bluuebunny/crossref_metadata_2025 huggingface dataset:
IRON DEFICIENCY WITHOUT ANEMIA IN COPD PATIENTS: ASSESSING EXERCISE CAPACITY AND EXACERBATION FREQUENCY
Authors: Abbasi Munir Ahmad , Aamir Nazir  , Sadaf Anwar Qureshi  , Nadia Haleem  , Naheed Khattak  , Muhammad Adnan Rashid  , Saima Iltaf
Published: November 2024

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health challenge with significant morbidity and mortality. Iron deficiency, including non-anaemic iron deficiency (NAID), has been identified as a potential comorbid in COPD, affecting patient outcomes and disease severity. This study aimed to investigate the prevalence and impact of iron deficiency on the severity and clinical outcomes in COPD patients. Methods: In this descriptive cross-sectional study, 289 individuals diagnosed with COPD were enrolled and underwent comprehensive medical assessments, including haematological tests and spirometry from December 2019 to December 2023. The study focused on measuring iron levels, exercise capacity, and exacerbation frequency, comparing iron-deficient and non-iron-deficient groups. Results: The study found that 46.7% of participants had iron deficiency. Those with iron deficiency showed significantly lower exercise capacity as measured by the six-minute walk distance and experienced a higher frequency of yearly COPD exacerbations. However, no significant differences were observed in airflow limitation and the overall quality of life between the iron-deficient and non-iron-deficient groups. Conclusion: The findings suggest that iron deficiency, particularly NAID, is associated with a more severe progression of COPD, characterized by reduced exercise capacity and increased exacerbation frequency. These results highlight the importance of considering iron deficiency in the management of COPD to potentially improve patient outcomes. Keywords: Chronic Obstructive Pulmonary Disease (COPD); Iron Deficiency; Non-Anaemic Iron Deficiency (NAID); COPD Exacerbations; Exercise Capacity in COPD; COPD Management Strategies
PECTORALIS MAJOR MYOCUTANEOUS FLAP SUCCESS RATE IN SURGICAL MANAGEMENT OF ORAL CANCER
Authors: Saeed Ullah Shah  , Hina Jabeen  , Fatima Waseem  , Haleema Dilawar
Published: November 2024

Background: The recurrence rate of Oral squamous cell carcinoma is between 26.5% and 56.3% of cases. The majority of handling failures are confined & local-regional. However, there is debate regarding the best course of action for these patients with recurring oral Malignancy.  The objective of the study was to assess the efficacy of the flap in the reconstruction of oral cancer patients and the complications that can result from it. Methodology: The study was conducted in Zia-Uddin Hospital, Karachi, Pakistan from 2020 to 2022. Forty patients of recurrent oral cancer, who underwent salvage surgery with a pectoralis major myocutaneous flap were included in the study. Information was taken from the case notes, & the clinical follow-up of the patients were done between one month and one year. Results: The surgery had an 80% overall success rate. Twenty patients (57.1%) experienced difficulties, including 17 (48.6%) who had flap-related issues. Seven patients (20%) experienced problems unrelated to the flap, such as temporomandibular joint pain and haemorrhage of the chest incision. 9 patients (25.7%) experienced major difficulties, compared to 8 patients (22.9%) who experienced minor complications. Conclusion: For the dependable restoration of significant soft tissue abnormalities brought on by the excision of recurrent oral cancer, the pectoralis major myocutaneous flap was found to be a good option. The main issues were related to the reconstruction site. Salvage surgery helps a lot of patients, and some of them can live for two to four years after the procedure.
RELATIONSHIP BETWEEN LOWER URINARY TRACT SYMPTOMS AND TREATMENT-RELATED BEHAVIOR IN HAZARA DIVISION
Authors: Muhammad Shahzad  , Nasir Jamil Muhammad , Faheem ul Haq  , Aminullah  , Ehsan Ul Islam  , Muhammad Faridullah Thaimur
Published: November 2024

Background: Lower urinary tract symptoms (LUTS) adversely affect the quality of life and are usually under-reported because of a stigma associated with these symptoms. Unless specifically probed for these symptoms, most patients do not report Lower urinary tract symptoms. This study focused on the treatment seeking behavior of otherwise healthy individuals who had LUTS. The study aimed to determine the relationship between lower urinary tract symptoms and treatment-related behaviours among adults in the Hazara Division. Methods: This was a descriptive cross-sectional, questionnaire-based study of healthy attendants of patients admitted at a private medical center for any reason who were enrolled in this study and were interviewed using a simple questionnaire after obtaining informed consent. The patients were administered validated tools such as OAB-8 and IPSS. Results: Overall, 23.5% of study participants reported LUTS. Among the 968 study participants, 530 reported having LUTS less than half the time and 438 reported LUTS more than half the time during the past 3 months. Over 23.5% of patients sought any type of treatment for their symptoms. the likelihood of seeking medical attention was more in males experiencing issues such as urgency with distress (aOR 2.21 (1.11-4.05) CI 95%), frequency with distress (aOR 1.88 (1.01-4.21) 95%CI), slow urinary stream with distress (aOR 2.33 (1.13-4.49) CI 95%), hesitation (aOR 1.81 (1.02-2.15) CI 95%), and feeling of incomplete bladder emptying (aOR 3.13 (1.38-4.95) CI 95%). Similarly, females with symptoms like urgency with a fear of urine leak (aOR 5.33 (1.67-10.93) CI 95%), frequency (aOR 4.88 (1.29-9.94) CI 95%), urgency with distress (aOR 6.11 (2.33-13.20) CI 95%), and intermittency (aOR 2.32 (1.33-3.78) 95% CI), were more prone to seeking medical help. Conclusion: There is marked under-utilization of treatment for LUTS. Physicians need to adopt a proactive approach to identifying these symptoms and offering treatment.
SCLEREDEMA DIABETICORUM; A RARE DISEASE
Authors: Amber Waqar  , Saleh Khurshied  , Mahvish Aftab Khan  , Aisha Baloch  , Mohammad Riaz Khan  , Nawal Khurshid
Published: November 2024

