Pakistan Journal of Medical & Health Sciences

Artificial Intelligence In Clinical Settings: Improving the practice of medicine and surgery

Fri, 19 Apr 2024 00:00:00 +0000

A lot of people use the term medical technology refer to a wide range of resources that can help doctors give patients and society an improved standard of life by finding problems earlier, preventing complications, simplifying treatments, making them more effective, and cutting down on the length of hospital stays.¹In the past, medical technologies were mostly standard medical devices like implants, prosthetics and stents². But cell phones, wearable tech, detection devices, and technology for communication have wholly transformed medical by letting clinicians carry around minimal tools driven by artificial intelligence (AI), such as apps. AI has changed the way medical technology works, and most people think of it as the part of the computer science field that can solve hard problems and find many uses in areas with lots of data but only a little theory³.

Clinical Evaluation of Impact of Acrylic Partial Dentures on the periodontal conditions of abutments

Fri, 19 Apr 2024 00:00:00 +0000

Aim: To evaluate the impact of wearing removable partial dentures on the periodontal health of abutments and find outtheage and gender association.

Study design: Descriptive case series.

Place and duration: Prosthodontic department of Lahore Medical and Dental College Lahore, from15^th January till 15^thJuly 2023.

Methodology: A total of 70 patients of both genders participated in the study. Removable dentures were delivered to the patients and they were recalled after one month of denture insertion to evaluate the abutment health, gingival recession was checked in terms of its presence or absence, plaque and gingival health index assessment were done using Loe and Silness index. Tooth mobility was checked by using Millar’s classification. Mean and SD was computed for quantitative data. Age and gender correlation was assessed using Pearson Chi -square test. Significant level was set to p<0.05.

Results: A total 41.4%males and 58.6% females were selected. A total of 68.6% maxillary partial dentures whereas 31.4% mandibular partial dentures were inserted. Gingival health index showed maximum patients with good health 57.1%. Dental plaque index of maximum patients 77.1% fell under zero score. Tooth mobility score of zero was frequently found in abutments 78.6%. Gingival recession around the abutments after one month of denture insertion was found in 15.7%whereas 84.3% abutments remained healthy. Association of Gingival index, plaque index, tooth mobility and gingival recession with gender did not show statistical significance however with respect to age significant results were obtained. Tooth mobility had no association with age.

Conclusion: Removable partial dentures use does not disturb the periodontal health of abutments if well fabricated dentures are provided and good oral hygiene maintenance protocolsare followed. Patients’ education regarding denture use along with regular recall visits are of utmost importance.

Keywords: Abutment, Acrylic dentures, dental plaque, Removable partial dentures, Periodontal health, periodontal diseases.

Distribution and Frequency of ABO and Rhesus blood groups among donors at Chughtai Institute of Pathology, Lahore

Fri, 19 Apr 2024 00:00:00 +0000

Aim: To assess the demographic background of blood donors in a referral institution located in Lahore, as well as the distribution of blood groups among those who donate blood. Additionally, the study will investigate the distribution of blood groups among those who donate blood.

Study design: A cross-sectional study

Place of Study: Chughtai Institute of Pathology, Lahore

Study duration: March to June 2023

Results: Among the participants, blood group O was most common 202(49.26%), followed by A 110(27.1%), B 82(20%) and AB 15(3.65%). Blood group O was most common. Blood group O was the least common among participants. The least common blood group was AB, with 3.65% of male participants and 1.7% of female participants. A statistical analysis found no significant difference between gender and blood type (χ2 = 2.9932, P value =0.912). All blood groups except AB had Rh-negative antigens. A comparison of blood types found no changes in RH (χ2 = 2.112, P value = 0.698).

Conclusion: For the functioning of a national health service, it is crucial to possess current information on the prevalence of blood types in various local settings. Currently, there is a lack of information on this important subject. Our research provides detailed information on the blood type and demographic characteristics of donors. Additional research and mobilisation are needed nationwide to adhere to the World Health Organization's suggestions regarding voluntary blood donation.

Keywords: Rhesus factor, ABO, blood donation, and transfusion medicine

Effectiveness of Abdominal Activation on Motor Control in Diplegic Cerebral Palsy: A Randomized Control Trial

Fri, 19 Apr 2024 00:00:00 +0000

Background: Cerebral palsy (CP) is a disorder of the nervous system manifested in movement, posture, muscle tone, and functional activity. Poor postural control is the most common problem related to CP. Neuro-developmental techniques, or facilitation techniques, were used to activate muscles and improve trunk control.

Aim: To determine the influence of the effects of abdominal activation for correcting posture in spastic diaplegic CP children.

Methods: A quantitative, randomized clinical trial was conducted, allocating 26 CP patients randomly into two groups: the control group and the treatment group. Baseline treatment was given to the control group, which included lower-limb passive stretching exercises and interrupted direct current. However, baseline treatment with neuro-developmental techniques was given to the treatment group. The measuring tool used for assessment of postural correction and stability was the trunk control measurement scale.

