ISSN(Print) 2076-2860 ISSN(Online) 2958-5945 Email: Editorial@jaimc.org Phone: +924299231453 PMDC & UHS (IP-0043)
VOL. 20, ISSUE NO.4
EDITORIAL
NON-COMMUNICABLE DISEASE SYNDEMICS AMONG LOW-INCOME POPULATIONS:PAKISTAN AND WAY FORWARD
Taskeen Zahra
DOI: https://doi.org/10.59058/jaimc.v20i4.80
ORIGINAL ARTICLES
COMPARATIVE TRIAL OF PERIUMBILICAL INCISION VERSUS INTRAUMBILICAL INCISION IN EMERGENCY LAPAROSCOPIC APPENDECTOMY IN A HIGH VOLUME LAPAROSCOPIC SURGERY CENTRE
Aakif Yousaf, Hafiz Muhammad Amjad, Ayesha Ulfat, Amna Munawar, Mahboob Alam Chishti, Abeera Mehmood
DOI: https://doi.org/10.59058/jaimc.v20i4.53
ABSTRACT
Background and Objective: An appendectomy is the surgical removal of the vermiform appendix. Laparoscopic Appendectomy is increasingly performed these days. Direct studies on comparison of complication rates of periumbilical and intraumbilical incision are lacking.The objective was to compare the frequency of infective complications of two different types of laparoscopic appendectomy incisions i.e. periumbilical incision versus intraumbilical. Methods: This retrospective study was carried out at Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland for 6 months (From 27.05.2015 to 26.11.2015). Medical records of 1044 patients who had Laparoscopic Appendectomy from 2010 to 2014 were analyzed. Their Preoperative, Intraoperative, Postoperative and clinical notes were reviewed. This included patients who underwent laparoscopic appendectomy with periumbilical incision technique and those who were operated with intraumbilical incision technique. All the data was analyzed using computer software SPSS version 21. Results: The mean age of the patients was 40.38±11.76 years. Ratio of Male to female was 1.6:1. The erythema was observed in 31.42% patients, edema was present in 242(23.2%), pain was present in 278(26.6%) and the purulent discharge was noted in 294(28.2%) patients. Overall wound infection was found in 16.86% patients. In intra umbilical group wound infection was found in 7.28% of patients while this rate was 26.44% in peri umbilical group. Statistically significant difference was found between the study groups i.e. p-value=0.000. Conclusion: Intraumbilical incision is a safer and feasible substititute for the periumbilical incision, and it promises better outcomes.
Nasir Iqbal, Sania Tahir, Hassan Abbas Abdullah, Muhammad Ijaz Bhatti, Usman Javed Iqbal, Mariam Tahir Siddiqi
DOI: https://doi.org/10.59058/jaimc.v20i4.74
ABSTRACT
Objective: To assess efficacy of modified Valsalva manoeuvre in comparison to standard Valsalva manoeuvre in treating Supraventricular tachycardia in an emergency department. Methods: It was a quasi–experiment conducted in Azra Naheed Medical College Lahore including 132 patients presented with supraventricular tachycardia (SVT) in an emergency department. Patients were equally divided and randomly assigned to receive standard Valsalva manoeuvre and modified Valsalva manoeuvre. ECG was recorded before and after the Manoeuvre. Subjects reverted back to sinus rhythm within one minute of allocated manoeuvre were considered successful. SPSS version 21 was used to manage and analyze data. Results: Mean age of participants was 40±11 years with 33% male and 66% were females. Mean duration of paroxysmal SVT in participants was 5 ± 4 years. The mean systolic and diastolic blood pressure was 112±15 and 72±10 mmHg respectively. The range of pulse rate per minute was from 136 to 240 with a mean of 184 ± 24. SVT was reverted by Valsalva Manoeuvre in 89 (67.4%) patients and did not revert by these Manoeuvers in 43 (32.6%) patients. Out of 89 reverted, 38 were reverted by performing Standard Valsalva method and 51 were reverted by performing modified Valsalva methods (p=0.025). There was no association between age, sex, duration of SVT, presence of Diabetes Mellitus, Hypertension or Ischemic Heart Disease with the effectiveness of Vagal Manoeuvre for termination to sinus rhythm. Conclusion: Modified Valsalva manoeuvre is significantly effective than the standard manoeuvre in terminating SVT without increasing adverse effects or time spent in the emergency department.
