CURRENT ISSUE

VOL. 21, ISSUE NO.4

EDITORIAL

From Crisis to Control: Navigating the Dengue Challenge

Warda Samad, Mehwish Akhtar, Shahid Mehmood Sethi

https://doi.org/10.59058/jaimc.v21i4.255

ORIGINAL ARTICLES

Association of Serum Sodium with Mortality in Patients of Congestive Heart Failure

Aiman Nadeem, Rashid Iqbal, Adnan Ahmad Ather, Sohail Bashir Sulehria, Muhammad Aftab

https://doi.org/10.59058/jaimc.v21i4.179

Background and Objectives: Heart failure (HF) is associated with considerable mortality and morbidity. Electrolyte levels are considered to play crucial role in determining the outcome in these patients. This study was conducted to determine the association of serum Sodium with mortality in patients of Congestive Cardiac failure.
Methods: It was an observational study conducted in Department of Medicine, Sir Ganga Ram Hospital, Lahore from 22-12-2021 to 22-6-2022. Sample of 100 patients included. Patients aged between 30-70 years, both genders with congestive heart failure were included in the study and were divided in two groups based on their serum sodium levels. (Group I: with serum sodium level <135 mEq/L). Group II: with serum sodium level ≥ 135 mEq/L. They were followed up during their in-hospital stay and mortality was noted in a predesigned proforma. Data were analyzed using SPSS version 24.0, and crude Relative risk calculated.
Results: Patients in exposed group had 52% mortality rate as compared to unexposed group in which mortality rate was only 18% respective crude(RR=2.88). Similarly, elderly patients (Relative Risk=3.23), Male patients (Relative Risk= 3.37), Overweight patients (Relative Risk=3.54), non-diabetic patients (Relative Risk=3.50), hypertensive patients (Relative Risk=2.95), ischemic heart disease patients (Relative Risk=4.12), Smoker (Relative risk=4.41) and duration of congestive HF (Relative Risk= 3.03) had higher risk for mortality.
Conclusion: Results obtained from this study showed that low serum sodium level had a significant effect on patients of congestive HF in terms of mortality. Keeping its prognostic importance, congestive HF patients should be strictly monitored for electrolyte imbalance.
Key Words: Serum sodium, Prognostic, Indicator, Mortality, Congestive Heart Failure.

Frequency of Post-Cholecystectomy Syndrome Among Patients Undergoing Cholecystectomy: A Teaching Hospital Experience

Muhammad Azhar, Muhammad Ali, Sadia, Munawar Latif, Tahira Tahseen, Hina Asiam, Ukashah Azhar

https://doi.org/10.59058/jaimc.v21i4.98

Background and Objectives: Post-cholecystectomy syndrome is defined as upper abdominal pain or dyspepsia that persists after the cholecystectomy. Some studies show its incidence is about 40%. This study aims to find out the frequency of early post-cholecystectomy syndrome at our hospital and its possible cause.
Methods: It was an observational study conducted at POF Hospital Wah Cantt from January 2018 to January 2022. 505 patients who underwent cholecystectomy were included in this study to find the incidence and cause of post-cholecystectomy syndrome. All the data were noted in a predesigned proforma and entered in SPSS version 24.0.
Results: Out of 505, 59 patients were diagnosed as cases of post cholecystectomy syndrome with an incidence of 11.68%. 40(67.7%) were female, 19(32.2%) were male. The mean age of the patient was 38.43±8years. In 36(61%) patients, no cause of pain was found. In 12(20%) patients the cause was acid- peptic diseases. Three(5%) patients have CBD stones, 2(3.3%) patients have the remnant of the gallbladder, 2(3.3%) patients had a fluid collection, 2(3.3%) patient had pancreatitis, 1(1.6%) patient had scar pain (hypertrophic scar) and 1(1.6%) patient had periampullary growth.
Conclusion: The incidence of post-cholecystectomy syndrome is significant. Any patient presenting with pain postoperatively should be examined and thoroughly investigated for possible treatable causes.
Keywords: Post-cholecystectomy syndrome, Acid peptic diseases, jaundice, laparoscopic cholecystectomy.

https://doi.org/10.59058/jaimc.v21i4.205

Background and Objectives: Patients with diabetes are more likely to experience electrolyte imbalances, which may be caused by an imbalance in the distribution of electrolytes. Impaired electrolytes balance in diabetics may lead to micro and macro vascular complications.The objective of this study is to investigate disturbances in serum electrolytes including Sodium (Na+), Potassium (K+) and Chloride (Cl) in Type II diabetics.
Methods: This was a descriptive cross-sectional study conducted over a period of 6 months. 3cc blood samples of 100 Type II diabetic patients were collected from diabetic OPD and medicine wards of Gulab Devi Chest Hospital Lahore and processed in Pathology lab of Gulab Devi Educational Complex to assess the electrolyte abnormalities in these patients using a predesigned proforma.
Results: Out of 100 samples of type II diabetic patients, there were 65 patients in which serum sodium levels were decreased. The mean levels of fasting blood sugar, serum sodium, potassium and choloride were 267.13±81.814 mg/dl, 130.13±5.408 meq/l, 4.0807±0.486meq/l and 99.053±4.5879 meq/l respectively.
Conclusion: In this study, serum sodium levels were significantly decreased in type II diabetic patients, while no significant alteration observed in serum potassium and chloride levels. Serum electrolytes should be routinely measured in diabetics to prevent complications.
Keywords: Type II Diabetes Mellitus (DM), Serum Electrolytes.

