Category: Nevin Manimala

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):599-602. doi: 10.55519/JAMC-04-12111.

ABSTRACT

BACKGROUND: Brain metastases are a common complication of cancer and approximately 20% of cancer patients develop them over time. Presently palliative whole-brain radiotherapy is used as a palliative treatment for brain metastases because of its cost-effectiveness and easy availability, especially in patients with multiple metastases who are not candidates for surgery or Stereotactic radiosurgery. This study aims to determine the survival in patients who have received palliative whole-brain radiotherapy for brain metastases and to evaluate some of the prognostic factors determining survival in patients with brain metastases.

METHODS: It was a cross-sectional study conducted in Shaukat Khanum Memorial Cancer Hospital and Research Centre and all the patients with brain metastases who had completed palliative whole-brain radiotherapy between July 2015 and July 2020 were included. Data was retrospectively collected and analyzed using SPSS 21.0. Overall survival was calculated using the Kaplan-Meier method, taking into consideration the period from the date of diagnosis of brain metastases until death or to the date of last follow-up, whichever was applicable. p-value of <0.05 was regarded as statistically significant.

RESULTS: Almost half (45%) of the brain metastases were secondary to breast cancer followed by lung and genitourinary cancers at 16.3% and 15.5% respectively. The median overall survival was lowest in breast carcinoma patients at 5 months followed by lung carcinoma at 7 months. The median overall survival was 5 months in patients having extracranial disease as compared to 12 months in those having no extracranial disease or those in whom the disease status was unknown.

CONCLUSIONS: Our study revealed that the most common tumour to metastasize to the brain was breast cancer. The younger age group had a poorer prognosis because most of them had breast cancer with triple-negative disease. Controlled extracranial disease significantly prolonged overall survival in patients with brain metastases.

PMID:38406943 | DOI:10.55519/JAMC-04-12111

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):593-598. doi: 10.55519/JAMC-04-11949.

ABSTRACT

BACKGROUND: There are several materials available in the market for the core buildup of endodontically treated teeth. The purpose of our study is to evaluate the fracture resistance of endodontically treated teeth restored with composite resin, amalgam and glass ionomer cement as core buildup materials.

METHODS: Forty-eight sound-extracted mandibular premolar teeth were randomly divided into 4 groups of 12 teeth each. The first group served as a control and consisted of intact sound teeth. In all of the remaining teeth, root canal treatment was performed first. In Group II composite resin was used as the core build-up material Group III amalgam and Group IV GIC. Teeth were then subjected to fracture using a universal testing machine.

RESULTS: One Way ANOVA test was performed to study the differences in the data of the four groups. The mean forces required for fracture were 1050 N for control teeth, 738 N for composite, 872 N for amalgam and 567 N for GIC. The variation is of statistical significance as depicted by a p-value of 0.003.

CONCLUSIONS: The highest strength was shown by intact sound teeth. Teeth restored with composite resin and amalgam had similar strengths and those with GIC had significantly lower resistance to fracture.

PMID:38406942 | DOI:10.55519/JAMC-04-11949

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):583-587. doi: 10.55519/JAMC-04-12015.

ABSTRACT

BACKGROUND: Vaginal birth after caesarean section (VBAC) is associated with reduced blood loss and transfusions, fewer infections, and fewer thromboembolic events as compared to caesarean delivery. The current rate of repeat caesarean after one previous caesarean is above the WHO standard of 15%. We aimed to determine the occurrence of VBAC and to determine the occurrence of feto-maternal outcomes in successful VBAC cases so that trials of VBAC can be given to carefully selected patients to reduce the rate of repeat caesarean section.