Scleredema Diabeticorum (SD) is a rare condition characterized by diffuse, symmetrical induration along with non-pitted swelling mostly on the upper back as a result of mucin being deposited in the dermis. It can also involve posterior neck, shoulders, and scalp. We report a case of 48 years old female patient from Pakistan, with uncontrolled diabetes mellites type 2 for the last 15 years, presenting with thickened skin at the back of the neck resulting in difficulty in neck and shoulder movements. This led to decreased functional class from I to II causing her to develop insomnia and depression. Scleredema diabeticorum is a difficult disease to manage as it runs a long and debilitating course with little propensity of remission with available treatments.
USING ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING APPROACHES TO ENHANCE CANCER THERAPY AND DRUG DISCOVERY
Authors: Marwan Abu-Zanona  , Bassam Mohammad Elzaghmouri  , Saad Mamoun AbdelRahman  , Ahmed Abdelgader Fadol Osman  , Asef Al-Khateeb  , Khurram Shahzad  , Fahmida Khatoon
Published: November 2024

This paper looks at how AI and machine learning have been applied over the last ten years to the development of anti-cancer drugs. By speeding up the synthesis of more desirable compounds and the identification of new ones, artificial intelligence (AI) has demonstrated substantial contributions to the research and therapy of anti-cancer therapies. Future developments in human cancer research and treatment are anticipated to be significantly influenced by AI. Protein-interaction network analysis, drug target prediction, binding site prediction, and virtual screening are examples of innovative techniques. Drug design and screening are enhanced by machine learning, and the use of multitarget drug development approaches has made it possible to develop cancer treatments with fewer side effects. AI does, however, have several drawbacks, such as a heavy reliance on data and a narrow scope of explanation. Interpretable AI models, which combine data and computation in AI-assisted cancer treatment research, will be the new development path in the future. For more than thirty years, computer-aided drug design techniques have been a key component in the advancement of cancer therapies. Artificial intelligence is a new and powerful technology that has the potential to speed up, lower the cost, and improve the efficacy of anti-cancer therapy development. This work is a narrative review that examines numerous uses of AI-based techniques in the development of anti-cancer medications. We go on to explain the underlying ideas of these techniques as well as their benefits and drawbacks. In addition, we aggregate a multitude of databases, such as the pharmacological, chemical compound, omics, and epigenomics databases. They can be taken into consideration and modified to suit the needs of other researchers.
SURGICAL SITE INFECTION WITH EXTREME DRUG-RESISTANT ACINETOBACTER BAUMANII: A WAKE-UP CALL!
Authors: Faraz Waheed  , Afaq Saeed Khan  , Usman Babar  , Manahil Saeed Khan
Published: November 2024

Surgical site infections are a common complication of surgery with a high prevalence in lower middle-income countries (LMICS). Excessive focus on antibiotic prophylaxis to prevent surgical site infections while neglecting other precautions like aseptic measures, patient nutrition, proper wound care has resulted in the emergence of antibiotic resistant microbials. Such organisms are a menace to healthcare. They cause prolonged hospital stay, use of expensive drugs, increased mortality and morbidity and overall, greatly increased cost of care per patient. We present a case of extreme drug resistant Acinetobacter spp causing surgical site infection following abdominal surgery, from Peshawar, Pakistan. Our patient was an 18-year-old lady who had undergone abdominoplasty following which she developed high grade fever, pain in abdomen and wound discharge. Empiric antibiotics treatment did not improve her condition. Culture and sensitivity report showed the growth of Acinetobacter spp. Which was resistant to almost all of the commonly used antibiotics, with the exception of tigecycline. Patient was treated with tigecycline which resolved her fever and wound infection and she was discharged in a stable condition. We believe our case highlights the importance of antibiotics stewardship and is a wakeup call to healthcare professionals and policy makers to take necessary steps to herald the danger of antibiotics resistance before it is too late.
COMPARISON OF COMMA INCISION VERSUS MODIFIED WARD'S INCISION IN MANDIBULAR THIRD MOLAR SURGERY- A CLINICAL STUDY
Authors: Lohana Vishal , Sundas Kunbher  , Shumaila Younus  , Suneel Kumar Punjabi  , Omaiz Memon  , Ghulam Ali
Published: November 2024

