ISSN(Print) 2076-2860 ISSN(Online) 2958-5945 Email: Editorial@jaimc.org Phone: +924299231453 PMDC & UHS (IP-0043)
VOL. 20, ISSUE NO.2
EDITORIAL
MONKEY POX – AN EMERGING PUBLIC HEALTH GLOBAL EMERGENCY
Syed Nazim Hussain Gardezi, Sana Abbasi
DOI: https://doi.org/10.59058/jaimc.v20i2.39
ORIGINAL ARTICLES
Shahid Mahmood, Huma Azmat, Namra Nisar, Taskeen Zahra, Ayesha Khalid, Imrana Aslam, Noreen Bokhari
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.28
Background and Objectives: Body Dysmorphic disorder (BDD) is a psychiatric condition characterized by preoccupation with an imagined flaw in appearance or slight defect in one's body. It is a disabling obsessive- compulsive spectrum disorder often goes unrecognized in clinical practice and found to be associated with social anxiety, distress and suicidal tendency. The aim of this study was to screen public sector college students for body dysmorphic disorder using a validated dysmorphic concern questionnaire® through an online survey and describing family, peers and media influences in relation to its occurrence. Methods: This descriptive, cross-sectional study was undertaken in two public sector medical colleges (Lahore and Sialkot) and one public sector general education college (Sialkot) during November 2019 to June 2022. Overall, 378 students completed a validated 7-items Dysmorphic Concern Questionnaire (DCQ)® online. Participants provided responses on a 4-point scale. They also responded to questions regarding social pressures and media influencing the dysmorphic concern. A BDD score was computed as per method described by Mancuso et al. and participants with score more than 14 were labelled as having BDD. Association between family, peers and media influences with BDD score was analyzed using logistic regression technique in SPSS version 25.® Results: Of 378 participants, 251 (66%) were medical students and 127 (34%) were general education students. About 1.3% medical students and 5.0 % non-medical students were classified having potential body dysmorphic disorder respectively. Adjusted odds ratio comparing medical and non-medical students for BDD is 4.4 (95% CI: 1.2-15.9; p=0.02) with higher odds of BDD observed for those aged 18-20 years (OR=3.3) and in females (OR=1.1, 95% CI=0.4-2.8; p=0.83). Conclusion: BDD is comparatively frequent in non-medical female students aged 18-20 years. Family and peer pressure alongside the influences from social, print and electronic media had considerable effect on non- medical students comparatively and may contribute the occurrence of body dysmorphic disorder.
Ali Sarfaraz, Mehwish Akhtar, Tahir Mahmud, Qurrat ul Ain Naqvi,
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.30
Background and Objective: The rise in incidence and prevalence of cases of Human immunodeficiency virus (HIV) has made it a disease of public health concern especially in under-developed countries. Timely diagnosis and initiation of treatment, the only effective strategy to break the chain of transmission in the community, is a caveat in the measures taken for its prevention. The objective of this study was to determine frequency and the reasons behind delay in initiating treatment after being diagnosed with HIV among patients presenting to a public sector hospital. Methods: This cross-sectional study was conducted in the HIV center of Aziz Bhatti Hospital, Gujrat for six months after approval from ERB. About 200 diagnosed HIV patients fulfilling the selection criteria were included in the study after an informed consent. Data were collected by personal interviews and information regarding their timing of initiation of therapy and reasons behind delay in treatment were noted in a questionnaire. Data entry and analysis was done using SPSS version 23.0 and cross tabulation was done keeping p-value <0.05 as significant. Results: Among 200 study participants, mean age was 26.5 ± 5.68 years including 126 (63%) males and 74 (27%) females. About 34 (17%) of patients were found to have a delay in initiation of treatment for more than 6 months. Patients reported multiple reasons behind the delay in initiation of treatment the most frequent was being in denial in which they did not believe the test results 32 (94%) followed by difficulty in accessing health care 28 (82.3%). Age was found to be significantly related with delay (p= <0.001) while relationship of gender with delay in treatment was found to be insignificant. Conclusion: It can be concluded that a considerable proportion of patients diagnosed with HIV delay their treatment because of lack of acceptance of results or access to health care. Proper educational session of these patients along with increasing the accessibility to health care facilities can result in timely management and better outcomes in these patients
Hassan Raza Asghar, Manzoor Ahmed Malik, Muhammad Adil Chaudhary, Mahboob Alam Chishti, Zulfiqar Saleem, Aleena Ahmed Khan
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.31
Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Avicenna medical college Lahore Pakistan. Files of all patients operated between January 2017 and July 2021 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data analysis of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3,6,12 and 24 months. Results: Mean age of patients was 41.13 years with range between 26-74 years.Most Common cause of urethral strictures were idiopathic 66(58.92%) followed by iatrogenic 27(24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC)was found to have a good success rate in bulbourethral strictures up to 1cm in selected patients.