METHODS: The Combined Military Hospital (CMH) Rawalpindi’s Obstetrics and Gynaecology department conducted this cross-sectional study from March 20 to September 19, 2021. After obtaining ethical committee approval, data was collected using a non-probability, consecutive sampling technique from 150 patients on a self-developed structured proforma. Patients between the age range of 20-35 years with a history of previous lower segment caesarean section, having gestational age between 37-41 weeks and who presented in spontaneous labour were included in this study. After taking informed consent, all women were given a trial of labour and the outcome of the trial was noted. Women were followed for the feto-maternal outcomes. The gathered information was analysed using SPSS version 25.0. Post-stratification, a p-value of 0.05 or lower on the chi-square test was deemed statistically significant.

RESULTS: Following a C-section, 28.67% of patients experienced successful vaginal births. PPH was found in 2.32%, scar dehiscence in 0.0%, low birth weight babies in 16.28%, APGAR score <7 at 1 minute was 23.26% and NICU admission as 9.30% in women undergoing vaginal birth after caesarean section.

CONCLUSIONS: Appropriate selection of patients for the trial of VBAC can help reduce the higher rate of repeat caesarean section after a previous caesarean section and increase the chances of successful vaginal birth.

PMID:38406940 | DOI:10.55519/JAMC-04-12015

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):579-582. doi: 10.55519/JAMC-04-11877.

ABSTRACT

BACKGROUND: The objective of this study was to determine the prevalence of the second mesiobuccal canal in permanent maxillary second molar in patients presenting to Peshawar Dental College and Hospital.

METHODS: One hundred and twenty patients advised for root canal treatment in the maxillary second molars participated in the study. Two detection procedures, clinical and radio graphical examination were used. Two pre-operative radiographs with different angulations and one post-operative radiograph were taken to examine roots and root canals. Access cavities were prepared and the second mesiobuccal canal was explored using magnifying dental loupes (3.5 x), endodontic explorer (DG16) and size 10 K-file. Descriptive statistics were recorded as percentages, frequencies and mean. The chi-square test was used for gender, age-wise comparison and right and left side of the maxillary jaw.

RESULTS: One hundred and twenty patients were recruited in the study. There were 65 (54.2%) males and 55 (45.8%) females. The second mesiobuccal canal was more common in males compared to females (p-value=0.434). The second mesiobuccal canal was most commonly found in 3rd decade with mean age, of 40.5±12.31, (p-value =0.51). The frequencies and percentages of the second mesiobuccal canal in maxillary second molars on the right and left side of the jaw were 70 (58.3%) and 50 (41.7%) respectively (p-value =0.310).

CONCLUSIONS: The second mesiobuccal canal was found in less than half of the second molars. The most successful method of detection in this study was both clinical and radiographic.

PMID:38406939 | DOI:10.55519/JAMC-04-11877

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):553-557. doi: 10.55519/JAMC-04-12057.

ABSTRACT

BACKGROUND: Peripheral arterial disease (PAD) affects a substantial proportion of the global population, particularly older individuals, affecting around 200 million people worldwide highlighting its significant impact on human health. Critical limb ischemia (CLI) is the most severe clinical presentation of PAD characterized by ischemic rest pain tissue ulceration or gangrene. The objective of the study is to assess the efficacy of infra popliteal angioplasty (in terms of wound healing and limb salvage) in patients with below-the-knee total chronic occlusion (TCO).

METHODS: In this cross-sectional study, all consecutive patients in one year with TCO and fulfilling the inclusion criteria were included.

RESULTS: A total of 64 limbs underwent angioplasty. The mean age was 55.38 ± 13.12 (Range 22-88) years and there were 73% (n=47) males. Diabetes mellitus was the most prevalent risk factor in 59.4% (n=38) of patients. 48.4 % (n=31) of patients had below-knee TCO in all three arteries. Technical Success was achieved in 95.3% (n=61/64). All 3 patients who had technical failure ended up with below-the-knee amputation. Furthermore, 2 more patients who had technical success also ended up with below-the-knee amputation. The difference between these two rates was significant (100% vs 3.3%; p-value =0.004). In terms of wound healing, statistically significant improvement was noted within the first 6 months (p-value = 0.05). The limb salvage rate was 90.6% (n=59/64). The primary patency rate was 81.3% (n=52) and 76.6% (n=49) at 6 and 12 months respectively.