Background: To evaluate the effectiveness of the two flap/incision techniques, viz. the comma incision versus modified ward's incision in mandibular third molar surgery. Methods: This randomized research comprised of 126 participants, 63 in every group. Male and female patients between the ages of 20 and 45 who had mesio-angular impacted mandibular third molar till the age of 20 to 24 years were enrolled in the research. Patients with specific problems, that is pregnancy, trismus, pericoronitis, horizontally impacted wisdom teeth, and disto-angular impaction, and limited mouth opening in which there was difficulty in access to third molar region due to any reason were omitted from the study. The independent t-test were used to evaluate the mouth opening over groups, and the chi-square test were used to evaluate the pain and edema. Results: The participants average age was 31.16±9.29 years. On the first day, the comma shaped group reported significantly mild pain (47.6%) compared to the Modified Ward's group (30.2%) (p=0.230). On the seventh day, the comma shaped group reported significantly greater mild pain (63.5%) and decreased severe pain (1.6%) compared to the Modified Ward's group, which reported decrease mild pain (55.6%) and more severe pain (4.8%) (p=0.032). On the first, third and seventh days, mouth opening was also considerably higher in the comma-shaped group than in the Modified Ward's group. On the third and seventh days, swelling was much decreased in the comma-shaped group than in the Modified Ward's group. Conclusion: Our study delivers some proofs that the comma-shaped incision is more effective than the modified Widman's incision at promoting good mouth opening and decrease post-operative edema and discomfort after flap surgery.
EVALUATION OF EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) EXPRESSION IN UROTHELIAL CARCINOMA: A POSSIBLE PROGNOSTIC ROLE
Authors: Basharat Shifa , Ayesha Sajjad  , Faryal Javaid  , Maria Khan  , Maria Tasneem Khattak  , Iqbal Muhammad Khan
Published: November 2024

Background: Urothelial carcinoma is a subtype of urinary bladder cancer which carries a higher morbidity and mortality worldwide. It is estimated that 90% of the patients presenting to the hospitals with history of bladder cancer are diagnosed with urothelial carcinomas. Objective of the study was to evaluate the strength of EGFR expression and its prognostic role in urothelial carcinoma. It was a cross-sectional study conducted at the Rehman Medical Institute Peshawar from July 2022 to February 2023. Methods: A total of 98 specimens of patients diagnosed with urothelial carcinoma were examined in histopathology department. Patients with other malignancies were excluded. Demographic characteristics of participants, tumour grading, invasion of the surrounding structures and EGFR expression was recorded, and data analysis was performed with SPSS-23. Results:  Mean age of the participants was 58.68±8.61 years. Gender distribution revealed 67(68.4%) males and 31(31.6%) females with a male to female ratio of 2.1:1. A total of 61 (62.2%) patients exhibited low grade of urothelial carcinoma while 37(37.8%) patients showed high grade malignancy. Expression of EGFR was not observed in 04 (4.1%) specimens while 62(63.3%) specimens revealed weak to moderate expression and 32(32.7%) showed strong expression of EGFR. Out of 61 patients with low grade of tumour, 04 (6.6%) patients exhibited no expression, 50(80%) patients exhibited weak to moderate expression and 07(11.5%) patients revealed strong expression of EGFR. Out of 37 patients with high tumour grade, 12(32.4%) revealed weak to moderate and 25 (67.6%) revealed strong expression of EGFR. Higher tumour grades and tumours with deeper penetration revealed a strong expression of EGFR with a p-value of <0.001. Conclusion: Strong expression of EGFR in tumours with higher grade validates its prognostic role and can be utilized for targeted therapy with potentially lifesaving consequences in patients presenting with urothelial carcinoma.
CP ANGLE MEDULLOBLASTOMA WITH SUPRATENTORIAL DROP METS
Authors: Razzaq Sana , Muhammad Assad Javed  , Ain Us Saba  , Niaz Ahmed  , Salman Habib  , Sana Razzaq
Published: November 2024

Medulloblastoma, is an undifferentiated neuroepithelial tumour of embryonic origin. It is an uncommon central nervous system tumour, and adult-onset is even rarer. It could form in an unusual or unconventional location, like the cerebellopontine angle (CPA), and such tumours don't frequently show supratentorial extension. Less than 2 per million persons are affected each year, with children being affected ten times more than adults. Case Presentation: We present a 17-year-old male with complaints of occipital headache and having trouble walking for three months. Right Cerebellopontine (CP) angle lesion with ipsilateral mass effect over the cerebellum was seen on MRI brain with contrast. The tumour was excised by right sub-occipital retro mastoid craniotomy and histopathology revealed medulloblastoma. Post-operatively patient underwent chemo-radiotherapy. Craniospinal MRI was done to look for any dropmets. Recovery was uneventful. Two years later, he complained about headaches and generalized tonic-clonic seizure, MRI brain with contrast revealed a lesion with extra-axial components with a mass effect in the right temporal lobe. Right temporal craniotomy was done and the tumour was excised and histopathology showed a round blue cell tumour (medulloblastoma). Conclusion: We report a rare case of medulloblastoma located at the CP angle along with supratentorial metastasis 2-years after treatment.
COLONIC MALAKOPLAKIA
Authors: Arit Prakash  , Noshaba Noor  , Ayesha Marchant  , Mariam Ghori  , Molani Rameen
Published: November 2024

This case report is of a 10-year-old female who presented with complaints of blood in her stool and colicky abdominal pain for the last 1.5 years. Biopsy samples from the rectum and left-sided colon were taken during a colonoscopy, revealing numerous histiocytes having calcified bodies (Michaelis-Gutmann bodies). Diagnosis of Malakoplakia was confirmed with no evidence of dysplasia, malignancy, or granuloma.
SELF-REPORTED MULTI-MORBIDITY WITH TUBERCULOSIS: DATA FROM THE KHYBER PAKHTUNKHWA INTEGRATED POPULATION HEALTH SURVEY (KPIPHS) IN PAKISTAN
Authors: Zia ul Haq  , Saima Afaq  , Farhad Ali Khattak  , Sana Hussain  , Sheraz Fazid  , Abid Rahim  , Muhammad Zeeshan Haroon  , Kamran Siddiqi
Published: November 2024

Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan. Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan. An interviewer-administered questionnaire was used to collect data, from adults, on demographics, education and socioeconomic status, physical and mental health, reproductive health, child health, health-related quality of life, and self-reported cardiometabolic diseases including Diabetes, hypertension, renal disorders, cardiac failure, angina, and stroke. Results: A total of 20,715 participants were recruited in the survey including 52.8% (n=10,943) males and 47.2% (n=9,772) females with a mean age of 41 (13.1) years. Data on TB status was available for a total of 14452 participants. The prevalence of TB in Khyber Pakhtunkhwa was found to be 0.49% (n=72) including an almost equal number of males and females [48% (n=34) vs 51% (n=36)], respectively. The mean age of the patients with TB was 47.5 (11.6) years. A higher proportion of people with TB had cardiometabolic diseases compared to people without TB (45.9% vs. 30.9%). Amongst the cardiometabolic disorders, self-reported hypertension (OR: 1.81, 95% CI 1.08-3.02, p=0.02), Diabetes (OR: 3.99, 95% CI 1.95-8.18, p=<0.002), and angina (OR: 3.88 95% CI 1.20-12.49, p=0.02) were positively associated with the occurrence of TB. In the adjusted analysis, only self-reported Diabetes was positively associated with the occurrence of TB (OR: 3.33, 95% CI 1.61-6.88, p=0.001). Conclusion: There is a higher burden of self-reported cardiometabolic diseases among people with TB, suggesting that this high-risk group should be screened for cardiometabolic diseases, especially Diabetes.
ADMISSION AND READMISSION IN HEART FAILURE, PREDICTORS OF READMISSION, AN EXPERIENCE AT AYUB TEACHING HOSPITAL ABBOTTABAD
Authors: Awan Muhammad Saleem , Iqbal Muhammad Khaleel , Matiullah Khan  , Naveed Danish , Afsar Rukhshanda , Jalil Shaista
Published: November 2024

Background: Heart failure is a long-term health condition that is characterized by multiple re-admissions throughout the patient's life. The economic burden and the impairment of quality of life are too prominent in patients with heart failure. The aim of the study was to determine re-admission rate and predictors of re-admission in patients with heart failure at Ayub Teaching hospital Abbottabad. Methods: A data of 350 patients with heart failure who were admitted & readmitted to the coronary care unit with heart failure were included in this study. Data was collected to determine the common factors that may dictate their readmission to hospital. Results: Over all re-admission rate was 58.28 %(n=204) for the patients in our study cohort. Regarding readmission rates within a 90-days period, 41.7% (n=146) of the sample had no readmission events, 35.1% (n=123) had one readmission, and 23.1% (n=81) experienced two or more readmissions. In terms of comorbid conditions, 36.9% (n=129) of the patients had a diagnosis of diabetes mellitus, while 57.7% (n=202) had hypertension. There was a statistically significant association between readmission within 90 days following first hospitalization for heart failure and diabetes mellitus, Increased Heart Rate, Nephropathy and an increased Neutrophil: Lymphocyte ratio (p<0.05). Conclusion: Diabetes mellitus, elevated heart rate, the presence of nephropathy, and an increased neutrophil-lymphocyte ratio were found to be independent predictors of subsequent heart failure readmission. These risk factors could potentially serve as simple indicators for forecasting the likelihood of heart failure readmission following patient discharge.
FACTORS CONTRIBUTING TO ABSENTEEISM AMONG STUDENTS OF GOMAL MEDICAL COLLEGE
Authors: Adnan Khan  , Israr Ul Haq  , Danish Zafar  , Nargis Noman  , Saima Bashir  , Samia Iftikhar
Published: November 2024

Background: Absenteeism in educational settings is a significant barrier to academic success and skill development. This study investigates the socio-demographic factors contributing to absenteeism among students at Gomal Medical College MTI, Dera Ismail Khan, KPK, highlighting the importance of class attendance for fostering essential job-related skills and overall student development. Methods: Utilizing a cross-sectional study design, this research was conducted from April to September 2023 within the Community Medicine Department of Gomal Medical College. The study population included students from 1st to final year, using a non-probability convenience sampling method. According to Raosoft Sample size calculator for population of 566 total students with confidence interval of 95%, margin error 5% and response rate 50%, the sample size was determined to be 230. Results: Among the participants, 42.4% were female and 57.6% were male, with 76.4% residing in hostels. Key factors leading to absenteeism included the perception of being able to pass exams without attending lectures, disrupted sleep patterns, and the need to prepare for other exams. College-related factors such as non-interactive classes and a communication gap with teachers were also significant. Conclusion: Absenteeism is influenced by both student-centric and institutional factors, with a prevalent belief among students that physical attendance is not essential for academic achievement.
COMPARISON OF PLATELET RICH THERAPY ALONE WITH PLATELET RICH THERAPY ALONG WITH DAILY TOPICAL 5% PROCAPIL APPLICATION FOR THE TREATMENT OF ANDROGENETIC ALOPECIA: A QUASI-EXPERIMENTAL CLINICAL TRIAL
Authors: Khoso Hina , Muhammad Fahim
Published: November 2024