Management of Congenital Talipes Equinovarus with Ponseti Technique in Children Under 2 Years of Age

Muhammad Zafar Iqbal Shahid, Waqas Ali, Asghar Ali, Aarij Elahi, Muhammad Siddique Hamid, Mubashir Farhan

https://doi.org/10.59058/jaimc.v21i4.212

Background and Objectives: CTEV is a complex congenital deformity of the foot and occurs due to the confluence of genetic & environmental factors. If it is not treated promptly and accordingly, it limits patient mobility and results in a painful foot. In most cases, it is treated conservatively using the Ponseti technique. This method was developed by a Japanese orthopedic surgeon Ignatio Ponseti who successfully treated CTEV in infants without extensive surgery. It is a manipulative technique with percutaneous release of tendoachilles that allows the ankle to obtain correction. This study was conducted to assess the functional outcomes of CTEV management by Ponseti method.
Methods: Ethical approval was obtained from the Ethical Review Board Of Services Hospital Lahore. This descriptive study was conducted at the department of orthopedic surgery from December 2018 to December 2020. A total number of 120 patients having CTEV deformity of the foot, aged less than 2 years, were included in the study. From these, 70 children had bilateral foot involvement. It was treated with 5-7 casts with each cast applied for 07 days according to the Ponseti method. In the final cast, a percutaneous Achilles Tenotomy was performed, where the deformity was restricted to 10 degrees from the neutral. After completion of casts, each patient was braced with Foot Abduction Brace.
Results: We used Pirani Score for pre- and post-operative assessment of correction of deformity via Ponseti method. There were 91% excellent results achieved through this method, whilst 6% of patients had good results and 3% had poor results.
Conclusion: Ponseti technique has got good functional & cosmetic results. It is economical and easy to apply.
Key words: Club foot, Pirani Shafique score, Ponseti technique, CTEV

Current Trends of Resistance Among Gram Negative and Gram Positive Bacteria Isolated from Tertiary Care Hospital

Ahmad Yar, Farhan Rasheed, Asma Ejaz, Iqra Jamil, Babar Yasin, Muhammad Bilal

https://doi.org/10.59058/jaimc.v21i4.124

Background and Objectives: Nosocomial infections (NIs) following antimicrobial resistance has become serious public health concern across the world. It affects the length of hospital stay and cost burden on the health care system. Rapid increase in resistance against commonly used antibiotics results in emergence of multi-drug resistant organisms. This study was conducted to assess the current resistance pattern of gram positive and gram negative bacteria isolated from clinical samples of a tertiary care hospital.
Methods: This retrospective study was done at CMH Sialkot over the period of six months. All types of clinical samples were included and were processed by using standard microbiological procedures. Organisms were identified by using different biochemical tests. AST were performed by Kirby-Bauer disc diffusion method on MH agar according to CLSI guidelines.
Results: Total 402 organisms were isolated among which 57% were gram positive while 43% were Gram negative bacteria. MRSA (31%) was most prevalent in Gram positive bacteria while E.Coli(50%) was found to be most common in Gram negative bacteria. Gram-positive bacteria showed maximum resistance against Fluoroquinolones, while Co-trimoxazole and Cephalosporins were least susceptible against Gram-negative bacteria.
Conclusion: Because of the clinical burden and importance of nosocomial infections, antibiotic usage policies should be considered and implemented on a priority basis in the agenda of the infection control committees of hospitals.
Key words: Nosocomial infections, antimicrobial sensitivity testing, Mueller-Hinton agar, Clinical and Laboratory Standard Institute.

Comparison of Iron-Supplementation Versus Combination of Vitamin-A & Iron-supplementation in Childhood Iron Deficiency Anaemia

