Journal of University Medical & Dental College

2023-09-04T20:13:56+00:00

Significance of shadowing and its contribution to the development of competent healthcare providers.

2023-08-31T10:57:42+00:00

Advancing Urological Surgery: Exploring the Potential of Single-Port Robotic Applications

2023-08-31T11:01:28+00:00

Whole exome sequencing reveals a missense mutation in the ADA gene causing severe combined immune deficiency in a Pakistani family ADA gene mutation causing SCID

2023-08-31T11:02:32+00:00

BACKGROUND & OBJECTIVE: Human adenosine deaminase deficiency, OMIM 102700 (ADA deficiency) is a genetic disorder which causes severe combined immunodeficiency (SCID). The enzyme adenosine deaminase is a housekeeping in nature and is involved in purine catabolism by catalyzing irreversible deamination of adenosine and deoxyadenosine. The SCID patients’ immune system is unable to fight off most of the bacterial and fungal infections due to profound lymphopenia (T^-B^-NK⁺). About 20% of the SCID patients are genetically homozygous for defective ADA gene. In our study we aimed to find out genetic variant in ADA gene in a family carrying severe combined immune deficiency. Objective in the current study is to unravel and characterize the molecular cause of the patient suffering from by birth SCID.

METHODOLOGY: In the present study we enrolled a 6-month-old female SCID patient belonging to highly consanguineous Pakistani family. Patient clinical features included repeated chest infection with failure to thrive, fever and chronic diarrhea. Whole blood samples from patient, parents and healthy siblings were acquired in EDTA tubes. DNA was extracted from all the blood samples.

RESULTS: Flowcytometry revealed lymphopenia (T^-B^-NK⁺) type of SCID. Whole Exome Sequencing (WES) identified a one nucleotide change (c.716G>A) in ADA gene exon 8. The segregation of the identified variant in the family was confirmed through Sanger Sequencing.

CONCLUSION: In this study, we presented detailed clinical and genetic description of patient suffering from severe combined immune deficiency. The immunological and genetic findings presented in this study will facilitate early diagnosis of the disease. Segregation of the identified variant in the family members will also aid in genetic counseling the family.

Effect of focal muscle vibration on flexibility and perceived stiffness in patients with mechanical low back pain

2023-09-01T03:27:49+00:00

BACKGROUND & OBJECTIVE: Low back pain is a major disabling pathology worldwide. A focal muscle vibrator can be a treatment option for reducing pain in such patients. The objective of this study was to determine the effects of focal muscle vibration on flexibility, perceived stiffness and pain intensity in patients with mechanical low back pain.

METHODOLOGY: A randomized clinical trial was conducted at Railway General Hospital Rawalpindi. Reviewing the limited number of studies done using focal muscle vibrator for low back pain, 44 participants were randomly divided into two groups. The experimental group received a focal muscle vibrator and physical therapy treatment, while the control group received conventional physical therapy treatment. Sessions were planned thrice a week for a total of four weeks. Baseline data was recorded at the start, with a final recording at the end of the fourth week for pain, muscle soreness and flexibility.

RESULTS: A total of 44 patients with mechanical low back pain aged between 25 to 45 years were recruited. Both groups showed improvement in pain, muscle soreness and flexibility, but there was a significant improvement in pain and flexibility in the experimental group (p≤0.05). There was no significant difference noted in muscle soreness in between group analysis (p≥ 0.05).

CONCLUSION: Focal Muscle Vibrator (myovolt 120 Hz frequency) along with Physiotherapy protocol is effective in improving pain and flexibility of mechanical low back pain patients, but muscle soreness showed less significant improvement in both groups, while between the groups analysis showed no significant statistical difference.

Comparison of two different techniques used for thyroidectomies; Conventional thyroidectomy vs. LigaSure

2023-09-01T06:29:59+00:00

BACKGROUND & OBJECTIVES: Certain interventions have been carried out to reduce blood loss during thyroidectomy to a great extent. The study aims to compare the efficacy of LigaSure thyroidectomy with conventional thyroidectomy.

METHODOLOGY: A quasi experimental study was conducted at Aziz Fatimah Hospital, Faisalabad, and 58 patients were divided into two groups. Group A underwent conventional thyroidectomy and Group B LigaSure thyroidectomy. Preoperative and postoperative variables were recorded and analyzed in SPSS 21. An Independent t-test was used to compare the mean difference between the two groups. A p-value less than 0.05 was considered statistically significant.

RESULTS: A total of 58 patients were enrolled in the study and divided into two groups. The mean age of patients in group A undergoing conventional thyroidectomy was (43.1±9.23) and in group B was (41.23±9.23) with p-value=0.4419 (non significant result was found among the age groups) . Mean operative time calculated for LigaSure-assisted hemithyroidectomy (28.57±3.45) minutes , subtotal thyroidectomy (43.33±2.86) minutes, and total thyroidectomy (73.15±9) minutes were significantly lower than those undergoing conventional thyroidectomies 40.12±6.5 minutes , 66.25±6.29 minutes , 87.35±7.02 minutes respectively. The mean difference in mean operative time and number of sutures used in both techniques were statistically significant p 0.05.