Background: Androgenetic alopecia (AGA) affects up to 50% of males and 40% of females by the age of 50. It is the result of progressive, patterned hair loss that occurs in genetically predisposed individuals having hypersensitive androgen receptors in hair follicles. Due to the variable efficacy and adverse effect profile of FDA-approved drugs, newer and alternative modalities need to be utilized. As no prior study evaluated the efficacy of Procapil in combination with platelet-rich plasma (PRP), this study aimed to fill the research gap. The objectives were to assess the effectiveness of topical Procapil 5% combined with PRP vs PRP alone in androgenetic alopecia. It was a clinical trial conducted at the Tehsil Headquarters Hospital Takhtbhai Mardan. Methods: One hundred and sixty patients with AGA were selected and divided into two groups,80 in each. Group A received 4 sessions of PRP alone, 4 weeks apart while Group B was treated with PRP in combination with topical 5%procapil solution applied twice a day. Final results are calculated at the end of 6 months using 7- 7-point patient' satisfaction and dermatologist evaluation scoring systems. Results: The mean age in Groups A and B was 29.34±5.3 &30.22±4.8 respectively. Disease duration was comparable between both groups. At the final Assessment Greater proportion of patients in group B achieved better scores on Dermatologist evaluation and Patient satisfaction scales (p-value<0.05). Conclusion: It has been established that combining PRP with 5% Procapil yields better results in treating AGA compared to PRP used alone.
COMPARISON OF NEGATIVE PRESSURE VACUUM THERAPY (NPWT) AND TIE OVER DRESSING IN HEALING SKIN GRAFTS
Authors: Farah Naz  , Rana Hassan Javaid  , Danish Almas  , Yousuf Bilal Yousuf , Sara Noor  , Aneeq Ahmed Awan
Published: November 2024

Background: Negative pressure wound therapy (NPWT) accelerates wound healing by inducing growth factors, evaporating fluid, removing microorganisms, and improving microcirculation.  Compared to it the traditional technique involves applying a dressing that is tied over and secured with nylon stitches commonly known as tie over dressing. Both the methods of graft fixing have their pros and cons therefore current study was designed to compare the efficacy of tie over dressing and NPWT methods for securing split thickness skin grafts and sheet grafts. Methods: A randomized control trial was conducted at tertiary care hospital of Karachi from July to December 2023. Participants who visited the department for grafting, fulfilled the inclusion criteria and given consent throughout the study duration were included in the study. The participants were selected by non-probability consecutive sampling technique and groups were allotted by sealed envelope method. Group 1 received tie over dressing and Group 2 received NPWT dressing. The wounds were evaluated after 5 days for tie over dressing and after 3 days for NPWT dressing. Results: The wound were assessed for outcome (healing and complications) after 14 days. The percentage of graft take identified as 11 (31.4%) participants of tie over dressing group and 28 (80%) participants of NPWT dressing material had more than 50% graft take however, remaining participants of both the group suffered the wound healing complications and delayed healing. The significant (p<0.05) differences were observed for graft loss, hematoma formation, and infection. However, 25 (71.4%) participants of Vac-NPWT faced no complication (p-value =0.001). No patient in either group had complete graft loss. Conclusion: NPWT dressing has superiority in preventing graft loss, hematoma formation, and infection over tie over dressing.
IMPACT OF ADJUVANT FAT GRAFTING ON IMPROVED UPTAKE AND HEALING OF SPLIT THICKNESS SKIN GRAFT AT TERTIARY CARE HOSPITAL
Authors: Anwar Saira , Faisal Akhlaq Ali khan  , Waqas Sami  , Maryam Noor  , Rabeeaa Farrukh  , Sindhu Khan
Published: November 2024

Background: Since the 1980s, autologous fat grafting has been one of the most widely used methods in plastic surgery to treat volume and contour problems. There are many advantages of autologous fat, i.e., it is cheap, biocompatible, and readily available autologous tissue in large quantities, minimal morbidity. Objective was to compare the outcomes of fat grafting combined with STSGs and STSGs alone in patients with chronic non-healing wounds presenting at a tertiary care hospital. Methods: It was a prospective cohort study carried out at the Department of plastic surgery, Civil hospital Karachi, Pakistan from 11th April to 12th October 2023. Patients aged 18-60 years with chronic non-healing wounds due to burn, trauma, or infection lasting at least six weeks were included. Group A received fat grafting followed by STSGs, while Group B received STSGs alone. Follow-up for both groups continued for 4-5 weeks, focusing on graft uptake and healing, with successful graft take defined as wound healing upon clinical examination. Data was analyzed by SPSS version 25. Results: Overall, the mean age of the patients was 36.47±8.57 years. In Group A, the median width was 8.00 cm, and in Group B, it was 7.00 cm, this difference was statistically significant (p=0.005). The proportion of healing in group A was significantly higher as compared to group B (66.7% vs 30%, (p=0.001). The odds of wound healing were 0.21 times lower in group B as compared to group A (95% CI=0.07 to 0.63). After adjusting for duration and width of wound, the odds of wound healing in group B remains significantly lower as compared to odds of wound healing in group A (OR=0.13, 95% CI=0.03 to 0.54). Conclusion: The combination of fat grafting with split-thickness skin grafts holds promising result for improved wound healing in patients with chronic non-healing wounds.
FREQUENCY OF COMPLETE HEART BLOCK IN PATIENTS PRESENTING WITH ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION
Authors: Muhammad Ali Khan  , Kinza Sammar  , Raisa Naz  , Shazia Tauqeer  , Maria Shafiq  , Shabana Naz
Published: November 2024