Wahab Qadir, Safia Khan, Ahmad Bilal, Muhammad Sohail Shahzad, Arshad Rafique, Muhammad Fakhar ul Zaman

https://doi.org/10.59058/jaimc.v21i4.140

Background and Objectives: childhood anemia is highly prevalent worldwide and its effective treatment is the cornerstone to improve health of these children. This study was conducted to compare the mean rise in haemoglobin (Hb) after iron-alone versus the combination of vitamin-A & iron supplementation in childhood iron-deficiency anemia.
Methods: This randomized controlled trial was done at Paediatrics Medicine Department, Jinnah Hospital, Lahore from January-2019 to June-2019. A total of 60 cases, as per inclusion criteria were enrolled from the Paediatric Medicine Department of Jinnah Hospital Lahore. Group-A was supplemented with a combination of vitamin-A and iron while Group-B patients were supplemented with Iron alone. Hb was checked at baseline and after 3 months of treatment as per the designated group. All information, as per predesigned proforma, was entered and interpreted using SPSS version 23.0. An Independent sample t-test was applied and a p-value < 0.05 was considered statistically significant.
Results: Sixty patients were included, keeping 30 in each group i.e. Group-A (Vitamin-A + Iron) & Group-B (Iron-alone). In both groups, most of the patients were male, i.e. 22(73.3%) and 23(76.7%) in group-A and group-B respectively. In group-A, the mean age was 1.96±1.6 years while 2.12±1.5 years in group-B. In group-A, the mean rise in Hb level after 3-months of treatment was 3.0±0.99 g/dl, on the other hand, it was 1.96±1.00 g/dl in group B, with a p-value of 0.00014.
Conclusion: Vitamin-A supplementation combined with iron replacement therapy is recommended for substantial improvement among children with iron deficiency anemia.
Keywords: Vitamin-A, Iron-Supplementation, Hemoglobin (Hb), Iron Deficiency Anemia (IDA).

Clinical Spectrum and Frequency of Bone Marrow Infiltration in Hodgkin Lymphoma Patients Presenting to a Tertiary Care Hospital

Abeeha Khalid, Masuma Ghazanfar, Ali Afraz, Urooj Ramzan, Ali Husnain Sheikh, Hassan Abdal

https://doi.org/10.59058/jaimc.v21i4.85

Background and Objectives: Hodgkin lymphoma (HL) is a lymphoid malignancy that affects peripheral lymph nodes as well as organs like lungs, liver and bone marrow. It has 05 types. The clinical features of HL include lymphadenopathy and constitutional 'B' symptoms (fever, night sweats & weight loss). This study was conducted to describe the clinical spectrum and frequency of bone marrow infiltration in Hodgkin lymphoma patients presenting to Hematology department of AIMC Lahore.
Methods: This descriptive study has utilized data of known cases of HL, referred by Oncology department for bone marrow biopsy from January 2019 to December 2022, retrieved from medical records. Information was noted regarding demographic profile of the patient along with the clinical features, type of HL and infiltration of bone marrow. Data were analyzed using SPSS version 24.0.
Results: The study consisted of 24 HL patients between 10 to 60 years of age. The median age was 41 years. There were 21 male (87.5%) and 03 female (12.5%) patients (male-to-female ratio: 7:1). Lympha-denopathy was the predominant clinical feature present in all 24(100%) patients followed by 'B” symptoms in 09(37.5%) cases while bone marrow infiltration was present in 7 (29.1%) patients.
Conclusion: Lymphadenopathy serves as a distinctive clinical feature of Hodgkin lymphoma and presence of bone marrow infiltration may be reasonable factor for accurate disease staging.
Keywords: Hodgkin lymphoma, lymphoid malignancy, bone marrow infiltration, staging

Comparison of Pentraxin-3 in Migraine Patients without Aura and Healthy Controls

Maham Tahir, Mariyam Khan, Shazia Ramzan, Mehwish Qamar, Maira Tahir, Adnan Ali, Hafiz Muhammad Usman

https://doi.org/10.59058/jaimc.v21i4.138

Background and Objectives: Migraine is a common cerebrovascular condition marked by one-sided, pulsating headache, which may or may not be accompanied with an aura. Migraine is mostly found in females who are of childbearing age. One of the speculated mechanisms for the pathophysiology of migraine is endothelial dysfunction. A new biomarker of inflammatory disorders, pentraxin-3 is often produced by endothelium injury. In earlier investigations, it was shown that migraine sufferers had elevated levels of pentraxin-3. Our study's objectives were to analyze the serum pentraxin-3 levels in migraine sufferers without aura and healthy controls.
Methods: It was a cross-sectional comparative study. This was done at the IMBB Department, University of Lahore, Lahore Pakistan, from March 2020 to April 2022. We took 40 diagnosed migraine cases and 40 healthy controls. Detailed examination was done and proformas were filled by both cases and controls. Serum was collected by each of them and pentraxin-3 values were determined by using specific Elisa kits. SPSS version 22 was used for statistical analysis. For normality of data Shapiro wilk test was used. Mann whiteny U test was used for the comparision of means of pentraxin-3 in migrainers and healthy controls.
Results: The data were non-normally distributed after the Shapiro-Wilk Test. The average age of the controls was 25±6.06 years, while that of individuals with migraines was 26±7.78 years. Patients with migraine were mostly women. The majority of the patients had BMI category 18 to 24.5. Patients with migraine had mean pentraxin-3 levels of 145.75 ±157.7 pg/l, compared to 43.65 ±33.01 pg/l in the control group. Median was
100.5 in cases and 31.15 in controls. P-value was 0.0001.
Conclusion: When compared to the control group, migraine patients had considerably higher blood levels of PTX-3, and no correlations between age, BMI, marital status, smoking history, and usage of preventative medications were found.
Key words: migraine, pentraxin-3, endothelial dysfunction, C-reactive protein (CRP),

Is Empagliflozin a New Drug in the Making for Patients with Acute Deco- mpensated Heart Failure?

