JAIMC: Journal of Allama Iqbal Medical College

RARE PRESENTATION OF OMENTAL CYST IN INGUINAL HERNIA: A CASE REPORT

Wed, 14 Aug 2024 00:00:00 -0600

A 6-month old female patient presented to OPD of the children's hospital and institute of child health Lahore with complaint of swelling in left labia majora. On Examination, a non-tender, reducible and fluctuant swelling was present therefore a diagnosis of left inguinal hernia was made. During surgery, a blackish colored cyst was identified in the hernia sac which was extending into abdomen. Laparotomy showed a large omental cyst originating from greater omentum which was completely excised followed by uneventful recovery

THE HEALTH IMPLICATIONS OF USING HAIR DYES

Hamid Arshad, Kaleem Ullah Ranjha, Ibtesam Allahi — Wed, 14 Aug 2024 00:00:00 -0600

The global rise in hair dye usage for cosmetic purposes, including gray hair coverage, is prevalent among all genders. Hair dyes are classified as permanent, semi-permanent, and temporary, differing in penetration and frequency. Concerns about safety persist, as many use hair dye without understanding potential health risks. Ahmadi et al.'s meta-analysis indicated a 10% higher cancer risk associated with hair dye, with greater risk for dark dyes and prolonged use. Takkouche et al. found increased hematological malignancy risk, while Gera et al. noted an 18.8% rise in breast cancer risk. Carcinogenic compounds like nitrosamines and PPD in oxidative dyes raise concerns, highlighting the need for safer alternatives and responsible manufacturing.

A MORPHOMETRIC STUDY ON ANATOMICAL VARIATIONS OF TRANSVERSE FORAMINA IN DRIED TYPICAL CERVICAL VERTEBRAE C3-C6

Sobia Ibrahim, Aliya Zahid, Tahira Athar — Wed, 14 Aug 2024 00:00:00 -0600

Abstract: Foramen Transversarium is a cardinal feature of cervical vertebrae. It transmits vertebral artery along with other contents. Variations in size and shape of foramen transversaria are associated with development or course of vertebral artery. Its compartmentalization can cause compression on the vascular structure causing vertebrobasilar insufficiency. Present study is to observe such variations of size and shape in typical cervical vertebrae to provide data to neurosurgeons and radiologists.

Methods: 170 intact typical cervical vertebrae of unknown sex and age were taken after approval of Ethical Review Board. They were observed for any accessory foramina, shape and size of foramen transversaria bilaterally and transverse and AP diameters of foramen transversarium were taken & recorded with digital vernier caliper. Statistical analysis was applied.

Results: Foramen tranversaria of majority were rounded in shape with 8-10% with incomplete/notched appearance. AP diameters of two sides reported a statistically significant difference. About 10% have accessory foramina and 5 are bilateral.

Conclusion: Vertebral artery injury is uncommon but may be a disastrous complication during cervical spinal surgery. Therefore, proper preoperative investigations and planning is essential for the surgeons.

DIAGNOSTIC ACCURACY OF CYTOCHEMISTRY TAKING FLOW CYTOMETERY AS GOLD STANDARD IN DIAGNOSING ACUTE LEUKEMIA

Rabia Ahmad, Hira Arshad, Ayesha Khalid, Masuma Ghazanfar, Ahmad Saleem — Wed, 14 Aug 2024 00:00:00 -0600