Background: Complete heart block (CHB) is a relatively common complication in post-acute myocardial infarction (AMI) patients. Data on the incidence and consequences of CHB in patients with ST-segment elevation myocardial infarction (STEMI) are limited. Besides serving as an indicator of widespread myocardial injury, the development of CHB in STEMI is also associated with a higher risk of sudden cardiac death. Although there has been an observed increase in the incidence of CHB complicating STEMI over the past few decades, attributed to improved reporting and timely diagnosis, the absolute or true incidence of CHB in STEMI patients receiving current management is underestimated. The present study aimed to determine the frequency of complete heart block in patients presenting with acute anterior wall myocardial infarction (AWMI). Methods: This was a descriptive study conducted in the Cardiology Department of Ayub Teaching Hospital, Abbottabad, from February to July 2020. All patients (N=244) presenting with acute Anterior Wall ST-segment elevation Myocardial Infarction were included, with ages ranging from 20 to 80 years and both genders (males and females) considered. Results: The mean age of the patients was 55.98±12.224, ranging from 20 to 80 years, out of a total of 244 patients. In terms of gender distribution, there were 160 (65.6%) males and 84 (34.4%) females. Regarding the frequency of smokers, 63 (25.8%) were smokers, and 181 (74.2%) were non-smokers. The frequency of complete heart block was 8 (3.3%), while 236 (96.7%) did not have acute anterior wall myocardial infarction-associated heart block. Conclusion: Patients admitted with inferior wall MI and right ventricular (RV) infarction were at an increased risk of mortality. The high incidence of heart block in AWMI suggests that underlying infarction and tissue damage may be extensive, leading to increased mortality secondary to complete cardiac failure.
PREVALENCE OF EXHUMATION IN DISTRICT HYDERABAD: A LOCAL EXPERIENCE
Authors: Shahla Imran  , Lubna Riaz  , Farah Waseem  , Sadia Abdul Qayyum  , Sono Mal  , Hanozia Shah
Published: November 2024

Background: Exhumation of bodies for forensic purposes serves as a pivotal tool in medico-legal investigations, yet there is scant data on the practice within the Pakistani context, particularly in the District of Hyderabad. Aim & Objective were to investigate the prevalence and outcomes of exhumations in Hyderabad, contributing to the knowledge base and understanding the cultural and legal factors influencing post-mortem examinations. Methods: A descriptive, observational, and retrospective analysis of 95 medicolegal exhumations carried out over two years, examining demographic data, the interval between death and exhumation, putrefactive changes, and the determination of the cause of death. Results: Of the 95 exhumations, 58 were male and 37 were female, with the majority of the deceased being under 40 years of age. Nearly half of the exhumations occurred within three months post-mortem, and advanced decomposition was a significant obstacle in determining the cause of death, which remained undetermined in 61.05% of cases. Conclusion: The study revealed a need for timely forensic interventions and highlighted the impact of decomposition on determining the cause of death. It underscores the necessity of advanced forensic methods to improve post-mortem examinations' outcomes. advance technics are virtual autopsy but we are using old conventional autopsy
A COMPARATIVE STUDY OF VICRYL RAPIDE SUTURE VERSUS CHROMIC CATGUT SUTURE FOR EPISIOTOMY REPAIR
Authors: Samreena Akhtar Chohan  , Saima Altaf  , Kausar Inayat  , Seemab Zafar  , Nosheena Shabbir  , Shehnaz Sheeba
Published: November 2024

Background: An episiotomy is a perineal incision performed to facilitate childbirth by enlarging the diameter of the vulvae outflow. Given the prevalence of long-term complications following episiotomy repair, this investigation employed vicryl rapide suture, a polyglactin analogue that induces reduced tissue reaction and is absorbed via hydrolysis (in contrast to chromic catgut suture). Produced from collagen, chromic catgut induces an inflammatory response within the tissues upon degradation by phagocytosis and proteolytic enzymes. There is disagreement regarding the superior suture material. This study was therefore designed to compare pain at 48 hours and analgesia requirement at 7th day in chromic catgut suture and vicryl rapide suture.  The purpose of this study was to determine pain at 48 hours and analgesia requirement at 7th day between vicryl rapide suture and chromic catgut suture. Methods:  This study was conducted at department of GYNAECOLOGY and OBSTETRICS at Shaikh Zayed Hospital Lahore. A total of 206 (103 in each group) females were enrolled in this study. Result: In this study the mean age of the cases in vicryl rapide group was 28.94 ± 3.50 and in chromic catgut group it was 29.05±3.43. A total of 103 (50%) female were enrolled in Group A and 103 (50%) were enrolled in Group B. In this study pain at 48 hours was found in 33 (32%) patients in vicryl rapide group and 52 (50.5%) in chromic catgut group p-value=0.007. Similarly, analgesia requirement at 7th day was found in 2 (1.9%) patients in vicryl rapide group and 26 (25.2%) patients in chromic catgut group with significant p-value <0.001. Conclusion:   This study concluded that vicryl rapide was the best suture material for episiotomy repair, resulting in decreased pain after 48 hours and lesser need for analgesia by the seventh day.
ENDOSCOPIC ENDONASAL TRANS-SPHENOIDAL SURGERY IN PATIENTS WITH MACRO-ADENOMA EXTENT OF SURGICAL RESECTION AND RECURRENCE RATE
Authors: Zia Ur Rahman  , Muhammad Idris Khan  , Muhammad Aamir
Published: November 2024