Results: The study recruited 26 CP patients, of who 10 belonged to the age groups 8–10 years and 11–13 years, respectively, while 6 children were from the age group 14–15 years. An independent sample t-test was used for between-group analysis, and the results showed a significant improvement in the TCMS score post-treatment, as the p-value was 0.012, while within-group analysis was done by applying a paired sample t-test. There was a significant improvement in the treatment group (p-value 0.000) where NTD was applied, compared to the control group (p-value 0.096), where only baseline treatment was given.

Implication: Neurodevelopmental approaches can improve trunk control in children with cerebral palsy, enhancing mobility, independence, posture, and functional skills. This reduces the risk of musculoskeletal issues and facilitates activity participation. Conclusion: The study showed significant improvement in postural control with the use of Neuro-developmental techniques in CP children. Children with cerebral palsy (CP) can benefit from improved trunk control using neurodevelopmental approaches, which can increase their mobility, independence, posture, ability to participate in activities, and functional skills.

Keywords: Cerebral palsy (CP), Neuro-developmental techniques (NDT), Interrupted direct current (IDC).

Blood Transfusion cross match on the basis of Phenotype & Rh Antigen in Donors and Receivers and Analysis of Variations

Fri, 19 Apr 2024 00:00:00 +0000

Background: In brief, knowing the local Rh blood group system frequency helps develop a donor pool for patients who need numerous transfusions and alloantibody-compatible antigen negative blood. Patients have been matched for component blood transfusions using ABO and Rh phenotypes since 2020. Our detection of all blood transfusion-needy patients began.

Aim: Our department began To detect C, E, c, and e Rh-specific antigens in multi-transfused patients in 2020.

Methods: For the aim of this investigation, 2300 patient samples were obtained from patients who required clinical blood transfusions at our hospital between March 2020 and October 2022. These samples were gathered for the purpose of this investigation. One patient was counted as a single sample even though they required repeated blood transfusions. 1900blood donor samples were provided by the Blood Centre of (duplicated samples were removed based on the identification numbers that were provided by the Blood Centre once they were identified).

Results: The study obtained 4200 samples, including 1900donor and 2300patient samples. The allele frequency distribution of blood group antigens in the studied population was compared with the prevalence observed in the present study. The D antigen exhibited a frequency of 99.34% in the studied population, slightly lower than the prevalence observed in the present study at 98.9% (95% CI: 98.5 - 99.0). Conversely, the C antigen was found in 93.1% of the studied population, with a slightly higher prevalence observed in the present study at 99.1% (95% CI: 92.0 - 99.2).

Implication: The study suggests serological testing is a cost-effective method for blood transfusion management, identifying Rh phenotypes. Compiling a database of donor Rh genotypes simplifies transfusion selection, reducing unfavorable responses. Pre-transfusion Rh phenotype examination is crucial for matching patient blood type with donor blood, reducing adverse reactions, and improving patient safety.

Conclusion: In transfusion applications, serological testing are cost-effective for Rh phenotype identification but not genotypes. Creating a database of blood donors' Rh phenotypes and evaluating each patient before their initial transfusion should lessen adverse reactions and speed up antigen-negative blood availability, saving more patients.

Keywords: Blood transfusion, phenotype, Rh antigen, donors, receivers, analysis of variations

Effect of Smoking on Survival in patients with Squamous Cell Carcinoma of Oral Cavity

Fri, 19 Apr 2024 00:00:00 +0000

Background: Oral squamous cell carcinoma (OSCC) is a growing disease affecting older men and those without risk factors. It's also increasing in younger individuals. Understanding the disease's evolving patterns and risk factors is crucial for effective management. Tobacco is the primary cause, contributing to 95% of OSCC. New prevention and treatment approaches are possible with genetic markers and environmental triggers.

Study Design: A cross-sectional study

Place of Study: Chughtai Institute of Pathology, Lahore

Study Duration: January 2022 to May 2023

Methodology: A study involving 46 patients with oral squamous cell carcinoma (OSCC) found that tobacco use significantly impacts the long-term prognoses and treatment. The patients underwent extensive surgery and received personalized adjuvant treatment. The study aimed to evaluate the impact of multimodal therapy on patient survival and quality of life.

Result: The patient also exhibited the table's traits. Most patients were male. The tongue was the most affected with 26 instances (65%), whereas the buccal mucosa had 10 cases (25%) Floor of mouth (10%). It is highly probable that the mouth was involved. 24% of patients had PT1, 35% had pT2, 11% had pT3, etc. 56% of patients had pathogenic nodal stage pN0, 15% had pN1, 27% had pN2, and 2% had pN3. The median depth of invasion was 10 millimetres, with the smallest margin being six.

Conclusion: The research also categorized patients based on age and tobacco consumption, revealing that smokers experience distinct psychological and functional effects. The findings could help tailor OSCC treatment to tobacco-consuming countries like Pakistan.