Nasir Iqbal, Muhammad Atif Qureshi, Muhammad Zahid Latif, Muhammad Ijaz Bhatti, Hassan Abbas Abdullah, Sania Tahir

https://doi.org/10.59058/jaimc.v21i4.206

Background and Objectives: Empagliflozin has dramatically enhanced outcomes in heart failure patients. The objective was to study the effect of Empagliflozin in acute setting as add-on treatment on cardiac hemodynamic by measuring pulmonary capillary wedge pressure (PCWP) and by Echocardio-graphy
Methods: It was a prospective observational study conducted on 75 patients presenting with acute heart failure at Chaudhary Muhammad Akram Teaching & Research Hospital Lahore,(CMAT & RH) with 4 days in-hospital echocardiographic follow up. After taking approval from IRB & written informed consent from patient, a questionnaire was used as data collection tool with information regarding basic demographic features prescribing empagliflozin as well as PCWP on day 0, day 1 & day 3 after fulfilling the inclusion criteria and results were calculated using Statistical Package for Social Sciences (SPSS) version v 20 32 bit.
Results: In our study, the mean age of participants was 57.5±7 years with 24% males (n=18) and 76% females (n=57). 93.3% of participants were known hypertensive, 57.3% were diabetic, 21.3% of cases were having significant family history of ischemic heart disease. Among all, 64% were having 2 or less risk factors and 36% were having more than 2 risk factors. In accordance to symptoms, 35% of participants were having NYHA class II to III symptoms and 65% were in NYHA class IV. 53% of participants were having chronic heart failure symptoms while 43% were having denovo symptoms. Among them, 42% were started with 25mg/day empagliflozin and 58% were started with 10mg/day according to their symptoms and requirements. Mean PCWP calculated at Day 0 was 22+7.5mmHg reduced to 14.3±5.2 mmHg at 1st day and10.6±3.3 mmHg at 2nd day after therapy which was statistically significant (p value=0.041).
Conclusion: This study concluded that addition of Empagliflozin to standard treatment significantly reduced PCWP in patients having acute decompensated heart failure.
Key Words: Pulmonary capillary wedge pressure(PCWP), Empagliflozin, Heart failure (HF).

Adverse Effects of Typbar-typhoid Conjugated Vaccine Among Children Vaccinated in University of Lahore Teaching Hospital

Mahwish Ejaz, Muhammad Naveed, Muhammad Bilal Safdar, Mujahid Razzaq, Anum Tahir, Ahsan Waheed Rathore

https://doi.org/10.59058/jaimc.v21i4.125

Background and Objectives: Rising incidence of XDR enteric fever in Pakistan requires extensive workup on safe availability of immunization. Aim of this study was to assess the frequency of adverse effects of Typbar TCV in children vaccinated in a tertiary care facility.
Methods: It was a descriptive study in which children aged 9 months to 15 years of age either gender coming for vaccination to paediatric opd from 1st Feb-2021 to 17th Feb-2021 were included. Post vaccination observation for 30 minutes was done for all children in hospital and were followed after 14 days on telephone for any local or systemic adverse effect after vaccination. Complications (systemic and local) were documented on proforma. All data were analyzed using SPSS 22.
Results: In our study, total 835 children were enrolled out of which 666 responded. Contact with 169 children was not possible because their lack of response and unavailability. Mean age was 4.9±4.06 years. Regarding local adverse effects, pain at site of injection was present in 30% children. Other local site reaction includes swelling in 17.7%, redness in 3% and limitation of movement in 2.4%. Systemic adverse effects included fever in 20.4%. Headache was present in 0.6% children, GI symptoms present in 0.9%.
Conclusion: With Typbar-TCV Typhoid Vi conjugate vaccine. fever, pain and local reactogenicity were the most common side effects. Safety profile of TCV can further be assessed with the help of large multi centre trials So Tybar –TCV Typhoid Vi conjugate vaccine can be encouraged to administered safely to all children as the incidence of XDR typhoid is rising.
Key Word: Conjugate vaccine, adverse effect, Enteric fever