Background: EETA has been employed for skull base tumors especially macro-adenomas, for the last decade in our setup. Here we are sharing our experience with the EETA for patients with micro-adenomas in terms of extent of tumor resection and its recurrence. The objective was to assess endoscopic endonasal trans-sphenoidal surgery in patients with macro-adenoma for extent of surgical resection and recurrence rate. Methods: This descriptive case series study was carried out from May 2021 till April 2023. Male and female patients with macroadenoma were enrolled which was diagnosed with contrast enhanced volumetric MRI brain. EETA and resection was performed. Extent of resection recurrence was confirmed on post-op MRI and follow up at 6 months respectively. Results: A total of 58 patients were enrolled. Mean age of the patients was 47.51 ± 7.93 years and male to female ratio was 1.3: 1. 42 (72.4%) tumors were non-functional. Somatotropin releasing tumor was the most common functional tumor (n = 09, 15.5%). Total resection was performed in 49 (84.4%) patients. Recurrence was observed in 09 (15.6%) cases. Conclusion: EETA has been shown to be a safe and effective technique for the resection of macroadenoma of the skull base.
VITAMIN E SHIELDS AGAINST ALCOHOLIC TOXICITY BY SAFEGUARDING HEPATIC PARENCHYMAL MORPHOLOGY AND LOWERING BLOOD ALT LEVELS
Authors: Noman Ullah Wazir  , Shabir Hussain  , Farzana Salman  , Momina Haq  , Munaza Khattak  , Shamaila Wadud
Published: November 2024

Background: Alcohol consumption can have detrimental effects on the liver, as it plays a crucial role in processing and detoxifying substances in the body, including alcohol. Alcohol has the potential to hinder the liver's capacity, which results in a variety of metabolic imbalances and deficiencies. This research aimed to investigate alterations in the liver tissue due to alcohol administered orally, along with exploring the potential protective effects of vitamin E against these alterations. Methods: An assortment of male pet rabbits (totalling 18) was part of the study. The categorized groups included: Control group A, which received normal saline as a placebo treatment. Experimental group B, administered with an oral dose of a 30% ethanol solution mixed with normal saline. Experimental group C, given an oral dose of a combination containing a 30% ethanol solution, vitamin E, and normal saline. At the end of experiment, blood samples were obtained to assess ALT levels, and liver tissue sections were stained with Hematoxylin and Eosin for microscopic analysis of hepatocyte structure. Results: Highly significant differences between the blood ALT levels, hepatocyte count/size/nuclear count/size, sinusoids size in control and experimental groups were observed. Vitamin treated rabbits showed preserved morphology of hepatocytes as compared to non-vitamin treated rabbits during alcohol consumption by showing less ballooning of hepatocytes and shrinkage of nuclei which are the main initial signs of hepatocytes damage. Conclusion: Frequent alcohol intake leads to swift alterations in liver tissue and blood ALT levels over brief spans, yet these effects may be reduced through the antioxidative properties of vitamin E.
EXPLORING THE IMPACT OF RISK FACTORS, PREVENTIVE MEASURES, AND MANAGEMENT STRATEGIES ON SURGICAL SITE INFECTIONS IN GENERAL SURGERY: A COMPREHENSIVE ASSESSMENT
Authors: Hamid ur Rehman  , Atif Iqbal  , Ibrar Ahmad  , Hina Fayyaz  , Liaqat Ali  , Javed Iqbal  , Qazi Mohammad Hameed
Published: November 2024

Background: Surgical site infections (SSIs) pose significant challenges in healthcare, leading to prolonged hospital stays, increased morbidity, and economic burden. Understanding the interplay between risk factors, preventive measures, and management strategies is crucial for effective infection control in general surgery.  This study aimed to comprehensively assess the impact of various risk factors, preventive measures, and management strategies on surgical site infections in the context of general surgery. Methods: The study was conducted atJinnah International Hospital Abbottabad, involving a study population of 120 patients undergoing general surgical procedures from May 2023 to April 2024. A retrospective analysis of patient records was performed to identify risk factors associated with SSIs. Additionally, preventive measures implemented preoperatively, intraoperatively, and postoperatively were evaluated. Management strategies employed for treating SSIs were also reviewed.
Results: The analysis revealed several significant risk factors contributing to the development of SSIs, including comorbidities, prolonged surgical duration, and inadequate preoperative preparation. Preoperative measures such as appropriate patient screening and optimization, intraoperative techniques like strict aseptic protocols, and postoperative interventions such as timely wound care significantly influenced SSI rates. Furthermore, effective management strategies such as early detection, antimicrobial therapy, and surgical debridement played pivotal roles in controlling SSIs and reducing associated complications. Conclusion: Our findings underscore the importance of a multifaceted approach involving identification of risk factors, implementation of preventive measures, and prompt management strategies to mitigate the incidence and impact of surgical site infections in general surgery. Comprehensive infection control protocols tailored to individual patient needs are essential for optimizing surgical outcomes and enhancing patient safety.
COMPARISON OF DENTIN HYPERSENSITIVITY MANAGEMENT OF EXPOSED ROOT SURFACES BY DENTIN BONDING AGENT AND THINLY APPLIED GLASS IONOMER CEMENT: A CLINICAL TRIAL
Authors: Akbar Iftikhar , Huma Kamal  , Ashfaq Azim
Published: November 2024