Keywords: Squamous cell carcinoma, survival, Oral cancer, tobacco

A Randomized Controlled Trial Comparing Injection Polidocanol, with Injection 50% D/W in Rectal Prolapse

Fri, 19 Apr 2024 00:00:00 +0000

Background: Rectal prolapse manifests as the protrusion of the rectal mucosa through the anal opening. There can be partial or full thickness prolapse. It usually occurs before 4 years of age. Rectal prolapse in childhood tends to affect both males and females equally.

Aim: To compare Inj. Polidocanol with Inj 50% D/W in rectal prolapsed in this randomized controlled trial.

Methods: The study was conducted in the pediatric surgical ward of Mayo Hospital & King Edward Medical University Lahore, after receiving approval from the Hospital's Ethical Committee. There were 60 patients rectal prolapse with 30 patients in each group. Polidocanol was used in group A while 50%dextrose water was used in group B. The procedure was performed under general anesthesia. In the postoperative period children were observed for early complications like fever, anaphylaxis, diarrhea, hemorrhage, pain while defecating, mucosal edema and constipation. Results were analyzed with SPSS.

Results: Out of 60, 36 were male while 24 were female. Group A included 16 male and 14 females whereas group B had 20 males and 10 female children. Mean age was 5.35years with SD of 2.7 and ranging from youngest child of 8 months till eldest of 12 years. In group A mean age was 5.44 while mean age of group B was 5.26 years. All 30 patients in group A were relieved of their symptoms after single session of Polidocanol so giving 100% of success rate while 28 patients (93.33%) in group B were relieved of their symptoms while 2(6.66%) patients developed recurrence with no significant difference. The complications observed in the study were post-operative constipation in 3(10%) patients in group A, however no patient developed postoperative stricture, infection or adverse drug reaction. In group B no patient developed any post-operative complication.

Practical Implication: This comparative study helps us to find more effective and better drug available as a sclerosing agent to treat rectal prolapse in pediatric population. It’s also cost effective and with fewer side effects and easily available.

Conclusion: In conclusion, injection sclerotherapy using polidocanol emerges as an equally successful procedure for managing RP in children. This medication demonstrates enhanced efficacy, safety, and accessibility. The process is not only less time-consuming but also entails minimal complications.

Keywords: Rectal Prolapse Manifests, Protrusion, Mucosa, Chronic Constipation, Hirschsprung’s Disease,

Suitability of Hemophagocytic Syndrome who had a graft rejection for repeat transplantation

Fri, 19 Apr 2024 00:00:00 +0000

Background: Hematopoietic stem cell transplantation (HSCT) is a crucial treatment for hemophagocytic lymphohistiocytosis, with reduced-intensity conditioning transplantation (RIC) being a superior strategy.

Aim: Engraftment failure is a significant challenge, necessitating additional HSCT so a case study involved ten patients who experienced engraftment failure and hemophagocytic syndrome after initial HSCT.

Place & duration of study: Chughtai Institute of Pathology, Lahore from March 2018 and January2023

Results: The study found that all five subjects who underwent a second allo-HSCT achieved rapid hematopoietic restoration, with ANC levels above 0.5 108 /L for granulocytes and 20 108 /L for platelets. After transplantation, three individuals experienced acute graft-versus-host disease (aGVHD) of varying severity, with a 60% prevalence and a median onset time of 26 days. Two patients managed their conditions with methylprednisolone, while two patients underwent treatment with second-line anti-GVHD medicine.

Implication: A study reveals that second allogeneic hematopoietic stem cell transplantation (allo-HSCT) can restore hematopoietic tissue in failed engraftment patients, particularly those with acute Graft-Versus-Host Disease (aGVHD).

Conclusion: A trial evaluating allogeneic hematopoietic stem cell transplantation (allo-HSCT) for engraftment failure in liver and heart failure patients showed a 80% success rate. Further studies are needed to predict success factors for a second allo-HSCT treatment, but the consensus is strong for its potential in treating hemophagocytic disorders.

Keywords Implantation failure, hematopoietic stem cell transplantation, Second allogeneic, Hemophagocytic syndrome

Translation and Validation of Leicester Cough Questionnaire for Cystic Fibrosis Patients

Fri, 19 Apr 2024 00:00:00 +0000

Aim: To translate and validate Leicester cough questionnaire in Urdu language for patients with Cystic fibrosis.

Methods: It is a cross-cultural linguistic study. 150 participants were included in the study and Non probability convenient sampling was used. Inclusion criteria includes parents of children with CF, who understand Urdu, and have symptoms of chronic cough. Children with severe respiratory exacerbations were excluded. Data was entered using SPSS version 25 and same software was used for data analysis.

Results: It took 6 months to achieve an Urdu version of LCQ, which proved to be satisfactorily acceptable when administered to 150 subjects. The questionnaire showed acceptable internal consistency (Cronbach’s alpha =0.916), test-retest reliability by Pearson correlation ranged from 0.203 to 0.99 and intraclass correlation coefficient value 0.2 to 0.9 showed high reliability.

