (t= 2.35; p= 0.02), where boys were more hyperactive than girls. No significant difference was obsereved for BMI and pro-social behavior. Conclusion: Screen time among children is considerably increased during lockdown and this is associated with low temper control, anxiety, hyperactivity, and conduct problems. Remedial strategies are required at national level; media and school authorities can play a vital role in this regard.
FREQUENCY OF TRANSFUSION-TRANSMISSIBLE INFECTIOUS DISEASES AMONG BLOOD DONORS AT AKHTER SAEED TRUST HOSPITAL LAHORE, PAKISTAN
Alia Waheed, Abdullah Farooq Khan, Nosheen Salahudddin, Atiqa Arshad, Ahsan Farooq Khan, Zainab Yousaf
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.26
Background & Objectives: Blood transfusion is an essential lifesaving treatment. The unsafe blood transfusion practices are one of the reasons of spreading transfusion-transmissible infections among individuals. It is necessary to screen all donated blood units for HBV, HCV, HIV, VDRL, and MP. The objective of this study was to assess the frequency of transfusion-transmissible infectious diseases among donors in a trust hospital of Lahore. Methods: It was a cross-sectional study which included 9114 blood donors who attended Akhtar Saeed Trust Hospital Lahore from January 2020 to September 2022. After informed consent, 3-5 ml of venous sample was drawn from donors using aseptic technique. Screening of blood was done by Chemiluminescence immunoassay (Maglumi-800) for HBV, HCV, HIV and VDRL. The MP was confirmed by peripheral blood picture on slide. Positive results of HBV, HCV, HIV and VDRL was calculated using manufacturer's guidelines and cut-off values. Results: The mean age of participants was 27.8 ± 12.1 years. The number of volunteer and replacement donors were 961 (10.54%) and 8153 (89.45%) respectively. The total number of positive donors for transfusion- transmissible infectious diseases were 591/9114 (6.48%). The sero-positivity was found to be 170/9114 (1.9%) for HBV, 324/9114 (3.7%) for HCV, 33/9114 (0.4%) for HIV, 64/9114 (0.7%) for VDRL, and 0/9114 for MP respectively. Conclusion: We found a low risk of transfusion-transmissible infectious diseases but the availability of safe blood is contingent on screening tests and appropriate donor selection.
Muhammad Zafar Iqbal Shahid, Muhammad Khalid Syed, Muhammad Khalid, Siddique Hamid, Mubashir Farhan, Asim Islam
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.64
Background: Platelet rich plasma (PRP) is a supra-physiological concentrate of growth factor. It is biologically safe, minimally invasive and low cost injectable technique for tendinopathies. Evidence suggests that PRP contains bioactive protein and growth factor that promote regeneration. Aim of this study is to assess the efficacy of PRP in tennis elbow and to evaluate its impact on pain and functional outcomes. Methods: It was a prospective observational study in department of orthopedics surgery, Services Hospital Lahore from December 2017 to June 2019. Forty 40 patients with chronic tennis elbow lasting 4-6 months, both males and females with aged between 18-60 years were included. Thirty milliliters of patient's autologous blood was taken from median cubital vein and 6-7ml of platelet rich plasma was injected at the point of maximal tenderness at extensor carpi radialis brevis (ECRB) tendon. Patients were followed at 2 weeks, 6 weeks, 3 months and 6 months. Functional outcomes were assessed at each visit using Oxford Elbow Score, while visual analogue score (VAS) was used to assess pain. Results: Mean Pre-injection VAS was 8.0 ± 2.01 in all patients. At six months, VAS was 1.06 ±1.90 in 34 patients. In six (15%) patients, VAS did not improve. Pre-injection Oxford Elbow Functional score (OES) was 20.12 ± 4.08 (range:22.2-26.8). After 6 month of injection, among 34 patients, it improved to 72.12 ± 12.25 (range: 42.34-90.52) Conclusion: PRP is effective in terms of pain and improvement of function of elbow in patients with tennis elbow. It is cost effective, minimally invasive, simple and safe. Although literature shows some controversy of PRP in tendinopathies but still the regenerative medicine has opened a new window for restoration of tendinopathies
NEUTROPHIL-LYMPHOCYTE RATIO: A PREDICTOR OF COMPLICATIONS IN TYPE 2 DIABETES MELLITUS PATIENTS
Mazhar Hussain, Warda Irshad, Nida Tasneem Akbar, Muhammad Aamir Rafique, Rahat Sharif, Momal Zahra
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.65
Background: Chronic inflammation plays a potential role in development of diabetes related complications in type 2 diabetes mellitus (T2DM). Neutrophil-lymphocyte ratio (NLR) is one of the potential markers of systemic inflammation. The objective of this study was to examine an association between NLR and T2DM associated complications. Methods: A cross sectional study was conducted at Sheikh Zayed Medical College & affiliated hospital in Rahim Yar Khan from June - September 2022. About 360 patients were divided in to three groups. Group A were comprised of T2DM patients without diabetic complications while group B and C were T2DM patients with micro- and macro-vascular complications respectively. Micro- and macrovascular complications were assessed by history, physical examination and medical records. Association of diabetes related compilations with NLR value was done using regression analysis with SPSS version 25. Results: The baseline demographic characteristics of three study groups did not show statistically significant difference. However TLC count is significantly elevated in group B (with microvascular complications) and group C T2DM with macrovascular complications (P<0.001) respectively compared to control group A. Similarly NLR ratio was significantly higher (4.8±2.0 & 5.0±1.8) in group B and group C respectively, compared to group A (2.2±0.8 with P<0.001). Regression analysis showed that NLR was positively correlated with diabetes related micro and macrovascular complications (OR: 4.62, 95% CI: 2.51-7.26, p<0.001) along with HbA1c (OR: 1.732, 95% CI: 1.82-2.22, P=0.002). Conclusion: High NLR ratio is associated with diabetes related micro and macro vascular complications. It should be routinely measured in T2DM patients for prevention of diabetes related complications.