Saroash Iqbal, Aman Ur Rehman, Nausheen Henna, Zara Madiha, Sahar Moeed, Uzma Aslam
DOI: https://doi.org/10.59058/jaimc.v20i4.59
ABSTRACT
Background and objective: To determine the frequencies of various histopathological parameters of relapse in previously diagnosed cases of ulcerative colitis .Study Design: Cross sectional type. Setting: Histopathology department at Sheikh Zayed hospital Lahore. Duration: Six months period from 1/6/2014 to 1/12/2014.Methods: Two hundred and seventy colonic biopsies were assessed using 3% margin of error and 95% of the confidence level. Patients clinically relapsed with ulcerative colitis including both genders in age group from 11 to 80 years were included. Biopsy specimen fixed in 10% formalin were received. Processing was done and sections stained with hematoxylin and were examined by the pathologist. College of Physicians and Surgeons Pakistan gave approval for this study. Data was then analyzed and entered by the SPSS version15.Results: Total number of patients were 270,out of which all of the patients have shown chronic inflammation and increase number of neutrophils in lamina propria (100%), focal lymphoid aggregate in 162/270(60%), increased number of eosinophils in lamina propria in 108/270(40%), cryptitis in 216/270(80%), crypt distortion in 202/270(75%), mucin depletion in151/270 (56%) and crypt abscess formation in 148/270(55%). Conclusion: Hence, cryptitis and crypt abscess were observed to be most commonly occurring significant and reliable indicators of relapse in ulcerative colitis.
COMPARATIVE STUDY OF RIVAROXABAN WITH ENOXAPARIN AS THROMBO PROPHYLAXIS IN TOTAL HIP REPLACEMENT
Muhammad Zafar Iqbal Shahid, Muhammad Khalid, Tanveer Haider, Muhammad Siddique Hamid, Muhammad Khalid Syed, Asim Islam
DOI: https://doi.org/10.59058/jaimc.v20i4.54
ABSTRACT
Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in symptomatic venous thromboembolic complications without risk of major bleeding.The objective of the study was to assess and compare the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total hip and total knee replacement. Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services Hospital Lahore. After permission from the Institutional review board, a total number of 200 patients who underwent total hip replacement (THR) were enrolled in the study. These patients were divided into 2 equal groups A and B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10 mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients’ anticoagulant prophylaxis was started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay. Results:Group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of DVT in the final follow up while In patients of Group B DVT occurred in 2 patients (2%) during the 1st week post operatively. This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin (RR0.70 & CI95%). Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high bleeding.
Saima Nouman Khan, Ahmad Hassan, Amina Umer, Aneela Chaudhary, Sadia Salman, Muhammad Ijaz Bhatti, Shehryar Aamer
DOI: https://doi.org/10.59058/jaimc.v20i4.45
ABSTRACT
Background and Objective: Metabolic syndrome is characterized by central obesity, deranged lipid profile, high blood pressure and abnormally high levels of blood sugar. It is an independent risk factor for cardiovascular disease. Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect joints, skin, brain, lungs, kidneys, and blood vessels. The extent to which metabolic syndrome is frequent in our population is less known. The objective of this study was to assess the frequency of metabolic syndrome amongst SLE patients. Methods: This cross-sectional study was undertaken in a public sector tertiary care hospital of Lahore from February 2021 through August 2021, including 110 confirmed SLE cases. After institutional approval and taking an informed consent, blood pressure, fasting and random blood sugar levels and fasting lipid profile were measured. Central obesity was assessed using waist circumference. Data were transferred to SPSS 21 for descriptive and inferential analyses. Frequencies were determined using numbers and percentages. Results: Of 110 SLE patients, 14 (12.3%) were males and 96 (87.7%) were females. Mean age of SLE patients was 42.9± 9.9 years. Mean BMI was 28.7±4.7 kg/m2. The frequency of metabolic syndrome in studied SLE patients was 37/110 (33.6%). Conclusion: Systemic lupus erythematosus patients had abnormally high serum triglyceride and cholesterol levels, diabetes mellitus, central obesity, high levels of fasting plasma glucose and hypertension. Therefore, one-third of SLE patients may have metabolic syndrome in our population.
PREVALENCE OF THROMBOCYTOSIS IN ANEMIC PATIENTS OF AKHTAR SAEED TRUST HOSPITAL LAHORE, PAKISTAN
Alia Waheed, Abdullah Farooq Khan, Nosheen Salahuddin, Raana Akhtar, Zainab Yousaf, Ahsan Farooq Khan
DOI: https://doi.org/10.59058/jaimc.v20i4.60
ABSTRACT
Introduction: Anemia is the one of the most widespread disorder all across the world characterized by low haemoglobin levels in blood causing reduced oxygenation of red blood cells and consequently producing symptoms such as lethargy, malaise and shortness of breath according to its severity. Thrombocytosis is a condition in which the number of platelets is increased and it can be identified by same methods which we use for te diagnosis of anemia. In previous studies, it has been found that thrombocytosis is associated with mild, moderate and severe forms of anemia. Materials & Methods: In this cross-sectional study, the patients with anemia who were less than 18 years old were included. Samples were collected from the outdoor and indoor patients of Akhter Saeed Trust Hospital Lahore, who were not treated with any therapy to cure anaemia. About 2-3 ml of venous blood was drawn and sent to laboratory for CBC. Data regarding the MCV, MCH, and platelet count was collected on structured performa. Result: From total 224 patients, 64.73% were males, and 35.27% were females. Statistically, the p-value showed a significant association between all age groups [first (p =0.001), second (p =0.001), third (p =0.001), and fourth (p =0.001)], and genders [males (p =0.001), and females (p =0.001)] with all (mild, moderate and severe) anemias. The prevalence of thrombocytosis in iron deficiency anemia patients was 23.57%. Conclusion: The present study concluded that the patients having iron deficiency anemia can also be affected with thrombocytosis.