Conclusion: Leicester Cough Questionnaire is a valid and reliable tool for assessing the impact of cough on quality of life in patients with Cystic fibrosis.

Keywords: Cystic fibrosis, Cough, Health related quality of life, Leicester cough questionnaire.

Comparative Analysis of Topical Insulin Dressing Vs Normal Saline Dressing in Diabetic Foot Ulcers Wound Healing

Lyba Ghayour, Faiza Irem, Baseerullah, Adnan Riaz, Abrar Ashraf Ali — Fri, 19 Apr 2024 00:00:00 +0000

Background: Foot ulcers, a dangerous and common consequence of diabetes, currently have no particular therapeutic options. There are many topical medicines and ointments available for wound management.It has been observed that topical insulin dressings effectiveness is better than other dressings.

Aim: To determine the effectiveness of Topical Insulin dressing VS Normal saline dressing in diabetic ulcer in terms of rate of reduction in ulcer area in days and need for re debridement

Methods: A randomized control trial conducted in Emergency and Outdoor Department of South Surgical ward, Mayo Hospital, Lahore.Study was carried out insix months from Sept 2022 to March 2023. A total 86 patients fulfilling the selection criteria presented to outdoor/Emergency of South surgical department of general surgery of Mayo Hospital, Lahore falling in Wagner’s classification I and IIwere enrolled in the study after taking informed consent. Patients were divided by method of random allocation (lottery method) to Group A (Topical insulin dressing) and Group B (Normal saline soaked dressing) after explaining the procedure. Rate of reduction in ulcer area was measured in days. Need of re-debridement was labeled as ‘yes’ if patient needed re-debridement or ‘no’ if patient did not need re-debridement.

Results: Baseline mean wound area in Group A and in Group B was 34.87±29.23 cm² and 27.45±24.00cm². After 2 weeks the wound area reduced to 9.35±10.75 cm² and 7.33±9.29 cm²respectively. Mean days for rate of reduction in ulcer areas was significantly less in Group A patients than in Group B patients (p-value<0.001). Rate of re-debridement for Group B patients was significantly higher than patients in Group A (Group A: 18.6% vs Group B: 46.5%, p-value= 0.006). Improved wound healing will reduce need of redebridement and minor to major foot amputations.

Conclusion: This study concludes that topical insulin dressing is more effective as that of normal saline soaked dressing for management of diabetic ulcer in terms of rate of reduction in ulcer area in term of days and need for re debridement.

Keywords: Effectiveness, Normal saline Dressing, Topical Insulin dressing, Diabetic foot ulcer, Ulcer area, Re-debridement.

Safety of Dapagliflozinin Reducing Cardiac Events and Deaths among NYHA Class II and III Cardiac Failure Patients.

Shabana Mohammad Ali — Fri, 19 Apr 2024 00:00:00 +0000

Background: In last few decades, a global transition in incidence of heart failure with reduced ejection fraction from hypertension and valvular heart disease to coronary artery disease has taken place.

Aim: To assess the safety of Dapagliflozin in reducing the cardiac events and deaths among class II and class III heart failure patients. Study design: Randomized controlled trial.

Methodology: Cardiac patients (n=480) who belonged from class II and III with mild to moderate reduced ejection fraction were added in this study. This study was held at Cardiology Department at Mayo Hospital. All patients received sodium–glucose co-transporter-2 (SGLT2) inhibitors at a dose of 10mg once daily or matching placebo, in addition to usual therapy for eight weeks. SPSS-v25 analyzed the entered data. Mean ± SD presented age, blood pressure and eGFR level. Chi square test was used to compare the gender, NYHA class, primary composite outcome, and cardiovascular death.

Results: Dapagliflozin showed lower rates of the primary composite outcome (15.8% vs. 23.3%, p = 0.038). There was no statistically significant difference in cardiovascular death between both groups (5.8% vs. 8.8%, p = 0.219).

Practical Implication: Due to lack of research culture in our setups, common health issue like chronic heart failure remained clandestine. Present study highlighted the role of oral dapagliflozin in reducing worse cardiovascular events and deaths among NHY class II and III heart failure patients.

Conclusion: It was concluded that dapagliflozin showed significant reductions in various cardiovascular events and deaths compared to placebo thus highlighting its potential as a beneficial intervention in our population.

Keywords: Heart Failure, Reduced Ejection Fraction, NYHA Classification, Urgent Visits and Cardiac deaths.

Effectiveness of Dapagliflozin in Reducing Incidence of Worsening Heart Failure Events among patients with Reduced Ejection Fraction

Mohammad Asif, Talha Laique — Fri, 19 Apr 2024 00:00:00 +0000

Background: Sodium–glucose co-transporter 2 (SGLT2) inhibitors are the groups of oral hypoglycemics that decreases the worse events among cardiac patients of chronic heart failure.