Background & Objective: Acute leukemia are malignant neoplastic diseases that arise when the hematopoietic stemcells have malignant transformation into undifferentiated cells permanently. Flow cytometry is the gold standard to diagnose acute leukemia but it is available at few laboratories among private and public setups in Punjab and that too is very costly. Cytochemistry is an alternative and relatively cheap option which is available at most of the setups. So this study was planned with an aim to evaluate the diagnostic accuracy of cytochemistry using Sudan black B and Periodic Acid Schiff. stains, for acute leukemia diagnosis in a resource-constrained laboratories.
Methods: After meeting the inclusion criteria and taking appropriate ethical review board approval ,80 patient were enrolled in this cross sectional analytical study. Detailed history and physical examination with complete blood cells count and numerous hematological indices were obtained by using semi- automated analyzer; SYSMEX KX-21. Slides were made by using peripheral blood / bone marrow smears, fixed by methanol and stained for different cytochemical stains. Leukemia cell analysis was done by using the conventional immunofluorescence method by using the monoclonal antibodies directed against cMPO, CD2, CD5 , CD7 , CD 10 , CD11 c , CD 14 , CD 19 ,CD 20, CD33 , CD 34 , CD 45 , CD 64 , CD 79a, HLA-DR
, KAPPA, LAMBDA and TdT. The results of flow cytometry and cytochemistry were noted in a pre-designed proforma and results were entered in SPSS for analysis.
Results: The mean age of patients included in the study was calculated to be 39.40±14.76 years, and male to female ratio was 1.3:1. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of cytochemistry using SBB stain for diagnosis of acute leukemia was 91.94%, 100%, 100%, 78.26% & 93.75% respectively taking Flow cytometry as gold standard. Similarly, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of cytochemistry using PAS stain for diagnosis of acute leukemia was 100%, 91.94%, 78.26%, 100% & 93.75% respectively taking flow cytometry as gold standard
Conclusion: According to this study, the cytochemistry using both SBB and PAF stains showed good accuracy for acute leukemia. Therefore, it may substitute Flow ctometry in many cases, in restricted resource settings.

PATTERN OF SELF-MEDICATION AMONG MBBS STUDENTS OF SHEIKH ZAYED MEDICAL COLLEGE, RAHIM YAR KHAN

Wed, 14 Aug 2024 00:00:00 -0600

Background & Objective: Self-medication among medical students, particularly MBBS students, is a global concern due to its potential impact on future healthcare practices. The aim of this study was to evaluate the patterns of self-medication among MBBS students.
Methods: A cross-sectional study at Sheikh Zayed Medical College, Rahim Yar Khan, investigated the pattern of self-medication among MBBS students. All MBBS students participated in the data collection period, which ran from August 15 to September 15, 2023. A WhatsApp group was used to deliver an online questionnaire, which was completed by 130 individuals who met the inclusion criteria. The survey examined demographics, self-medication habits, motivations and sources of medicine. Statistical analysis was performed using SPSS version 25.
Results: Of the 130 participants, a considerable proportion 67 (51%) admitted to self-medicate for more than 2 symptoms with convenience cited as the main reason by the participants (46.15%). Headaches were the most frequently self-medicated condition (51.54%), while skin wounds had the lowest percentage of self- medication (10%). Moreover, a significant percentage of individuals (36.15%) reported modifying their pres- cription dose.
Conclusion: The high rate of self-medication among MBBS students highlights the importance of targeted measures to encourage future healthcare workers to use medications responsibly and to prioritize patient safety.

AWARENESS AND PRACTICES OF ANTENATAL CARE AMONG PREGNANT FEMALES IN A TERTIARY CARE HOSPITAL OF LAHORE

Wed, 14 Aug 2024 00:00:00 -0600

Background and Objective: Worldwide maternal mortality ratio(MMR) is 216/100,000, in south Asian countries is 182/100,000 and in Pakistan MMR is 178/100,000. The risk of maternal mortality is 200 times more in developing or low income countries than developed or high income countries. The objectives of the study were to determine the awareness and practice levels regarding antenatal care(ANC) among pregnant females visiting Arif memorial teaching hospital, Lahore.
Methods: It was a cross sectional study done among 350 pregnant women from 1st March, 2022 to 31st August 2022, with singleton pregnancy presented at a tertiary care center using purposive sampling technique. The predesigned questionnaire was used to collect information regarding socio-demographic factors as well as knowledge and practice questions regarding ANC. Scoring was designed with >70% designated as adequate knowledge or practice levels. Information was entered and results were obtained using SPSS 24.0.
Results: Among total 350 respondents, mean age was 28.54±5.26 years. The mean knowledge and practice scores were 27.56±6.11 and 12.33±3.14 and there were 110 (31.4%) and 50 (14.3%) women having adequate knowledge and practice respectively. Respondent's literacy was significantly associated with knowledge (p=0.015) and working women had better practices than house wives (p<0.001).
Conclusion: Knowledge and practices regarding ANC were considerably low falling in inadequate area. To improve community awareness on ANC community campaign and mass media should be used. Family support and government support both should be provided in parallel to pregnant female in order to improve maternal health.