Shahid Mahmood, Izza Jahangir, Sidra Ghazanfar, Ayesha Khalid, Ghazia Qasmi, Imrana Aslam
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.32
Background and Objectives: Seroprevalence studies provide necessary data on extent of SARS-CoV-2 infection in a community. Identifying immune response of individuals exposed to this virus is one way of assessing community disease transmission and herd immunity. The aim of this study was to measure SARS- CoV-2 IgG antibody among adult individuals of Sialkot city overall and stratified by age and sex. Additionally, to describe COVID-19 presenting symptoms and its duration in these participants. Methods: This descriptive, cross-sectional study was undertaken in Sialkot city, where 453 participants completed in-person interview on COVID-19 symptoms, socio-demographic profile and provided 5ml blood sample for SARS-CoV-2 IgG antibody testing using electro-chemiluminescent immunoassay (ECLIA) technique. SPSS version 22 was utilized for data management and analysis. Sero-prevalence was calculated as percent of reactive for IgG among all tested. Chi-squared test was used for determining statistical significance with p <0.05 was considered significant. Results: Overall, sero-prevalence of SARS-CoV-2 IgG antibody among adults in Sialkot was 64%. Almost, 134(29.5%) of these positive for COVID-19 IgG antibody had antibody titres level 15 units/dl or above. Three out of every four individuals reported one or more symptoms of COVID-19 dry cough (17%), fever (30%) loss of taste (6%), sore throat (5%) and anosmia (4.6%). Conclusion: Almost two-third of adult population in Sialkot city had SARS-CoV-2 IgG antibody during 2021 survey that implies that herd immunity level for COVID-19 is achieved and negligible number of COVID-19 cases reported in Sialkot city supports this evidence.
Nabeel Saleem, Saima Zafar, Muhammad Anwar, Aftab Iqbal, Hafiz.M.Dawood Hummira Rashid, M. Bilal Anwar
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.33
Background and Objective: Polio is still endemic in Pakistan and Afghanistan. In Pakistan, transmission of polio virus is high due to poor political environment and internal security threats especially in war against terrorism in Swat and FATA. Meanwhile, some groups tried to create misconception about polio vaccine. The objective of the study was to describe the reasons underpinning the refusals to polio vaccine in District Multan. Methods:This descriptive, cross sectional study was conducted in a District Multan. A closed ended pre- tested questionnaire in Urdu language was used to collect data from 34 parents of under five year children, who refused polio vaccination during polio campaign. Results: Out of 34 polio vaccine refusal parents, 15 did not respond or either locked the doors as researcher tried to interview them. About 29% refusing parents mentioned religious reasons, about 42% have apprehensions on polio vaccine contents. One third reported that it was a western world conspricy against mullims. 45% states that government vaccine supply is of poor quality, as the main factor for refusal. Conclusion: Majority of refusing parents were uncomfortable in responding to the survey or either they were never counseled for Polio and now they are habitual refusals or may be perception about polio vaccine is negative. In District Multan, religious reasons and misconception that vaccine causes sterility in male children were main reasons of polio vaccine refusal. Efforts will be required in changing the perception of parents.