Aim: To assess the effectiveness of Dapagliflozin in reducing the incidence of worsening heart failure events among chronic heart failure patients.

Study design: Randomized controlled trial.

Methodology: This study enrolled 480 cardiac patients with mildly reduced ejection fraction. This study was held at Punjab Institute of Cardiology. All patients received dapagliflozin 10mg once daily or matching placebo, in addition to usual therapy for four weeks. The data was entered and analyzed in SPSS 25. Independent sample t-test was used to compare the mean age and body mass index between two groups. Chi square test was used to compare gender and hypertension with primary composite.

Results: There were 138(57.5%) males in Dapagliflozin group and 131(54.6%) males in placebo group. Dapagliflozin demonstrated significant benefits compared to placebo, as evidenced by lower rates of the primary composite outcome (15.8% vs. 23.3%, p = 0.038), hospitalization for heart failure or an urgent visit (10.4% vs. 20.0%, p = 0.003).

Practical Implication: Chronic heart failure with mildly reduced ejection fraction is a major problem in modern era. Present study will highlight the effect of oral hypoglycemic, dapagliflozin, in reducing worse cardiovascular events among chronic heart failure patients. As there is a lack of local literature review on this health issue so this study added information to existing literature and add new dimensions in its treatment.

Conclusion: It was concluded that dapagliflozin reduced worsening of cardiac events among heart failure patients with mildly reduced ejection fraction thus this drug is effective treatment option among cardiac failure patients in reducing hospitalization.

Keywords: Heart Failure, Reduced Ejection Fraction, Effectiveness, Urgent Visits and Hospitalization.

Prescription Pattern in patients with Acute Tonsillitis, attending Outpatient Department

Fri, 19 Apr 2024 00:00:00 +0000

Background: Acute tonsillitis is a major health problem among children and adults which is badly effects the quality of life.

Aim: To determine the antimicrobial prescription pattern in patients with acute tonsillitis, attending ENT OPD of Kulsumbai Valika, Social Security, Post Graduate Teaching Hospital Karachi..

Methodology: This cross-sectional study was conducted among the patients attending the outpatient of ENT, with acute tonsillitis. Study was conducted in Outpatient of ENT department of Kulsumbai Valika Social Security S.I.T.E. Hospital, Karachi. from 1^st January 2023 to 31^st December 2023. Data collection was done from the prescription of each patient. Statistical analysis was carried out using SPSS version 23.

Results: A total of 210 acute tonsillitis patients, with 116(55.23%) were male. Mean number of the drugs in prescription 4±1.4. All the prescriptions included antimicrobials, 185(88%), and NSAIDs. Amoxicillin / Clavulanic acid (24.8%) and Ceftriaxone (12.2%) were the most commonly prescribed antimicrobials. Parenteral route was preferred in 113(53.8%). None of the patients was offered culture or sensitivity test of the microorganisms.

Practical implication: Acute tonsillitis patients admitted and started parenteral antibiotic along with anti-inflammatory drugs.

Conclusion: Antimicrobials thosewere prescribed in almost all cases of acute tonsilitis, and most frequently prescribed were Amoxicillin / Clavulanic acid and Cefixime. Injectable antibiotics were also prescribed very frequently. Most of the patients were given just one antibiotic. This study findings highlighted the gaps the rational practices in drug prescribing for acute tonsilitis.

Keywords: Acute tonsillitis, Amoxicillin,antimicrobials, Clavulanic acid, Cefixime, prescription.

Trends in Maternal Mortality in a Tertiary Care Hospital of Khyber Pakhtunkhwa

Maimoona Qadir — Fri, 19 Apr 2024 00:00:00 +0000

Background: Maternal mortality is an extremely devastating event for family, surviving children, hospital staff and community.

Aim: To analyse the rate, demography, causes and timing of maternal deaths in a tertiary care hospital of Mardan.

Methodology: This retrospective study was conducted in Gynaecology Department, Mardan Medical Complex, Mardan from January 2016 to December 2020. All patients received in the study period were included and counted and causative factors of maternal deaths were recorded. A predesigned proforma was used for collection of data from the medical records. SPSS 23.0 was employed for data analysis.

Results: MMR of 657.7/100,000 live births was recorded. Most of the deaths (50%) were in 21-30 years age group, followed by 31-40 years age group (26%).34(39%) patients were multigravidas,27(31%) were primigravidas and 26(30%) were grand multigravidas.72(82.7%) were booked and 15(17%) were unbooked cases. Haemmorhage was responsible for 39(45%) maternal deaths, Hypertensive disorders ±HELLP caused 21(24%), Sepsis and thromboembolism caused 7(8%) each, cardiac diseases 5(5.7%), anesthesia complicated 3(3.4%), Anaphylaxis and hepatic encephalopathy lead to 2(2.2%) each, and epilepsy caused 1 maternal death. Most (44%) maternal deaths occurred in 6-12 hours of admission.