CONCLUSION: Less mean operative time and suture ligations have increased the surgeon's compliance toward the device. These devices are now the first choice for physicians and surgeons for thyroidectomies not only in Pakistan but also across the globe.

Comparison of safety and effectiveness between phacoemulsification and suture less small incision procedures in Cataract surgery

2023-09-18T06:10:32+00:00

BACKGROUND & OBJECTIVE: Cataract is major cause of preventable blindness, worldwide. Phacoemulsification and manual small incision are most common surgical methods of cataract. The objective of our study was to compare surgical outcomes and complications in phacoemulsification (Phaco) and manual small incision cataract surgery (MSICS) patients

METHODOLOGY: A Prospective Observational study was conducted at Ophthalmology department of POF Hospital Wah Cantt, Pakistan. Study duration was 6 months (January 2020-June 2020). We calculated sample size of 30 cataract patients. Selection of cataract patients in OPD was done through non probability consecutive sampling technique. Afterwards, they were divided randomly into two different groups using lottery method; Group A patients cataract extraction was done with Phacoemulsification while in group B patients cataract extraction was done with small incision cataract surgery. Patients were followed for 5 weeks. Fisher-exact test and independent and paired T-test was applied to get statistically significant results. P value ≤0.05 was considered significant.

RESULTS: Total 30 patients were included in study. There were 19(64.5%) male and 11(35.5%) female. Mean age of patients was 48.3±7.5SD. There was a significant change in pre and post operative visual acuity in both groups (Group A p=0.000 and Group B p=0.000). MSICS showed high surgery duration as compared to phacoemulsification (29.6±1.5 vs 22.2±2.1, p=0.000).

CONCLUSION: Phacoemulsification and Manual small incision cataract surgery are safe and clinically effective surgical techniques that did not show any difference in surgical outcomes. However, Phacoemulsification is associated with less post-operative complications as compared to MSICS.

Comparison of titanium elastic nailing and spica casting outcomes in preschool children following femoral diaphyseal fractures

2023-09-01T06:34:03+00:00

BACKGROUND & OBJECTIVE: Pediatric femoral diaphyseal fractures are common fractures in preschool children. The titanium elastic nailing technique is becoming prevalent in developed and developing countries. To compare the frequency of efficacy, safety and mean surgical fixation outcomes among patients who underwent titanium elastic nailing versus spica casting in diaphyseal femur fractures

METHODOLOGY: A prospective study was conducted at department of orthopedics, Pakistan Ordinance Factory (POF) hospital. The study duration was 2 years (March 2018-March 2020). A sample size of 42 children was calculated using WHO calculator. Children selection was made on the basis of non-probability (consecutive) sampling. Group TEN underwent titanium elastic nailing, while group SPICA underwent hip spica casting. Patients were followed for six months. We used SPSS version 24 for the analysis of data. Fisher exacts and independent T-test were applied for measuring associations and comparisons of two groups. P-value ≤0.05 was considered significant.

RESULTS: Total of 42 patients were included in the study. The mean age of patients was 3.4 years±1.4SD. The TEN group showed satisfactory results in malalignment (p=0.000) and complications (p=0.000). SPICA group showed significantly high assisted weight bearing duration (p=0.000), full weight bearing duration (p=0.000), greater operative time (p=0.000), lower range of motion (p=0.000) and less patient satisfaction (p=0.000) as compared to TEN group.

CONCLUSION: Titanium elastic nailing is safe, effective, and allows faster recovery in pediatric patients with diaphyseal femoral fractures. We recommend titanium elastic nailing as a valid treatment option for femur fractures in preschool children.

Viral load in interferon treated & untreated patients of HCV

2023-09-01T06:38:36+00:00

BACKGROUND & OBJECTIVE: Hepatitis C (HC) is a chronic viral disease that chronically infects liver cells. It has got at least 6 genotypes. The virus uses cellular machinery to multiply and increase in number. Viral load is the copies of HC virus ribonucleic acid (RNA) that can be quantitatively measured on polymerase chain reaction (PCR) test. There are many treatment options available for the treatment of HCV, including standard interferon, pegylated interferon with oral anti-viral drugs. In our research, we studied the levels of viral load in Hepatitis C (HC) positive patients who were treated with interferon and those HC-positive patients who were untreated and observe the effect of interferon treatment on viral load. To measure and compare the viral load in treated and untreated patients of the Hepatitis C virus.