Ameena Nasir, Maryam Rao, Qanita Mahmud, Wardah Anwar, Zunaira Kanwal, Aiza Asghar
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.66
Background: Intrauterine life is the most pivotal period of development that determines vital outcomes in postnatal life. Diabetes Mellitus may lead to disturbed fetal growth and maternal vasculopathy resulting in placental insufficiency with subsequent development of intrauterine growth restriction (IUGR). This study aims to find an association between hyperglycemia and the risk of IUGR, comparing pregnancies with IUGR with those with adequate for gestational age pregnancies. Methods: This cross sectional study was conducted in Federal Post Graduate Medical Institute (FPGMI) from January 2015 to January 2016, including 106 pregnant women using non-probability convenient sampling technique. Participants were divided into two groups: Group A comprises of pregnant women with adequate for gestational age pregnancies (n=53) and groups B includes pregnant women with intrauterine growth restricted pregnancies (n=53). Random blood sugar level was estimated by glucose/oxidase test and IUGR was confirmed by ultrasonography at 28-35 weeks of gestation. Shapiro-Wilk test was used to examine data normality and independent t-test was used to compare statistically significant difference. A p- value of <0.05 was considered significant. Results: Mean basal sugar level of group A was 98.9 ± 7.1 mg/dL and that of group B was 97.9 ± 6.0mg/dL. This mean difference was not statistically significant (p-value= 0.566). Conclusion: We found no statistically significant association between raised maternal basal glucose level and the occurrence of intrauterine growth restriction at 28-35 weeks of pregnancy
Syed Kumail Abdi, Akhtar Ali Syed, Ammara Butt, Sumaya Batool
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.67
Background & Objectives: Depression and anxiety are common mental health disorders around the world. This study aims to examine efficacy of eidetic image therapy in comparison to cognitive behavior therapy for treating depressive and anxiety disorders, and to compare the patients' dropout ratio in these therapies. Methods: This was a randomized controlled trial conducted from January through June 2021 in psychiatry department of Sir Ganga Ram hospital Lahore. Using DSM-5 diagnostic criteria, 60 adult patients with depressive and anxiety disorders were recruited and were randomly and equally assigned to experimental (eidetic image therapy) and control (cognitive behavior therapy) groups. These participants received respective therapies and followed. Beck Depression Inventory and Beck Anxiety Inventory were used at baseline and after conducting five therapy sessions. Paired t-test was used to compare the mean difference and p-value of <0.05 was considered statistically significant. Results: Descriptive analysis demonstrated a major difference in dropout numbers of eidetic image therapy (9; 30 %) and cognitive behavior therapy (25; 83 %). The efficacy of both interventions was statistically incomparable due to this excessive number of dropouts in control group. However, eidetic image therapy showed a significant difference (p<0.001) in pre and post therapy ratings; each patient exhibited a marked decline in depression/anxiety symptoms after taking 5 sessions. Conclusion: Eidetic imagery is a promising therapeutic utility for depressive and anxiety disorders. Cognitive behavior therapy is also an effective treatment methodology but this narrative is based on analysis of few cases.
Asma Akhtar, Rabia Ahmad, Sidra Sonia Chaudhary, Shizra Kaleemi, Naureen Saeed, Mariam Danish
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.68
Background & Objective: Aplastic anemia is a rare and heterogeneous disorder. Literature shows inconsis- tencies in frequency and its clinico-hematological findings. Objective of this study was to assess frequency of different severity grades and clinico-hematological features in newly diagnosed cases of aplastic anemia in adults. Methods: In this descriptive, cross-sectional study, conducted in Allama Iqbal Medical College Lahore from October 2021 through April 2022, a total of 100 diagnosed cases of acquired aplastic anemia were included. Modified Camitta's criteria were applied to assess the severity of aplastic anemia. Clinical features such as pallor, fever and bleeding manifestations were determined by history and physical examination. About 3ml whole blood was collected in EDTA vial and run for complete blood count on automated hematology analyzer for hematological Parameters (Hb, Platelets, total leukocyte count and absolute Neutrophil count). Data were entered and analyzed using SPSS version 20. Quantitative variables like age, Hb, TLC and platelet count were expressed as mean ±Standard deviation. Qualitative variables such as gender, severity of aplastic anemia and clinical features were expressed as percentages. Results: In this study, 55% participants were male and 45% were female. All patients had pallor, 61% had fever and 66% had bleeding on presentation. Regarding severity of aplastic anemia, 56% were categorized as severe, 24% as very severe and 20% were as non severe aplastic anemia. Conclusion: Severe aplastic anemia is frequent among male population and at younger age. This information has prognostic implications. Therefore, all patients with aplastic anemia should be assessed for severity for further clinical management.