Arooj Ahmad, Shabbir H Chaudhry, M.Umar Farooq, Sana Ali
DOI:https://doi.org/10.59058/jaimc.v20i4.57
ABSTRACT
Background and Objective: COVID-19 cause extensive effects on virtually all organs. It causes inflammation, endothelitis, vasoconstriction, hypercoagulability, and edema. Different organs may be affected at different times. Hence we aim to determine the cause of death and pattern of the injuries to the internal organs among the dead bodies of patients diagnosed with coronavirus disease. Methods: This Cross-sectional study was conducted in the Department of Forensic Medicine, Allama Iqbal Medical College, Lahore over a 1-year period from 2021 to 2022. 150 autopsies of COVID-19-positive patients who died from Covid, during the peak era were received. Autopsies were performed and internal organs were carefully examined clinically along with histopathological evidence. Reports were assessed and the presence or absence of single or multiple organ dysfunction was recorded. The data was recorded in a proforma and entered and analyzed in SPSS version 25. Results: The mean age of dead bodies at the time of death was 54.5 ± 14.73 years. 112 (74.7%) of these patients were males while 38 (25.3%) were females. The mean duration of COVID-19 was 14.22 ± 9.41 days and the mean duration of death until the presentation of the body for autopsy was 21.89 ± 6.37 hours. Out of 150 cases, death due to respiratory failure was observed in 67 (44.7%) cases, renal failure in 21 (14.0%) cases, liver failure in 18 (12.0%) cases, Venous thromboembolism in 16 (10.7%) cases, meningitis in 10 (6.7%) cases, intestinal perforation was observed in 9 (6.0%) cases, in 5 (3.3%) cases, peritonitis was observed and cardiac failure in 5 (3.3%) cases. Conclusion: There are higher chances of organ failure in patients suffering from COVID-19, as proven by autopsies of COVID-19 cases.
CASE REPORT
GIANT PSAMMOMATOID OSSIFYING FIBROMA MANAGEMENT CHALLENGES AND ROLE OF VIRTUAL SURGICAL PLANNING
Bisma Iftikhar, Gulraiz Zulfiqar, Shehryar Alam Khan
DOI: https://doi.org/10.59058/jaimc.v20i4.43
ABSTRACT
Ossifying fibroma is a fibro-osseous tumor that tends to be well-defined, has a propensity for the mandible, and has a high potential for recurrence. Psammomatoid ossifying fibroma is an aggressive variant of juvenile ossifying fibroma and can destroy surrounding structures. This case describes the unusual presentation of psammomatoid ossifying fibroma of the mandible. A 30-year-old female patient presented with a history of progressive swelling on the right side of her face from the past 10 years, causing facial contour deformity. It details the diagnostic process, treatment challenges, and potential implications of a massive psammomatoid ossifying fibroma affecting the mandibular ramus. The clinical, radiological, and histological findings about management plans and outcomes are discussed and pertinent literature has been reviewed. The impact of the multidisciplinary approach on treatment outcomes and patient quality of life will also be taken into account. The worth of immediate reconstruction with free flaps and a 3D stereolithographic model is also discussed.
REVIEW ARTICLES
Ayesha Khalid, Imrana Aslam, Izza Jahangir, Anum Khalid, Rabia Umair
DOI: https://doi.org/10.59058/jaimc.v20i4.75
ABSTRACT
Background & Objective: In developing countries, allopathic medicine is widely practiced similar to the advanced countries, however, people also believe in other forms of practices including homeopathic, Unani Tibb, spiritual healing and Chinese medicine. It is important to understand the health seeking behaviour of chronically ill patients in order to devise strategies for proving health care in a developing country. The aim of this review is to describe the current evidence on health seeking behaviour of chronically ill patients in a developing country. Methods: We used Google Scholar, PubMed, CINAHL , Web of Science, Embase and Scopus search engines to search for literature related to health seeking behaviour of chronically ill patients in a developing country using keyword search and using MeSH. Three authors screened articles independently using title and abstracts. Eventually we recruited relevant articles for the full text review. Results: 893 articles were retrieved using our search strategy. Of these 877 articles were excluded since these were not relevant and in line with our inclusion criteria, leaving 16 articles for full text review. Allopathic medicine is widely preferred by individuals in urban area, however, with increased duration of disease especially cancer and arthritis, a considerable section of population seeks help from Hakeem, homeopathic and spiritual healers. Conclusion Allopathic medicine with reliance on modern medical therapies is the most preferred choice in urban areas of developing countries, however, desperate chronically ill cancer patients, and patients with arthritis and psoriasis seek treatment from hakeems, homeopathy physicians and spiritual healer, especially in rural and inaccessible areas.