Clinical Spectrum and Fetomaternal Outcomes in Near Miss Patients

Presenting to a Tertiary Care Hospital

Fatima Waheed, Sadaf Zahra Syed, Sadia Afzal, Sadaf Zahra, Munazza Naheed, Shaiza Sharif

https://doi.org/10.59058/jaimc.v21i4.127

Background and Objectives: Maternal near miss events are life threatening obstetric conditions which need urgent medical help in order to prevent maternal death. Audit of near miss events is a surveillance tool which is used to assess the quality of antenatal care in a setting and help in identifying causes to improve the maternal outcome. The objective was to find out the frequency, clinical spectrum and fetomaternal outcome in near miss patients presenting to a tertiary care hospital.
Methods: This was case-series observational study, conducted in Lady Willingdon Hospital, Lahore from January 2022 to December 2022. Eighty women were included. Each case was analyzed regarding age, gestational age, parity, examination findings, laboratory diagnosis, management plan, feto-maternal outcome, level of post-operative care, number of blood transfusions and complications.
Results: Most patient's were from age bracket 30-40 years, gestational age 28-36 weeks, parity P2-P4. The leading causes of near miss events were hemorrhage (48.75%), followed by hypertensive disorders (31.25%), viral hepatitis (8.75%), uterine rupture (6.25%), sepsis (5%) and ruptured ectopic pregnancy (3.75%). As maternal outcome, there were four deaths. Our fifty-eight patients (72.5%) required regular level-1 care, eighteen patients (22.5%) required high dependency unit level-2 care and four patients (5%) required intensive care unit level-3 care. Seventy-one babies were delivered. Sixty-one were born alive while ten were still born. Neonatal ICU admissions were twenty-seven, out of these twenty-two were discharged from nursery and early neonatal deaths were five.
Conclusion: Near miss events, if treated timely at well-equipped facility may prevent progression to life threatening situations.
Keyword: Near miss events, hemorrhage, hypertension, antenatal care

Comparison of Facial Angular Measurements Between Males and Females Presenting at a Tertiary Care Hospital

Mehwish Nisar, Ayesha Ashraf, Shazia Ramzan, Muhammad Azeem, Maimoona Batool, Farhana Ashraf

https://doi.org/10.59058/jaimc.v21i4.117

Background and Objective: The effectiveness of orthodontic diagnosis and treatment planning is dependent on an accurate assessment of the patient's soft tissue profile. The objective of the study was to compare the facial angular measurements between males and females.
Methods: The study comprised 100 volunteers (50 males and 50 females) ranging in age from 12 to 16 years. The respondents were chosen through convenience sampling technique from orthodontics department of children hospital Lahore. Cephalometric and photographic profile analysis was used, with angular measurements based on standard cephalometric and photographic records taken in natural head position. The study included four factors in total.
Results: The mean cephalometric and photographic naso-frontal angle was 121.050 and 121.030 respectively, where as cephalometric and phographic measurement in females were 122.240 and 122.840 respectively.
Conclusion: There was no significant difference in angular measurements between two genders.
Keywords: Photographic analysis, Cephalometric analysis, Naso-labial angle, Naso-mental angle, Naso- frontal angle, Naso-facial angle

Comparison of Outcome of SAC Ligation Versus No SAC Ligation in Pediatric Patients Undergoing Inguinal Orchidopexy for Incompletely Descended Palpable Testes: A Randomized Control Trial

Wajeeh ur Rehman, Muhammad Shafqat, Imran Hashim, Soban Hameed, Asif Iqbal, Nabila Talat, M. Saleem, Anoshia Shakeel, Muhammad Sarwar

https://doi.org/10.59058/jaimc.v21i4.256

Background and Objective: The case of undescended Testis (UDT) is one of the most common condition presented to a pediatric surgeon. The standard procedure to rectify UDT is known as Orchidopexy. The main objective of this study is to examine and compare the results of orchidopexy surgeries conducted with or without sac ligation in palpable undescended testis of pediatric patients.
Methods: This randomized controlled trial was done over a period of 12 months (July 2018 to July 2019) at
the Department of Pediatric Surgery, Children's Hospital & Institute of Child Health, Lahore. The selection of cases was made dependent upon fulfillment of departmental criteria and approval by ethical review committee. Consequently, 280 cases divided into two equal groups i.e. Group-A and Group-B (140 cases in each group) were shortlisted for the study after detailed scrutiny. The allotment of patient to above mentioned groups was randomized by lottery method. The patients in Group-A underwent orchidopexy with ligation of sac while the patients of Group-B were operated without sac ligated. The surgeries were performed under general anesthesia by consultant surgeons of same caliber and competence. Moreover, in order to quantify and analyze the results of surgeries parameters such as Mean Operative Time, Postoperative Manifestations and recurrence of UDT were recorded on proforma. Subsequently, SPSS version 25 statistical software was utilized for calculating the mean and standard deviation of numerical variables such as age and operative time. Additionally, the frequency and percentage of variables such as recurrent UDT were also calculated. Chi-square test was applied to recurrent UDT and development of inguinal hernia. It is highlighted that P-
value ≤0.05 was taken as significant.
Results: Among 140 patients of sac ligation group, 40.7% were 1-4 years old and among 140 patients of no
sac ligation group, 42.9% were 1-4 years old. In sac ligation group, 60.0% patients had right undescended testis while in no sac ligation group, 67.1% patients had right undescended testis. In sac ligation group, the mean operative time was 37.81 + 8.82 minutes while in non-sac ligation group; the mean operative time was
24.34 + 4.12 minutes. In sac ligation group, no patient had post-operative hernia while in non-sac ligation group, 1.4% patients had post-operative hernia (p=0.15). In sac ligation group, 1.4% patients had recurrent UDT while in non-sac ligation group, 2.1% patients had recurrence. (p= 0.65)
Conclusion: Study concluded that non-sac ligation technique is more effective than sac ligation technique in
terms of operative time and should be preferred for patients by surgeons.
Keywords: Orchidopexy, undescended testes, testicular atrophy, inguinal hernia, recurrence