CONCLUSIONS: Angioplasty results in statistically significant wound healing leading to a higher limb salvage rate, in patients with TCO of infrapopliteal arteries.

PMID:38406934 | DOI:10.55519/JAMC-04-12057

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):544-548. doi: 10.55519/JAMC-04-12300.

ABSTRACT

BACKGROUND: EDTA-dependent pseudo thrombocytopenia (EDTA-PTCP) refers to a falsely low platelet count occurring in the presence of ethylene diamine tetra-acetic acid (EDTA) anticoagulant during blood sample collection, which results in the formation of platelet clumps in vitro. This phenomenon has significant clinical implications, including unnecessary administration of platelets. Our study aims to evaluate the efficacy of sodium citrate anticoagulant for the resolution of EDTAPTCP.

METHODS: This retrospective study was conducted in the haematology laboratory of Shifa International Hospital (SIH), Pakistan. Patients with pseudo thrombocytopenia (i.e. platelet count less than 150,000/ul with platelet clumps seen on peripheral smear) were included in this study if they had blood samples drawn in both EDTA and sodium citrate tubes less than 48 hours apart. Data was analyzed using IBM® SPSS Software Version 22.

RESULTS: A total of 151 study participants were included in this study. The mean age was 48.95±20.69 years and the majority were female (52.3%). Wilcoxon signed-rank test showed that there was a statistically significant difference in platelet count measured in both tubes (Z = -3.223, p=0.001). Overall, blood samples processed in sodium citrate tubes showed lower platelet count than EDTA samples. Sodium citrate anticoagulant was able to correct EDTA-PTCP in 47 (31.1%) of the cases.

CONCLUSIONS: Sodium citrate anticoagulant was only able to resolve one-third of our EDTA-PTCP cases. Our findings do not support the use of sodium citrate as a suitable alternative for correction of EDTA-PTCP.

PMID:38406932 | DOI:10.55519/JAMC-04-12300

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):538-543. doi: 10.55519/JAMC-04-12065.

ABSTRACT

BACKGROUND: Anaemia in patients with HIV infection is commonly multifactorial in origin. Nutritional deficiencies and the presence of opportunistic infections as well as HIV infection itself can cause anaemia. HIV medications like zidovudine can also cause anaemia in patients with HIV infection. This study aimed to study the prevalence and risk factors of anaemia in patients with HIV infection on a zidovudine-based HAART regimen.

METHODS: This hospital-based prospective cohort study was done at the ART (anti-retroviral therapy) centre. All adult patients with HIV attending the ART centre were included in the study. After obtaining written informed consent, the patient’s demographic data, risk factors, WHO staging, and body mass index (BMI) were noted. Study population was divided into two groups as patients with or without anaemia and compared using appropriate statistical tests.

RESULTS: Out of the 202 patients with HIV infection on a zidovudine-based regimen, 52 patients (25.7%) developed anaemia. Anaemia was common in stage 3 or stage 4 of WHO staging (OR-9.94, CI-3.89-25.36) and in patients with low CD4 counts (OR-0.988, CI-0. 982-0.995). Patients with anaemia had significant opportunistic infections.

CONCLUSIONS: Anaemia is common in patients with HIV on zidovudine-based HAART regimen, which is seen as early as less than 8 weeks. WHO staging, and CD4 count were the primary risk factors for anaemia, which a change of treatment regimen and supportive measures can reverse.

PMID:38406931 | DOI:10.55519/JAMC-04-12065

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):530-533. doi: 10.55519/JAMC-04-11651.

ABSTRACT

BACKGROUND: Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug.

METHODS: Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron,15 minutes before spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not.

RESULTS: 67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001).