Conclusion: The common causes of maternal mortality are haemmorhage, hypertensive disorders, sepsis and thromboembolism. Improvement of the maternity units in tertiary care facilitiesis need of the day and awareness of the general population is strongly favored to reduce or prevent maternal mortalities.

Keywords: Maternal Mortality, Eclampsia, Postpartum Haemmorhage, Hypertension, Thromboembolism, Sepsis.

Comparison of Task-Oriented and Bobath-Based Trunk Training on Balance, Functional abilities and Walking in Ischemic Stroke Patients

Fri, 19 Apr 2024 00:00:00 +0000

Aim: To determine the outcome of task oriented and bobath based trunk training on balance in ischemic stroke patients

Study design: Randomized controlled trial

Place and duration: Physical Therapy department, Younas health care Hospital Shahdara

Methodology: Sixty-six patients rewarding the inclusion and exclusion criteria were assigned in two groups, Group 1 and Group 2. Group 1 was given conventional treatment + Task oriented trunk and Group 2 was given receive Convention treatment + Bobath based trunk training. Participants in both groups were joined in a 12-week physiotherapy session that seen three days a weekly for one sixty minute respectively day. They stayed examined at starting point and after the 12-week mark. Berg Balance Scale and Trunk impairment scale were used as outcome measures.

Results: The adjustment score of BBS was 8.93 (6.32-11.54) that helps in investigational set (P<0.001). Furthermore, variation score of the Trunk Impairment Scale between the groups was 3.34 (1.48-4.91). It also helps the Task-oriented group with (P<0.001). However, task-oriented approach is more effective.

Conclusion: Exercises performed with task-oriented approach are more effective to improve balance and functions of the patients with ischemic stroke as associated to patients who were treated with Bobath approach. Besides, better improvement has been found on purposeful balance suggesting the surplus effects with task-oriented exercise.

Keywords: Stroke, Bobath, Task-oriented, Balance

Acetabular Fracture; its Management and Early Functional Outcome

Thu, 09 May 2024 00:00:00 +0000

Aim: To evaluate the functional results of open reduction and rigid internal fixation with Reconstruction plates and screws in acetabular fractures

Methods: This prospective case series study was carried out on 47 consecutive patients, of either gender and age ranging from 18 to 60 years, who presented with an acetabular fracture within a month of injury at the Orthopedic and Trauma Department of the Medical Teaching Institute Lady Reading Hospital (LRH) in Peshawar, Pakistan, from January 2018 to September 2023. Excluded from the research were patients receiving traction therapy with a trochanteric pin for an open fracture. A non-probabilistic sequential sampling method was applied. Clinical grading followed D'aubigne and Postel's guidelines, with Matta's modifications. We measured range of motion, pain, and gait.

Results: There were 47 patients in total, ages ranging from 20 to 60, with an average age of 37.52. there were 31 males (66.0%) and 16 females (33%). In 19(40.4%) patients, 5(10.6%) patients have physical violence and 23(48.9%) of the patients, the cause of injury was a road traffic collision. Our study shows that of the patients, 29(61.7%) were involved on the right side and 18(38.3%) on the left. In five (10.6%) of the instances, there was plate loosing. It is shown that 24(51.1%) cases, excellent outcomes were attained, in 15(31.9%) case good, 5(10.6%) cases fair, 3(6.4%) cases poor outcome were attained.

Conclusion: According to Matta Grading, all acetabular fractures, including those involving osteoporotic bone, respond excellently to rather well to open reduction and internal fixation using a 3.5-millimeter reconstruction plate and screws.

Keywords: Acetabulam, Fracture, Internal fixation, Open Reduction, Rigid Fixation.

Comparison of patient Satisfaction of Return to Work in Early Post-operative Periods in patients with High Radial Nerve Injury undergoing Primary Nerve Repair Plus Tendon Transfer Versus Primary Nerve Repair Alone

Thu, 09 May 2024 00:00:00 +0000

Background: High radial nerve injuries present complex challenges in upper extremity reconstruction, impacting both motor and sensory functions. The decision-making process for choosing the appropriate surgical intervention involves careful consideration of various factors, including the type of nerve repair and the potential need for adjunct procedures like tendon transfer.

Aim: To compare patient satisfaction outcomes between these two surgical approaches, assessing grip strength, pinch strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and Quality of Life (QOL) scores.

Methodology: This prospective, comparative, and observational study included 62 participants, equally divided into two groups: Group 1 undergoing Primary Nerve Repair plus Tendon Transfer (n=31) and Group 2 undergoing Primary Nerve Repair Alone (n=31). Data collection involved patient interviews, medical records review, and standardized questionnaires, covering variables such as age, gender, occupation, type of surgery, duration of injury, post-operative pain levels, and patient-reported satisfaction scores. Statistical analysis using SPSS vr 23.0 included descriptive statistics, independent samples t-tests, and chi-square tests.