Reasons for Delay in Fungating Breast Cancer Presentation at a Tertiary Care Facility of Pakistan

Faryal Azhar, Farwa Zohaib, Iffat Atif, Tausief Fatima

https://doi.org/10.59058/jaimc.v21i4.198

Background and objective: Breast cancer is a treatable disease resulting in complete cure. Late presentation is not uncommon in third world countries. The factors leading to delay in reporting to the hospital must be studied. The objective of this research was to identify the factors responsible for late presentation of fungating breast cancer patients at a tertiary care hospital of Pakistan.
Methods: It was a descriptive, cross-sectional study conducted at Jinnah hospital Lahore from January 2020 to December 2022. A total of 56 respondents were selected through non-probability purposive sampling technique. A pre-tested structured questionnaire was administered, data were gathered after taking informed consent and data confidentiality was ensured. The collected data were analyzed using SPSS version 23. The stage 1 and 2 carcinoma breast patients are excluded from the study. The sample size was calculated by using WHO calculator.
Results: A total of 56 cases of fungating breast growths were included in the present study carried out for a period of two years. Among 56 cases the mean age of patients was 45+9 years. The study found that the reasons leading for the delay in seeking treatment were poor socioeconomic status, belief in traditional faith healers, cultural myths, reliance on alternative medicine, fear of medical procedures, resistance from family members, and lack of accessibility.
Conclusion: The delayed presentation of breast cancer leading to fungating growth is a significant concern that needs to be addressed. By identifying the reasons for delayed presentation, healthcare providers and policymakers can develop targeted interventions to improve early detection and prompt treatment, eventually improving the prognosis and quality of life of breast cancer patients.
Key Words: delayed presentation, fungating breast cancer, reasons, tertiary care facility.

Knowledge and Perception of Soft Skills Among Medical Students and Postgraduate Residents at Services Hospital Lahore

Saira Yunus, Tahira Nasrin, Salma Zaman, Tayyaba Wasim

https://doi.org/10.59058/jaimc.v21i4.189

Background and Objectives: Soft skills have emerged as a novel focal area for health care practitioners. Objective of this study was to assess the perception of medical students and postgraduate residents regarding soft skills and the need of incorporating these skills into the curriculum.
Methods: This cross-sectional descriptive study was conducted at the Services Institute of Medical Sciences and Services Hospital in Lahore from January 1st to March 31st, 2023. A total of 192 participants, divided into two groups on the basis of their academic and clinical experience(Group 1 medical students final year and group 2 postgraduate residents of SHL (1st year) were included in the study after informed consent. Participants were given a pre-designed, validated questionnaire to record their details and assess their soft skills.
Results: Postgraduate doctors were more effective at educating and motivating patients regarding treatment plans (84.4% vs. 15.6%, p < 0.0001), problem solving in critical situations (83.3% vs. 16.7%, p = 0.0001), and managing ethical conflicts (82.3% vs. 17.7%, p < 0.0001) compared to medical students. Doctors reported being taught communication skills (88.5% vs. 67.7%, p = 0.0005), critical thinking and problem- solving skills (81.3% vs. 31.3%, p=0.0001), time management skills (89.6% vs. 10.4%, p = 0.0001), and leadership skills (77.1% vs. 57.3%, p = 0.0035) more than medical students. A higher proportion of doctors had been assessed by their supervisors on communication skills (71.9% vs. 41.7%, p = 0.00003), critical thinking and problem-solving skills (49.0% vs. 27.1%, p = 0.0018), and leadership skills (74.0% vs. 33.3%, p = 0.0001) compared to medical students.
Conclusion: Postgraduate doctors exhibit stronger aptitude in essential soft skills as compared to medical students therefore efforts should be made to integrate soft skills in healthcare educational program for better patient care and prepare medical students and residents for the multifaceted challenges they will face in their career.
Key words: soft skills, perception, curriculum.