CONCLUSIONS: Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication.

PMID:38406929 | DOI:10.55519/JAMC-04-11651

J Ayub Med Coll Abbottabad. 2023 Oct-Dec;35(4):523-529. doi: 10.55519/JAMC-04-11760.

ABSTRACT

BACKGROUND: Recently various combinations of direct acting antivirals (DAAs) have been tried successfully. The Sofosbuvir + Daclatasvir combination has been used with promising results. Recently, resistance has been noticed against DAAs. Therefore, polymorphism at particular sites in the interleukin 28B gene are under study to find possible association with resistance. This study was aimed at finding out any association of SNPs rs8099917 and rs12979860 (IL28B gene) with response and resistance to treatment in HCV genotype 3 patients in Khyber Pakhtunkhwa.

METHODS: This cross sectional, Analytical study was conducted at Gastroenterology/hepatology OPD of Prime Teaching Hospital, Peshawar Medical College. Collected Samples were stored at -20o C in PCR Lab of the College. DNA extraction and genotyping was carried out at BJ Molecular Biology Lab in Rawalpindi. Data was analyzed by using SPSS version 21. Chi-Square Test was used to see the statistically significant differences between rs8099917 T/G and rs12979860 T/C model.

RESULTS: In the IL28-B gene, single nucleotide polymorphism at rs12979860 T/C model, we observed that there are 37.5% CC homozygous, 12.5% TT homozygous and 50% CT heterozygous genotypes in resistant patients and 42.85% CC homozygous, 28.57% TT and 28.57% CT genotype in responder group. In rs12979860 T/C model, genotype of IL28-B in the responder and resistant group significantly varies at p-value =0.00572.

CONCLUSION: We conclude that in SNP at rs12979860, CC genotype is associated with clearance of HCV, while CT genotype was more prevalent in the resistant group and associated with chronicity.

PMID:38406928 | DOI:10.55519/JAMC-04-11760

J Hypertens. 2024 Feb 16. doi: 10.1097/HJH.0000000000003693. Online ahead of print.

ABSTRACT

BACKGROUND: The correlation between systolic blood pressure (SBP) and mortality in hypertensive patients with different phenotypes of heart failure (HF) has not been adequately studied, and optimal blood pressure control targets remain controversial. To explore the link between SBP and prognosis in all or three ejection fraction (EF) phenotypes of HF patients with hypertension.

METHODS: We analyzed 1279 HF patients complicated by hypertension in a retrospective cohort. The SBP <130 mmHg group included 383 patients, and the SBP ≥130 mmHg group included 896 patients. The major end point was all-cause mortality.

RESULTS: Of the 1279 study patients, with a median age of 66.0 ± 12.0 years, 45.3% were female. The proportions of the three subtypes of heart failure complicated with hypertension (HFrEF, HEmrEF, and HFpEF) were 26.8%, 29.3%, and 43.9%, respectively. During the 1-year follow-up, 223 patients experienced all-cause death, and 133 experienced cardiovascular death. Restricted cubic splines showed that the risk of all-cause and cardiovascular death increased gradually as the SBP level decreased in patients with HFrEF and HFmrEF. Furthermore, the multivariate Cox proportional hazards model revealed that SBP <130 mmHg was also associated with an increased risk of all-cause death [hazard ratio (HR) 2.53, 95% confidence interval (CI) 1.23-5.20, P = 0.011] and cardiovascular death (HR 1.91, 95% CI 1.01-3.63, P = 0.047) in HFrEF patients. A trend toward increased risk was observed among HFmrEF patients, but it was not statistically significant. This trend was not observed in HFpEF patients.

CONCLUSION: In HFrEF patients, SBP <130 mmHg was associated with an increased risk of all-cause and cardiovascular mortality. A trend toward increased risk was observed among HFmrEF patients, but not among HFpEF patients.

PMID:38406922 | DOI:10.1097/HJH.0000000000003693