Background: Dentin hypersensitivity is a common clinical problem all over the world and it is called the common cold of dentistry. This study aimed to compare the efficacy of glass ionomer cement and dentin bonding agent in management of dentin hypersensitivity in patients presenting to X Dental College. Methods: This Quasi-experimental study was conducted on patients presented to the Department of Operative dentistry and Endodontics from February to August 2022. A total of 60 patients in the age range of 18-70 were selected based on convenience sampling. The patients were divided into 2 groups. Group A received glass ionomer cement and Group B received dentin bonding. The sensitivity was evaluated before treatment using visual analogue scale and documented as baseline reading by using tactile and evaporative stimuli, then immediately after treatment and after 1 and 6 week using visual analogue scale by using tactile & evaporative stimuli.
MANAGEMENT OF EROSIVE ORAL LICHEN PLANUS ASSOCIATED WITH CHRONIC HEPATITIS C
Authors: Medini Taissir , Besbes Amira , Nasri Wafa , Ben Abdeljelil Nouha L , Selmi Jamil
Published: November 2024

Hepatic disorders are generally silent, with slow progress, and are usually detected when the organ's function is severely affected. Several studies have shown that oral lichen planus (OLP) is one of the most Hepatitis C-associated diseases. The emergence of such an extrahepatic manifestation is frequent and can lead to an early diagnosis. Patients with chronic hepatitis C virus (HCV) infection exhibit extensive forms of OLP, with frequent periods of exacerbation of symptoms refractory to treatment, which is commensurate with the severity of the liver disease. When treating OLP in HCV patients, researchers have diverged results. This case report presents an extensive, erosive OLP in an HCV-positive female patient for whom clinical management was tremendous. Full remission was obtained after topical corticosteroid application and several sessions of oral cavity sanitation. This clinical case demonstrates that dentists play a major role in OLP diagnosing, managing, and malignant transformation preventing. They may also contribute to the screening of hepatitis C infection.
FLOCCULAR SYNDROME- AN ATYPICAL PRESENTATION OF PARANEOPLASTIC CEREBELLAR DEGENERATION
Authors: Saba Zaidi  , Haneea Yasir  , Ayesha Jaka
Published: November 2024

The flocculus, a small and distinct region of the cerebellum, plays a crucial role in coordinating eye movements, especially in stabilizing visual images on the retina during head movements. Damage or lesions in the flocculus can lead to a specific neurological syndrome called floccular syndrome. This syndrome is characterized by abnormalities in the vestibulo-ocular reflex (VOR), which helps coordinate eye movements with head movements to maintain clear vision. Progressive ataxia, particularly affecting the flocculus, combined with vestibulo-ocular reflex abnormalities, strongly suggests the presence of paraneoplastic cerebellar degeneration. In our case study, we described the clinical presentation of a middle-aged woman who experienced gradually worsening dizziness and ocular issues. Due to the subacute onset of cerebellar symptoms and normal neuroimaging evidence of cerebellar atrophy, we initiated a paraneoplastic workup, revealing positive anti-Yo antibodies. This prompted consideration of the diagnosis of PCD with floccular syndrome. The patient underwent steroid therapy, resulting in partial symptom improvement. Despite thorough investigations for hidden malignancies, no occult tumour was found. Our case report aims to underscore the rare and distinct features of PCD, as observed in this particular patient.
SEROLOGICAL OUTCOMES OF TREATMENT WITH 3D-CRT AND IMRT IN LOCALIZED PROSTATE CANCER
Authors: Hanif Shoaib , Osmani Asif Husain , Malick Jawaid , Malick Jawaid
Published: November 2024

Background: Prostate cancer ranks the second most frequent cancer encountered worldwide in men. Radiotherapy has been effectively used to treat localized prostate cancer. Over the years more effective radiation techniques like 3D-Conformal Radiation Therapy (3D-CRT), Proton Therapy, Intensity Modulated Radiation Therapy (IMRT), and Brachytherapy has been evolved and effectively used to deliver radiation therapy. Herein, we compare serological outcomes of two radiation treatment techniques intensity modulated radiation therapy (IMRT) and 3- dimensional conformal radiation therapy (3DCRT) in localized prostate adenocarcinoma. Methods: It is a cohort study conducted at Department of Oncology, Dr Ziauddin Hospital, Karachi. Patients with localized prostate adenocarcinoma meeting the inclusion criteria were recruited from July 2016 to June 2022, underwent treatment with a total dose >74 Gy using two different advanced radiotherapy techniques, i.e., IMRT and 3D-CRT. Serum PSA levels were assessed prior to treatment, and 6 weeks and 12 months after treatment. Paired t-Test was applied to identify the difference in PSA levels before, and after the treatment. p-value less than 0.05 was taken as significant at 95% confidence interval. Results: A total of 78 patients with 39 in each group. The mean age of patients in 3D-CRT group was 68±10 years while in IMRT group was 68±07 years. Six weeks after initiation of treatment, we observed that both the treatment methods, i.e., 3D-CRT and IMRT reduced the PSA levels significantly p-value = 0.001 respectively. There was no significant difference in the mean of PSA levels on 06th week and 12th months. Furthermore, the analysis of PSA levels at 12th months when compared with the baseline PSA levels came highly significant in both the groups as depicted in paired-t teat analysis of PSA levels with acceptable toxicity. Conclusion: Radiation therapy modalities 3D-CRT and IMRT both showed a significant serological response with minimal or acceptable gastrointestinal and genitourinary toxicities in the 3D-CRT group in comparison to the IMRT group. Although the sample size is relatively smaller, but the results of this study are encouraging to treat those patients on 3D-CRT, who cannot afford more expansive radiotherapy treatment technique like IMRT.