Effect of Preoperative Administration of Dutasteride on Reducing Blood Loss in Perioperative Period of Transurethral Resection of Prostate

Shabbir Hussain Chaudhry, Salman Arshad, Shah Jahan Ur Rehman, Shoaib Javaid, Ismat Ullah, Arooj Ahmad

https://doi.org/10.59058/jaimc.v21i4.202

Background and Objective: Clinical benign prostatic hyperplasia (BPH), a condition that commonly occurs in aging men. It is characterized by the development of lower urinary tract symptoms (LUTS), which can lead to impairment of bladder function and potential renal complications. TURP is the gold standard surgical treatment of BPH. Dutasteride is a 5-reductase and is used for medical management. This study was planned to ascertain the effect of pre-treatment dutasteride in reducing blood loss in patients undergoing transurethral resection of prostate (TURP).
Methods: It was a randomized clinical trial carried out at Department of Urology, Jinnah Hospital Lahore in which the total study sample was divided in two groups. One group received dutasteride and the second group was the control group. The study variables were Haemoglobin and Hematocrit values, clotting profile PT and INR, serum Ca levels and uric acid, BMI, prostate volume, residual volume of urine and hospital stay. Results were presented as mean ± SD or frequency (%). The main study outcome variable was mean blood loss (calculated by change in hemoglobin and hematocrit level).
Results: 6 (10.3 %) patients needed blood transfusion in dutasteride group and 7 (12 %) in control group (p=0.14). Post-surgery change in haemoglobin and HCT levels were less in dutasteride groups as compared to the control group (ΔHb 1.94±1.27 g/dL vs. 2.16±0.73 g/dL, respectively, p=0.02; ΔHct 5.68 % ± 2.56% vs. 6.52 % ± 2.39 %, respectively, p = 0.04).
Conclusion: The present research suggests that administering Dutasteride four weeks prior to the TURPprocedure results in a decrease in blood loss during the peri-operative period, ultimately leading to improved patient outcomes.
Key words: Benign Prostatic Hyperplasia (BPH). Transurethral resection of Prostate (TURP), 5 Alpha Reductase Inhibitor (5-ARI)

Background and Objectives: Learning styles is one of the key predictor for academic success of students. This study was conducted with objectives to assess the learning styles of medical students using the VARK Questionnaire and to study factors related to their learning style preferences.
Methods: A descriptive cross-sectional study, using the validated 16-point VARK Questionnaire Version 8.01, was conducted among medical students in Lahore, Pakistan, from May to October 2023. Through non- probability virtual snowball sampling, 360 students from various medical colleges responded to online Google forms distributed via emails and WhatsApp groups. Data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences (SPSS) Version 26. The Chi-square test determined associations between variables, with a significance level set at p < 0.05.
Results: The respondents had a mean age of 21.56±1.608. The study found that 68.9% preferred a unimodal learning style, with visual (25%) being the most favored, followed by read/write (15.2%), aural (14%), and Kinesthetic (13.5%). No statistically significant relationships were found between learning style and gender, clinical year, schooling background, or institute type. However, significant relationships were found with age, academic performance, and preferred teaching methodology (p=0.05, p=0.04, and p=0.007, respectively).
Conclusion: The present study highlighted the independence of learning styles from demographics. The identified relationship between learning styles, preferred teaching methodologies, and academic performance emphasizes the significance of this knowledge for medical educators and students in fostering lifelong learning. It is noteworthy that majority of students demonstrated unimodal sensory preferences, reinforcing the importance of tailored teaching strategies to maximize learning potential.
Keywords: Learning, style, VARK, Medical Education, Teaching Methods, Medical Students

Background and Objective: Bullying and victimization remained severe and widespread issues in schools and colleges, and its occurrence has been well recognized via a large scale national and international studies. The current study aimed to examine the relationship between bullying-victimization, resilience, and students' adjustments (academic, social and psychological). Furthermore, the mediating role of resilience between bullying-victimization and adjustments will be examined.
Methods: This correlational study was conducted from May 2022 to September 2022 through an online survey and a sample of 200 college students, between the age of 15 to 20, was taken from Lahore city. For assessment purpose, Connor-Davidson Resilience Scale, The Multidimensional Peer-Victimization Scale, and Student Adaptation to College Questionnaire were used. Bullying-Victimization was taken as independent variable, resilience was taken as mediating variable, while adjustment (academic, social and psychological) was taken as outcome variable.
Results: The results indicated that bullying-victimization has a negative relationship with resilience (p < .05) and students' adjustments. However, resilience was found to be significantly and positively associated with students' adjustments (p < .01). The findings of Bartlett's Test of Sphericity and Kaiser-Meyer-Olkin showed the appropriateness of sample data for conducting factor analysis. Mediation analysis revealed that resilience significantly mediates in the association between bullying-victimization and adjustment (academic, social and psychological), accounting for 38.90% of the total association.
Conclusion: Bullying-victimization has a negative relationship with resilience and students' academic, social and psychological adjustments. Furthermore, resilience is positively associated with students' adjustments. Moreover, resilience mediates the relationship between bullying-victimization and adjustment.
Keywords: Bullying-Victimization, Resilience, Social, Academic and Psychological Adjustment