Faiza Javaid, Zahra Nazir Hussain, Sana Haseeb Khan, Fatima Saeed
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.69
Background & Objectives: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious virus associated with the development of COVID 19. Lack of valid biomarkers makes it difficult to predict disease severity. C-reactive protein (CRP) is an acute phase inflammatory marker that which may predict COVID-19 infection and its severity. The aim of this study was to describe the CRP levels in COVID- 19 positive cases presenting in Gulab Devi hospital Lahore. Methods: In this cross sectional study conducted in Gulab Devi Hospital Lahore for six month, 100 COVID- 19 positive cases were selected using convenient sampling technique. About 3 ml of venous blood was drawn for qualitative and semi-quantitative titration analyses to determine CRP concentration in blood. Descriptive analysis was performed using SPSS version-26 to describe the levels of CRP in relation to clinical features and disease severity. Results: CRP levels were elevated above normal range in 93% COVID-19 positive cases. Patients with severe infection had high levels of CRP (>6mg/L, range: 12-96 mg/L), mildly infected patients had moderate values of CRP and recovering patients of COVID-19 showed lowest value of CRP (<3mg/L ). Conclusion: The serum CRP level was substantially higher in COVID-19 positive cases in this study. CRP is an inexpensive, rapid test available to physicians for early detection of COVID-19 severity. Determining CRP levels can also help physicians to identify patients at higher risk of mortality and complications
Tooba Fateen, Sana Haseeb Khan, Saima Farhan, Amna Rani, Rajia Liaqat, Attiq Ur Rehman
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.40
Background & objective: Plateletpheresis is a process by which platelets are extracted from a donor. Deferred donors are those who are not eligible to donate blood due to medical history or serological testing. The aim of this study was to examine the reasons of donor deferral for a single donor plateletpheresis in a public sector blood transfusion centre of Lahore Methods: This cross-sectional study was conducted at department of Haematology and Transfusion Medicine, University of Child Health Sciences Lahore including 50 plateletpheresis donors who voluntarily came for donation. The donor questionnaire included brief medical history, general physical examination. Haematological parameters such as haemoglobin and the donor blood screening was done to determine fitness for the plateletpheresis. The reasons for deferral of donors were noted after all work-up was done. Informed consent was taken before plateletpheresis using COM.TEC Cell Separator instrument. Data were managed and analysed using SPSS version 20. Results: Of 50 donors, 34 donors were approved for procedure and 16 were deferred due to different temporary and permanent reasons. Donors were aged between 18 to 50 years. Major reason for temporary deferral was poor venous access (n=7, 14%), followed by low haemoglobin value (n=4, 8%). Permanent reasons for deferral were seropositive for HbsAg (n=2, 4%), seropositive for HCV (n=4, 8%) and tattoo (n=1, 2%). Conclusion: During donor selection for plateletpheresis, transfusion services should be very careful regarding donor safety measures and should consider low haemoglobin level as the reason of donor deferral. Screening for endemic transmissible infectious diseases in Pakistan should also be considered.
CASE REPORT
A RARE CASE OF PAPILLARY CARCINOMA OF THYROID IN A YOUNG FEMALE: A CASE REPORT
Khushbakht Ali Khan, Ammarah Afzal, Bilal Chaudhary
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i3.70
Background: The papillary carcinoma thyroid is a rare disease in adolescents and children. A high level of suspicion should arouse as soon as the physician comes across swelling in neck. Appropriate management yields a good survival rate. Case history: We present a case of the papillary carcinoma thyroid in a 13-year old girl presented to outdoor of Jinnah Hospital, Lahore with painless swelling in right side of neck for three months. There were associated smaller swelling matted on palpation. No history of palpitations, fever, weight loss and family history of tuberculosis contact or cancer in family. Initial radiology and blood investigations showed an euthyroid goitre. The fine needle aspiration of lymph node only showed reactive hyperplasia. The matted lymph node was partially excised for histopathology as suspicion of tuberculosis existed due to its endemic feature. Later, it was found to be papillary carcinoma of thyroid. Total thyroidectomy was done with neck dissection followed by treatment at nuclear medicine department. Conclusion: Thyroid cancer is quite uncommon in adolescents but strong suspicion should arise when dealing with neck swelling even in this age group. Thorough history, watchful physical examination and timely investigations can save clinician from missing the diagnosis.