METHODOLOGY: After obtaining written consent, a total of 54 HC patients, both male and female, were included in our study that were further divided into two groups Group-I included 26 freshly diagnosed patients of HC and Group II of 28. All the patients were from the Hazara division in Khyber Pakhtunkhwa (KPK), Pakistan. Quantitative PCR was performed to assess the viral load. Data obtained were analyzed using IBM SPSS version 23 and was also compared within groups.

RESULTS: There was a significant difference (p≤0.001) found in the viral load of interferon-treated and untreated patients of hepatitis C, but there was no significant difference found when compared among gender-different districts of the Hazara region.

CONCLUSION: Significantly higher viral load in untreated patients of HCV when compared to interferon-treated patients of HCV suggest that interferon is still effective against HCV.

Ketamine as a pre-emptive analgesia in patients undergoing caesarean delivery under spinal anesthesia

2023-09-01T06:39:53+00:00

BACKGROUND & OBJECTIVES: Lower segment caesarean section (LSCS) leads to moderate to severe pain in the patient. Pain severity is directly proportional to the functional limitations and depression in the postpartum period, making it essential to provide good pain relief after surgery. Maternal wellbeing and better nursing care of newborn requires good postoperative analgesia with minimal side effects. The main objective of the study was to evaluate the analgesic effect of intravenous low-dose ketamine, when administered pre-emptively, in patients undergoing caesarean delivery under spinal anesthesia.

METHODOLOGY: Two groups were made, each with 50 full-term pregnant females with a plan of caesarean section under spinal anesthesia. Group-A received spinal anesthesia with bupivacaine 0.5% along with intravenous placebo of 2cc normal saline, whereas group-B received 0.5mg/kg ketamine intravenously after administration of spinal anesthesia but before the start of surgical incision. Pain intensity was monitored using a visual rating pain scale (VRS), till the need for the first analgesic dose postoperatively.

RESULTS: Both groups were comparable in terms of age and weight. Analgesia was markedly prolonged, and postoperative pain scores were significantly less in Group-B (ketamine group) as compared to Group-A; with p-value< 0.001, demonstrating analgesic properties of ketamine when administered pre-emptively as an intravenous dose.

CONCLUSION: Our study concluded that pre-emptive analgesic dose of ketamine (administered before surgical incision), leads to prolong analgesia in post-operative period in patients who underwent LSCS under spinal anesthesia.

Clinical outcome of femoral diaphyseal fractures in adults treated with open verses closed interlocking nail

2023-09-01T06:41:03+00:00

BACKGROUND & OBJECTIVE: There are different methods for treatment of the long bone fractures, including femoral diaphyseal fractures, ranging from closed intramedullary nail, open intramedullary nail to flexible nail, plating, and external fixator in open type 3 B and 3C fractures. The aim of this study was to compare the functional outcome of open versus closed techniques in treating femoral diaphyseal fractures in skeletally mature adults.

METHODOLOGY: A simple observational study was conducted at the Department of Orthopedics, Allied Hospital Faisalabad, from January 2018 to January 2020 with a total of 60 skeletally mature patients with mean age 38.4+1.2 who fulfilled the inclusion criteria were operated, and five patients lost in follow-up. Group A consisted of 27 patients (18 males and 9 females) who were operated with closed interlocking technique. Group B consisted of 28 patients (12 males and 16 females) who were operated with open technique. Both groups were followed prospectively for two years to evaluate the outcome. T-test was used for statistical analysis.

RESULTS: The rate of union in group A was better than in group B. Patients in group A had a reunion 1.99±0.86 weeks earlier than group B a significant difference between the two groups with p<0.001. Nonunion occurred in 02(7.40%) patients of group A and 03(10.71%) patients of group B. Only 01 (3.7%) patient from group A and 02 (7.40%) patient of group B suffered from deep infections.

CONCLUSION: Closed interlocking for femoral diaphyseal fractures provides earlier reunion of the bone and should be considered the treatment of choice. In case of lack of technical availabilities, open interlocking should be considered as a suitable option.

The frequency of work related-stress among physical therapists of Pakistan–an online survey

2023-09-01T06:42:32+00:00

BACKGROUND & OBJECTIVE: Job related stress an important predictor of quality of work among health care professionals. The stress can affect the efficiency and capability of a working team. The objective of this study was to determine the work-related stress among physical therapists from different regions of Pakistan.

METHODOLOGY: This was a cross sectional study having 264 participants after ethical approval from June 2020 to November 2020. The data was collected using convenient sampling technique. Physical therapist from the age range of 25 to 50 years old, both genders, with at least 2 years of clinical or teaching experience who were actively employed in either the public or private sector without a break were included. Data was collected through an online questionnaire “stress evaluation questionnaire for health care provider”. Microsoft Excel and SPSS Version 21 were used to present and analyze data.