OUTCOME OF PRIMARY FIXATION OF TRAUMATIC ACETABULAR FRACTURES PRESENTING TO PRIVATE SECTOR HOSPITALS

Muhammad Bilal, Muhammad Adeel Abbas, Muhammad Shakeel Basit, Asifa Karamat — Wed, 14 Aug 2024 00:00:00 -0600

Background and Objective: Traumatic acetabular fracture is a rare injury with high mortality, morbidity and long recovery period. Incidence of acetabular fracture is 3 per 100000(0.003%) population. Surgical management of acetabular fracture is a technical challenge needing high level of skills and vigilance because of the complex anatomy and risk to surrounding structures. We aim to look at two surgical techniques for fixation of acetabular fracture and their outcome in this study.
Methods: Between April 2018 and March 2023, we performed a retrospective analysis of rare acetabular fractures at the department of Orthopedic Kazi hospital Lahore and Doctor's hospital and Medical Centre Lahore. Record of total of 26 patients (15 males and 11 females) who were treated for acetabular fracture fixation were analyzed. Among these 10 were treated with minimal invasive technique i.e. Close reduction and per-cutaneous fixation as good reduction was achieved under image guidance and 16 patients had open reduction and internal fixation (ORIF) with use of various recon plates, screws and wires.
Results: Record of all the patients who were followed up for 12 months was retrieved. Among all patients, the clinical outcomes were recorded as excellent in 17 patients (65%), good in 5 (19%), fair in 2 (7.7%), and poor in 2 (7.7%), according to the modified Merle d'Aubigné-Postel score. The average modified Merle d'Aubigné- Postel score was 15 ± 2.0 points (range, 10–18 points). The radiological healing was assessed according to the Matta score [22] and were reported excellent in 15 patients (15/26, 57.6%), good in 7 (7/26, 26.8%), fair in 1 (1/26, 3.8%), and poor in 3 (3/26, 11.5%).
Conclusion: Our study shows comparable clinical outcome for acetabular fracture fixation using either ORIF or CRPF technique. Right patient choice and good knowledge of anatomy is of paramount importance.

FREQUENCY AND ANTIMICROBIAL SUSCEPTIBILITY OF KLEBSIELLA SPECIES ISOLATED FROM URINE CULTURES AT A TERTIARY HEALTHCARE FACILITY OF LAHORE

Tariq Mahmud Tariq, Samia, Mariam, Asma , Sana — Wed, 14 Aug 2024 00:00:00 -0600

Background and Objective: Klebsiella is found ubiquitously in nature and is a potential pathogen to infect different anatomic sites including urinary tract. Due to high resistance to antimicrobials it is considered as one of the most challenging pathogens. The study aimed to determine the frequency and antimicrobial sensitivity of Klebsiella species isolated from urine.
Methods: The data of urine cultures conducted during 1st Sep 2021 to 31st Aug 2022 was collected through Electronic Medical Record system. Uropathogens were recognized based on culture characteristics and biochemical tests with API-20E (bioMérieux) profile. Antibiotic susceptibility and extended spectrum beta- lactamase (ESBL) detection was performed by disc/combined disc diffusion using Kirby Bauer method.
Results: Of 2438 urine samples submitted for culture during the study period, 746 (30.6%) showed significant growth of a known uropathogen. The frequency of Klebsiella was 14.75% which was second most common uropathogen after E. coli (57.37%). Other isolates reported were Enterococcus (12.87%), Candida (8.71%), Pseudomonas (2.68%), Staphylococcus (1.48%), Proteus (1.07%) and Citrobacter species (1.07%). The isolates showed high sensitivity to imipenem (87.3%) followed by meropenem (85.5%), amikacin (84.6%) and fosfomycin (81.5%). A reduced sensitivity was observed against gentamicin (68.2%), piperacillin-tazobactam (61.8%), nitrofurantoin (58.2%) and cefotaxime (50%), but the least sensitivity was seen for ciprofloxacin (40.9%), cotrimoxazole (36.4%), cefuroxime (20%) and ampicillin (10%). Of all isolates 37 (33.6%) were ESBL producers.
Conclusion: Carbapenems, amikacin and possibly fosfomycin are the most efficient drugs for treating UTI due to Klebsiella species in our hospital setting. An on-going surveillance for ESBL producers as well as carbapenemase-producing Klebsiella pneumoniae (KPC) is needed