Hassan Raza Asghar, Manzoor Ahmed Malik, Muhammad Adil Chaudhary, Mahboob Alam Chishti, Zulfiqar Saleem, Aleena Ahmed Khan
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.34
Background: Lower ureteric calculi can be treated by different modalities. There are many minimally invasive interventional (e.g.,ESWL, ureterorenoscopy, the holmium: YAG laser and basket devices) as well as expectant (watchful waiting) treatments are in practice for the management of distal ureteric calculi. selected method depend on the type of equipment available, location, type and size of stone, needs of the patient and skills of the surgeon. Most of the work on the potency of tamsulosin in lower ureteric calculi expulsion has been done in the developed countries. Methods: Our randomized controlled trial in Avicenna Hospital Lahore included 100 patients over 18 years of age with stone Size ≤8mm in distal one third of ureter. Patients were randomly assigned into two groups (A & B). Group A Patients were given Capsule Tamsulosin 0.4 mg, once daily up to four weeks while group B patients were given placebo, one Capsule daily up to four weeks. The final result was the expulsion rate. Informed consent was obtained from all the patients. Stone Expulsion time, analgesia requirement, need for hospitalization and drug adverse effects were secondary endpoints. Results: A total of 49 patients in group A and 48 patients in group B came for follow up, therefore 97 out of 100 patients were evaluated. Mean age of the patients was 36.34 years (range 18–57 years). Mean stone size was 5.78 mm (range 4–8 mm) in largest dimension. A stone expulsion rate of 85.71% (42 patients) was noted in group A and 54.20% (26 patients) in group B. Group A showed a statistically significant advantage in terms of stone expulsion rate (p=0.032). Considering expulsion time in days group A demonstrated statistically significant advantage (p=0.015). Regarding age, sex, stone size and stone lateralization (right/left), there was no remarkable difference between the group A and B. No drug adverse effects were seen in both the groups. Conclusion: Tamsulosine can be used as medical expulsion therapy in lower ureteric calculi of size less than or equal to 8mm.
Neha Tanveer, Rehana Kanwal, Jawairiah Liaqat, Faisal Ashraf, Muhammad Abdullah Rashid, Qurratulain Mushtaq
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.35
Background & Objective: A substantial number of pregnant women develop gestational diabetes mellitus (GDM). Various biomarkers are being used to diagnose gestational diabetes mellitus. Early detection of GDM can done by using inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and the platelet- to-lymphocyte ratio (PLR) that are rapid, inexpensive and easy to use in different clinical setting. The objective of this study was to evaluate diagnostic accuracy of raised neutrophil to lymphocyte ratio for detection of gestational diabetes mellitus taking OGTT as gold standard. Methods: This was a cross-sectional study held in Department of Obstetrics and Gynecology CMH Lahore from November, 2018 –May, 2020. After approval from hospital ethical review committee and taking an informed consent, 473 pregnant women enrolled in first trimester between age 18-35 years, fulfilling the inclusion criteria were included whereas known diabetics, patients with cardiovascular disorders, previous history of GDM were excluded. Blood samples in sterilized manner were drawn and sent to hospital laboratory for analysis of NLR. Then they were screened during 24-28 weeks of gestation for diagnosis of gestational diabetes mellitus on OGGT. The females were labelled for positive NLR and GDM as per operational definition. Diagnostic accuracy of NLR was calculated for development of gestational diabetes mellitus. Results: Mean age of females was 26.72 ± 4.90 years and mean gestational age was 15.50 ± 1.67 weeks. 94(19.9%) females who had raised neutrophil to lymphocyte ratio while 397(80.1%) females had normal neutrophil to lymphocyte ratio and there were 90(19%) females who had gestational diabetes mellitus while rests of 383(81%) did not have gestational diabetes mellitus. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of NRL was 95.56%, 97.91%, 91.49%, 98.94% and 97.46%, respectively. Conclusion: The study concluded that raised neutrophil to lymphocyte ratio is significantly high among gestational diabetes mellitus and NLR has a high diagnostic accuracy for predicting gestational diabetes mellitus.