Results: Results indicated significant improvements in grip strength (Mean ± SD: 35.2 ± 4.2 pounds, p < 0.001), pinch strength (Mean ± SD: 7.9 ± 1.4 pounds, p = 1.081), DASH scores (Mean ± SD: 11.5 ± 2.9, p = 2.59), and QOL scores (Mean ± SD: 93.8 ± 7.3, p = 0.73) in both groups, emphasizing the positive impact of surgical interventions on functional outcomes and patient satisfaction. These findings contribute valuable insights into refining surgical strategies for high radial nerve injuries, emphasizing the enhancement of patient outcomes and satisfaction.

Practical implication:The study's findings offer crucial guidance for surgeons in selecting optimal surgical strategies, ultimately leading to improved functional outcomes and higher patient satisfaction in individuals with high radial nerve injuries.

Conclusion: Both surgical approaches demonstrated significant improvements in grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) scores, and Quality of Life (QOL) scores. Notably, grip strength showed a substantial increase (Mean ± SD: 35.2 ± 4.2 pounds, p < 0.001) in both groups, emphasizing the positive impact of surgical interventions on upper limb function. While pinch strength and QOL scores showed non-significant changes, the overall findings underscore the effectiveness of both surgical strategies in enhancing functional outcomes and patient satisfaction in the early post-operative periods for high radial nerve injuries.

Keywords: High radial nerve injury, nerve repair, tendon transfer, patient satisfaction, early return to work, observational study.

Antimicrobial Susceptibility Patterns of Salmonella Typhi and Salmonella Paratyphi in Tertiary Care Hospitals

Thu, 09 May 2024 00:00:00 +0000

Background: Salmonella typhi and Salmonella paratyphi are significant causes of enteric fever, posing substantial public health challenges globally. Monitoring their antimicrobial susceptibility patterns is crucial for guiding treatment strategies and combating antimicrobial resistance, particularly in tertiary care hospitals where severe cases are managed.

Aim: To determine the antibiogram profile of Salmonella typhi and Salmonella paratyphi isolated from blood cultures of paediatrics patients presenting in Lady Reading Hospital Peshawar.

Methodology: The study examined the prevalence, clinical characteristics, and antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi infections among 530 participants aged 13 to 18 years presenting in Lady Reading Hospital Peshawar. Over the course of two years using a prospective observational cohort design. Recruitment, clinical evaluations, and laboratory validation using accepted methods were all part of the data gathering process. Testing for antibiotic susceptibility was done, and statistical analysis was done using SPSS version 28. Both informed consent and ethical approval were obtained.

Results: The research included 530 instances of enteric fever, of which 318 cases (or 60%) were due to Salmonella typhi and 212 cases (or 40%) to Salmonella Paratyphi. There were 40.25% female cases and 59.75% male cases among them. The age group of 15–16 years old accounted for the largest percentage of cases (38.68%), followed by 13–14 years old (33.02%) and 17–18 years old (28.30%). Different patterns emerged from antimicrobial susceptibility tests; drugs such as ampicillin (66.04%), azithromycin (74.26%), cefixime (87.47%), ceftriaxone (92.77%), chloramphenicol (91.51%), ciprofloxacin (92.40%), and co-trimoxazole (55.03%) showed substantial susceptibility rates. Compared to Salmonella typhi, Salmonella paratyphi showed notably greater sensitivity rates for azithromycin (94.47%) and ceftriaxone (95.45%).

Practical implication: This research provided the community with important advantages and practical consequences. The study helps healthcare professionals choose efficient treatment plans by identifying the antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi, particularly in tertiary care facilities.

Conclusion: This study highlights the importance of continuous surveillance and species-specific treatment strategies to combat antimicrobial resistance and improve patient outcomes in enteric fever, particularly in tertiary care settings.

Keywords:Antimicrobial susceptibility, Salmonella typhi, Salmonella Paratyphi, Tertiary care hospitals

Association of Different Risk Factors with Iron Deficiency Anemia in Children

Novera Khalid, Afsheen Batool Raza, Aimen Javed — Thu, 09 May 2024 00:00:00 +0000

Iron Deficiency Anemia (IDA) arises from an imbalance in the body's iron production and demand, making it a prevalent form of anemia in children. While its causes are varied, many contributing factors to IDA are adjustable. If identified and addressed promptly, these factors can be modified to improve both immediate and extended health effects in children. ¹³It is an established fact that iron is an important component for growth of body and our nervous system. IDA in children may permanently disturb their sensory and cognitive ability. It is therefore important to determine its risk factors to ensure early screening and prevention among children.

Aim and Objective: To determine correlation of different risk factors with Iron deficiency Anemia.

Material and Methods: This case-control study, comprising 150 participants in each group, was carried out in the Pediatric department of Jinnah Hospital Lahore over a nine-month period, spanning from May 1, 2022, to January 31, 2023. Inclusion criteria involved children aged between 6 months and 12 years. Non-Probability consecutive sampling was employed to collect data, with informed consent obtained from parents/guardians. A pre-designed proforma was utilized for data collection. Statistical analysis using SPSS v.22 involved calculating mean and standard deviation for quantitative data, and presenting frequency and percentages for categorical data. Risk assessment and association were determined using odds ratio and chi-square tests, with a p-value below 5% considered significant.