RESULTS: A total of 264 physical therapists from different regions of Pakistan participated in this study. Out of them 56% were males and 44% were females with a mean age of 34.5+ 9.5 and 31.5+ 8.5 respectively. From these, 38% of physical therapists were employed in academic organizations while 62% were working in clinical setups. Out of these, 211 (80%) participants were satisfied with their job but 57.6% of these participants had mild level of stress, while 14.4% had moderate stress and 2.7% had severe stress with p-value = 0.295. There was no difference observed in work related stress in male and female.

CONCLUSION: The study concluded that 7.6% participants had mild, 14.4% had moderate and 2.7% had severe level of work related-stress.

Effectiveness of topical vs. combination ciprofloxacin for the treatment of Chronic Suppurative Otitis Media

2023-09-01T06:44:09+00:00

BACKGROUND & OBJECTIVE: Topical antibiotics are a popular choice for treating chronic suppurative otitis media (CSOM), but there is no consensus on their penetration ability in the middle ear, mastoid cavities, and effectiveness against the causative pathogens. Hence, the present study aimed to compare the efficacy of empirical treatment of Chronic Suppurative Otitis Media (CSOM) with topical ciprofloxacin alone and in combination with oral ciprofloxacin.

METHODOLOGY: In this prospective study, 98 consecutive patients presented with diagnosed CSOM of tubotympanic type were recruited from the ENT Department of Bahawal Victoria Hospital. The enrolled patients were randomly subjected to the treatment groups (49 in each group), i.e., topical ciprofloxacin drops alone or oral and topical ciprofloxacin in combination; the therapy continued for 1 week. After 7 days of treatment, patients were assessed to observe the resolution of discharge and adverse effects of the drugs.

RESULTS: It was observed that 95.9% of the patients had complete resolution of discharge after 7 days of treatment; the outcomes were comparable in both treatment groups (p=1.00). There was no statistically significant difference between the patients of both treatment groups concerning gender, age, and discharge duration (p>0.05). There were minimal side effects but apparently, they were more frequent among group B patients than in group A.

CONCLUSION: It is concluded from the study that topical ciprofloxacin alone is as efficacious as oral and topical combination therapy for the treatment of CSOM.

Frequency of interior knee joint pain after interlocking intermedullary nailing for fracture tibia shaft

2023-09-01T19:31:34+00:00

BACKGROUND & OBJECTIVE:Tibial shaft fracture treatment with intermedullary nailing is very common these days. In the current study, our objective was to determine the percentage of patients with anterior knee pain following tibial shaft fracture treatment with interlocking intermedullary nailing.

METHODOLOGY:Our research design was a Descriptive cross-sectional study. The study duration was approximately one year (03-3-2020 to 3-3-2021). The study was conducted at the orthopedics department of CMH Muzafarrabad. A sample of 125 participants was calculated. All patients underwent interlocking intermedullary nailing. We analyzed data using SPSS version 24. p-value less than 0.05 was considered statistically significant for result authenticity.

RESULTS:In the present study 125 patients were included.Mean age of patients was 42.4±8.6SD years.Among all the patients, 82(65.6%) reported no pain while 43(34.4%) reported pain. Visual analogue scale showed mean pain scores 3.22±2.5SD and lysholm scores were 80.74±3.28SD (p≤0.000 and p≤0.000, respectively).

CONCLUSION:Tibial shaft fractures are common these days. A relatively high incidence of anterior knee pain following intermedually nailing after tibial shaft fracture was found in our study.

Women s' perception on role of breast self-examination in early breast cancer detection

2023-09-01T20:11:02+00:00

BACKGROUND & OBJECTIVE: A good knowledge of the predictive and precepting factors can reduce the risk of breast cancer. This study aimed to assess female patients' knowledge of breast cancer, self-examination techniques, and other screening methods.

METHODOLOGY: A cross-sectional descriptive study was carried out at the territory care hospital Khurrianwala Faisalabad, including 500 women attending the outpatient department from June 2022 to November 2022 after taking informed consent. Data collected by filling out a validated questionnaire was analyzed through SPSS software version 22.0. Relationships between categorical variables were tested by using the chi-square test, and a p<0.05 is considered highly significant.

RESULTS: Out of 500 study participants, 304(60.8 %) know about breast cancer, of which 64(12.8 %) have a positive family history, 436(87.2 %) have no history of breast cancer, and 196(39.2%) were unaware of breast cancer. Out of the total participants, 60.8 % were aware of Breast self-examination, while 39.2% did not know. There is a significant association for the practice of breast self-examination in the population above higher education p-value≤0.001. Similarly, occupation p-value≤0.001, marital status p-value=0.040, and education p-value≤0.001 have significant associations with BSE.

CONCLUSION: The current study showed that knowledge of breast cancer and the practice of BSE and mammography were very poor. A health education program involving the local and governing bodies should be organized to reduce the prevalence and create awareness.