Zaeem Sohail Jafar, Aniq Ahmed, Muhammad Nauman Akram, Muhammad Junaid Mirza, Khalida Ahtesham
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.36
Objective: To find the frequency of non-alcoholic fatty liver disease (NAFLD) and its association with diabetes mellitus, hypertension and cholelithiasis. Methods: This was a cross-sectional study conducted in department of radiology, Sughra Shafi Medical Complex, Narowal. About 545 subjects who fulfilled the inclusion criteria were included through nonprobability/ convenient sampling technique. Abdominal ultrasound of every participant was conducted to determine frequency of NAFLD among sample size. A structured questionnaire consisting of demographic details and comorbidities was designed. Diabetic, and hypertensive status was determined on patient’s history and choleli-thiasis was assessed on ultrasonography. Data were entered in SPSS 21 software and presented as frequency and percentages. Results: Among 545 patients there were 282 (51.7%) male and 263 (48.3%) female participants with mean age of 48.56 ± 3.67 years SD. The overall frequency of NAFLD in the sample size was 39.8%. Diabetes was found in 115 (21.1%) participants, NAFLD was present in 44(64.7%) diabetic males and 29 (25.2%) diabetic females. Hypertension was found in 92 (16.9%) participants, NAFLD was present in 30(32.6%) hypertensive males and 24 (61.5%) hypertensive females. Cholelithiasis was found in 18 (8.0%) patients NAFLD was present in 30(32.6%) hypertensive males and 24 (61.5%) hypertensive females. There was no statistical significant difference among gender and presence of NAFLD. (P>0.05) Conclusion: It is concluded that on ultrasound NAFLD is a common finding and it is associated with diabetes mellitus, hypertension and cholelithiasis.
Attique Abou Bakr, Tayyab Shahzad, Naeem Aslam
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.37
Objectives: To evaluate the diagnostic validity of PIVKA-II for Hepatocellular carcinoma in cirrhotic patients with uncertain liver nodules on Ultrasound. Methods: This was a cross-sectional study conducted in 01-11-2020 and 31-12-2021 at Hepatitis clinic at Jinnah Hospital Lahore. Patients who fulfilled the selection criteria(n=100) were enlisted for this study. Blood samples were obtained to test for PVKA-11 and AFP in cirrhotic patients who had liver nodules that had been previously verified by ultrasound imaging. Data were entered and analyzed in SPSS ver: 21.0. Sensitivity, specificity and predictive values were calculated using CT imaging and biopsy as gold standard. ROC curve evaluating AFP, PIVKA-II, and a combination as indicators for Hepatocellular carcinoma at 95% Confidence Interval was calculated with a p < .05 value was taken as statistical significant. Results: HCC was confirmed in 45 of the 100 instances, and it was invariably at an early or very early stage. At a threshold of 62.5 mAU/mL, PIVKA-II and HCC were significantly correlated (P =.015 and P =.036, respectively) in univariate and multivariate analyses. For AFP, 7.5 ng/mL was the ideal cut-off. For PIVKA- II, sensitivity was 62% and specificity was 91% , while for AFP, they are 66% and 69% respectively. The positive and negative predictive values for PIVKA-II were 81% and 74%, respectively, while for AFP sensitivity was 63% and specificity was 72%. The combination of both biomarkers improved the precision of diagnosing HCC (sensitivity = 74%, specificity = 95.5%, NPV = 81%, PPV = 92%, and AUC = 0.781). Conclusion: PIVKA-II is a valid indicator for defining the characteristics of liver nodules in cirrhosis and when combined with AFP, it signifies superior accuracy for HCC diagnosis.