Background and Objective: Obesity is now taking the shape of an epidemic worldwide and is on the rise among women of reproductive age especially over the last 40 years. This happening has a major bearing on reproductive outcomes as per latest studies. During pregnancy and childbirth, obese women are more likely to develop fetomaternal complications than women with a normal body mass index (BMI). The objective was to determine the frequency of normal weight, over weight and obese women among those presenting for antenatal care and to compare the fetomaternal outcome in different BMI categories.
Methods: This descriptive cross sectional study was conducted from 29 October 2022 to 29 April 2023 at Lady Willingdon Hospital, Lahore. 200 subjects meeting the inclusion criteria were enrolled in the study after informed consent. BMI was recorded and weight category assigned. All relevant details noted on especially designed performa. Data analysis was done using SPSS No. 24.
Results: Frequency of obesity in pregnant females was recorded as 25.5 %( n=51) and overweight women as
40.5 %( 81). A total of 200 females with an overall mean age of 29.9 ± 3.5 years were included in this study. The mean body mass index was 27.5 ± 3.9. The proportion of preeclampsia was significantly (p-value < 0.05) higher in obese women (31.9%) followed by overweight (22.2%) and normal women (15.6%), respectively. Likewise, the rate of eclampsia (22.8%, 13.6% and 8.3%), gestational diabetes (28.6%, 18.5, and 9.7%) and hypertension (27.7%, 16.1% and 11.4%) was also significantly higher in obese women followed by overweight women and normal weight women. In addition, a significant (p-value < 0.05) greater rate of C-section (41.5% vs. 35.8% vs. 14.4%) was reported in obese weight groups as compared to overweight versus normal weight women. The mean birth weight of new born was significantly higher in obese women as compared to overweight and normal weight women. Six (11.8%) babies born to obese women were macrosomic and only (1.3% and 1.5%) babies had macrosomia in overweight and normal weight women. APGAR score at 1 minute and 5 minute was significantly higher in normal weight women followed by overweight and obese women. The requirement of admission to NICU was statistically significantly higher in obese women (55.4%) followed by overweight (45.7%) and normal weight women (28.3%).
Conclusion: Fetomaternal morbidity is significantly increased in obese and overweight pregnant females.
Keywords: Pregnancy, obese, over-weight, prevalence, fetomaternal, outcome.

Background and Objective: Leakage of bile after open or laparoscopic cholecystecmy is rare, but if occurred, is associated with higher risk of morbidity and mortality. The objective of this study was to describe the experience of managing post-cholecystectomy biliary leak in a tertiary care hospital of Lahore, Pakistan.
Methods: In this descriptive, cross sectional study, twenty-two cases were included using purposive sampling technique. These cases presented with bile leakage after cholecystectomy (open and/or laparoscopic) over the period of 3.5 years in a surgical unit. The patients were managed on case-to-case basis using a standardized revised algorithm. All patients were managed by ultrasonography guided drainage, and laparoscopic wash with control of sepsis. Magnetic Resonance cholangiopancreatography (MRCP) was conducted to classify injury using Strasberg's classification and managed according to the injury type. Data were managed and analyzed using SPSS version 25 and described using frequency and percentages.
Results: Cases were aged between 30-60 years and out of 22 patients, twelve presented with bile leaks through drain left in-situ (55%), six presented with peritonitis with drain in-situ (27%), four patients (18%) had abdominal distension and peritonitis. Firty-one percent patients were managed by ultrasound guided drainage and in 9/22 patients laparoscopic wash and drain placement was done. In six patients, ERCP with stent was used. In 5/22 patients, hepaticojejunostomies were performed.
Conclusion: Post-cholecystectomy iatrogenic biliary leak can be managed by drain placement, abdominal wash and antibiotics. Presented algorithm will help surgeons to manage post-cholecystectomy biliary leak effectively with low risk of mortality and morbidity.
Keywords: Bile duct disease, post-operative complications, Common bile duct injuries, Biliary fistula , fistula biliary, biliary leakage, Cholecystectomy

CASE REPORT

Mature Cystic Teratoma of Left Adrenal Gland Diagnosed as Myelolipoma

Afifa Zahid, Farooq Ahmad, Naila Jabbar

A 32 year old woman who presented with fever, sore throat and abdominal pain that was evolving from last 7 months. A huge mass was palpable in left hypochondrium and left lumbar region. All baselines were within normal range. On ultrasonography, it appeared as well defined diffusely echogenic area in epigastric region likely arising from adrenal/pancreas, while CT scan findings reported a large heterogenous fat containing mass in left supra renal region. On the basis of CT findings, diagnosis of adrenal myelolipoma was made, exploratory laparotomy was done, the adrenal mass was excised and sent for histopathology. The biopsy report has shown that microsection of lesion were composed of benign squamous and pseudostratified epithelium, fat cartilage and glial tissue. Postoperative recovery of patient was uneventful.
Keywords: extragonadal teratoma, retroperitoneal teratoma, adrenal myelolipoma, mature cystic teratoma of adrenal gland

https://doi.org/10.59058/jaimc.v21i4.153