Results: The mean age of cases and controls was 8.47 ± 3.91 years and 8.41 ± 4.08 years respectively with 55% males. The mean Hb in cases was 8.84 ± 1.13 g/dL and in controls was 11.77 ± 3.28 g/dL. There were 71(47.3%) mothers in cases and 26(17.3%) in controls groups who were illiterate (p-value < 0.0001 & OR = 4.286), 80(53.3%) cases and 45(30%) controls that had family size > 5 (p-value < 0.0001 & OR = 2.667), and 67(44.7%) cases and 29(19.3%) controls had a history of cow milk usage ( p-value < 0.0001 & OR = 3.368). Significant association was found of the IDA with each risk factor in each strata (p-value <0.05) but there was no significant association between IDA and cow milk in females ( p-value > 0.05).

Conclusion: There is significant association of IDA with illiteracy of mothers, family size > 5 and usage of cow milk. IDA can be minimized by improving these conditions in order to minimize further morbidities related to IDA.

Keywords: Iron deficiency anemia, Cow milk, Illiteracy, Family size.

Magnetic Resonance Imaging Validates the Clinical Accuracy of the Mcmurray's Test in Diagnosing Medial Meniscal Tears

Thu, 09 May 2024 00:00:00 +0000

Background: A physical examination method to find medial meniscal tears is the McMurray's test. The purpose of this research was to evaluate how effectively the McMurray's test can identify medial meniscal tears in a clinical situation that have been verified by MRI. However, arthroscopic evaluation is now replacing the traditional methods.

Aim: To determine diagnostic accuracy of McMurray's test is in diagnosing Medial Meniscal knee injuries.

Methods: This prospective case series study was conducted in the department of Orthopedic MTI Lady Reading Hospital Peshawar on 100 consecutive patients who received an MRI for suspected medial meniscal tears between August 2022 and July 2023. Each patient underwent the McMurray's test, and the findings were compared to those of the MRI scans. Positive and negative predictive values, as well as the sensitivity and specificity of the McMurray test, were calculated. The McMurray test was performed on all patients to check for meniscal tears, and arthroscopy was then performed on the affected knees to evaluate the accuracy of the test.

Results: Overall, one hundred patients took part in the study. There were 65 males and 35 females among the patients. There was a wide range of ages represented in the group, from 18 to 75. A total of 45 out of the 100 cases were young adults. The mean age was 31.46, while the standard deviation was 9.12 years. Participants of all ages were involved in the study. Forty-seven patients (47%) were in the 18-30 age range, 25(25%) were in the 31-45 age range, 19(19%) were in the 46-60 age range, and 9(9%) were in the 61-75 age range. In 100 patients MRI and McMurray tests can diagnose medial meniscal abnormalities. According to the study, the sensitivity of McMurray's test is 62.9%, the specificity is 81.6%, the positive predictive value is 84.8%, and the negative predictive value is 57.4%.

Practical Implication: McMurray's Test is a good alternative to MRI for diagnosis of medial meniscus in areas where the facility of imaging is not available.

Conclusion: The McMurray's test is a good clinical method for detecting medial meniscal tears that has been verified by magnetic resonance imaging (MRI).

Keywords: McMurray test, meniscal tears, Magnetic Resonance Imaging, arthroscopy, accuracy.

Navigating the Twisted Path of Delusional Disorder: A Patient Case Study

Ans Waseem, Mirrat Gul Butt — Thu, 09 May 2024 00:00:00 +0000

Background: Delusional disorder of the jealous type is a rare psychiatric condition characterized by persistent and unfounded beliefs that impair functionality and compromise relationships. This case study explores the presentation, management, and potential treatment outcomes for a patient experiencing an acute episode of Delusional Disorder.

Aim: To assess the effectiveness of Cognitive behavioural Therapy in modifying delusional beliefs.

Method: Cognitive behavioural therapy using psychoeducation, activity scheduling, trigger management, evidence gathering, reality testing, behavioural experiments, reasoning skills, 3C's, and verbal challenges.

Results: The findings suggest that CBT techniques may be beneficial in managing Delusional Disorder, particularly the jealous type. This is evidenced by the significant improvement observed in the patient.

Implications: Unawareness of Delusional Disorder can lead to misinterpretations as domestic disputes, delaying crucial interventions. Early diagnosis and treatment can help control symptoms and potentially prevent dangerous actions by the patient.

Conclusion: The patient's significant improvement suggests that CBT may be a valuable tool for addressing delusional beliefs and associated disruptions. This finding highlights the need for further research to explore the broader applicability of CBT in treating various presentations of Delusional Disorder.

Keywords: Delusional disorder, cognitive behavioural therapy, jealous paranoia.