Attique Abou Bakr, Naeem Aslam, Tayyab Shahzad, Imran Mehfooz
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.38
Objective: To compare the effectiveness of Concomitant therapy with standard triple regimen in H.pylori Eradication. Methods: It was a randomised control trial at OPD of Department of Gastroenterology, Jinnah Hospital Lahore and involved 170 patients, who fullfilled the selection criteria of study were enrolled in the study from OPD of Department of Gastroenterology, Jinnah Hospital Lahore. 85 cases were given Concomitant therapy (Group-A) and 85 cases were given Standard triple regimen (Group-B). Informed consent was obtained. Demographic information (name, age, and sex) were taken. The mean age was 40.43 ± 17.01 years in the Concomitant therapy group and 42.99 ± 12.98 years in the Standard triple regimen group. In group A, 62% cases had ages less than 45 years, and 37.6% of cases had age 45 years or above. In group B, 68.2% cases had an age less than 45 years and 31.8% of cases had an age of 45 years and above. In group A, 50.6% cases were male and 49.4% cases were female. In group B, 72.9% cases were male and 27.1% cases were female. In group A, 58.8%, 22.4%, and 18.8% of cases had low, middle, and high socioeconomic status respectively. In group B, 57.6%, 29.4 and 13% of cases had low, middle, and high socioeconomic status respectively. Results: In the Concomiant therapy group, eradication was achieved in 93.8%. In conventional triple regimen, eradication was achieved in 61.4% cases (p-value<0.001). Conclusion: Eradication achievement was significantly more common with Concomitant therapy as compared to the conventional triple regimen. Concomitant therapy was much effective than the Standard triple regimen in all age groups, both genders, and all socioeconomic groups.
CASE REPORT
Rajia Liaqat, Firdous Iqbal, Amna Rehman
ABSTRACT
DOI: https://doi.org/10.59058/jaimc.v20i2.29
Background & Objectives: Ectopic deciduosis refers to an abnormal occurrence of decidual tissue beyond the endometrium, predominantly on the surface of the uterus, fallopian tubes, ovaries and omentum. Diffuse omental and perito-neal involvement is a perplexing manifestation that may mimic peritoneal carcinomatosis. It is not accompanied by any symptoms and complications in most of the cases and does not require treatment. However, rarely it can present with acute abdomen or imitate peritoneal malignancy and, thus, associated with diagnostic difficulties and unnecessary interventions. Aim of this case report is to describe a rare case of peritoneal deciduosis in a young female, found incidentally, during a caesarean section, mimicking metastatic nodules. Afutile hysterec-tomy along with omentectomy was performed. Methods: A case of diffuse ectopic deciduosis mimicking as peritoneal carcinomatosis in a 29 years young female with full term pregnancy was found during a lower segment caesarian section, undertaken in a tertiary care teaching hospital of Lahore, Pakistan. The histopathological diagnosis was based on common technique of paraffin embedding and hematoxylin-eosin staining along with ancillary immune-histochemical evaluation. Results: Histopathological evaluation showed ectopic decidual tissue consisted of solid nests and loosely cohesive aggregates; large polygonal cells with abundant granular eosinophilic cytoplasm; sharply defined cell borders, bland nuclei with dispersed chromatin and single conspicuous nucleoli on the surface of uterus and in omental fat. Weak staining for CD30 was observed in the decidual cell cytoplasm and negative staining for CK and Calretinin in decidual cells was found. Calretinin and CK highlight benign mesothelial cells and help to rule out differentials of mesothelioma and metastatic carcinoma. Conclusion: Peritoneal deciduosis represents a rare entity and it is important to consider this condition in patients, especially in pregnant women, to prevent unnecessary intervention In addition, distinguishing this condition from malignant neoplasms will help in deciding correct treatment options.