Category: Nevin Manimala

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):799-802. doi: 10.55519/JAMC-04-14150.

ABSTRACT

BACKGROUND: Firearm injuries are critically important in criminal proceedings and jurisprudence discussions. The aim of the current study was to reinforce the growing concern of firearm violence in society and authenticate findings through autopsy examinations in the casualty department of Ayub Teaching Hospital Abbottabad.

METHODS: This retrospective observational study was conducted in the casualty department of Ayub Teaching Hospital Abbottabad. Data was collected from registers spanning 1st September 2023 to 31st May 2024, after obtaining permission from the hospital administration.

RESULTS: Data from 56 cases were analyzed using SPSS 22. Among these, 50% suffered from firearm injuries, while the remaining 50% died due to sharp weapons, blunt weapons, poisoning, hanging, strangulation, road traffic accidents, electric shocks, or unknown causes. Of the total cases, 45 (80.4%) were male and 11 (19.6%) were female. The most affected age group was 20-40 years, comprising 36 (64.2%) cases. Furthermore, 42 (75%) cases were homicidal, 2 (3.6%) were suicidal, and 12 (21.4%) were accidental.

CONCLUSIONS: The most common weapon used in homicidal deaths is firearms. Firearm violence should be prioritized as a critical issue in global health discussions.

PMID:40121646 | DOI:10.55519/JAMC-04-14150

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):793-798. doi: 10.55519/JAMC-04-13811.

ABSTRACT

BACKGROUND: Diabetes mellitus is a leading cause of morbidity and mortality, with many ocular severe complications. This cross-sectional study determined adherence to proper eye care recommendations and regular eye examinations among local diabetic patients and factors associated with non-adherence.

METHODS: This cross-sectional survey assed the knowledge, attitude, and practices of 200 type I and II diabetic patients. The frequency of patients’ regular eye examinations, good knowledge of diabetic eye disease, and measures of the association of periodic eye examination with different variables were calculated.

RESULTS: There were 116 (58%) males and 84 (42%) females (mean age=55.28 years, SD=13.928 years). The majority belonged to the lower socioeconomic group with little education. 114 (57%) had never had any eye examination. 107 were unaware of the importance of eye examination. Only 35 (17.5%) had good knowledge, and 146 (73%) patients had poor attitudes towards diabetes. Periodic eye examination was significantly associated with occupation, area of residence, and overall knowledge of diabetic eye complications. In contrast, it had no significant association with gender, type of diabetes, presence of eye symptoms, or presence of other diabetes complications.

CONCLUSIONS: The knowledge of our local population about diabetic eye disease is very deficient. An extensive campaign of educating diabetic patients about ocular complications is necessary to address this.

PMID:40121645 | DOI:10.55519/JAMC-04-13811

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):783-787. doi: 10.55519/JAMC-04-14046.

ABSTRACT

BACKGROUND: The occurrence of a single beta thalassaemia allele is frequently related with microcytic hypochromic red blood cells and a rise in HbA2 levels. In some beta thalassaemia carriers, the outcome of this allele or its collaboration with other acquired or genetic defects may result in normal or borderline Haemoglobin bA2 levels. Objective was to establish the importance of molecular analysis in borderline HbA2 individuals and its significance in a population screening program.

METHODS: It was a cross-sectional study conducted over a period of six months, from July-December 2023. All 123 individuals with borderline HbA2 levels between (3‒3.9%) diagnosed by High-performance liquid chromatography (HPLC)/Capillary Zone Electrophoresis underwent molecular testing using multiplex amplification refractory mutation system-Polymerase Chain Reaction (ARMS-PCR) to detect common beta thalassaemia mutations: Fr8-9, IVS1-5, Fr41-42, Cd15, Cd5, IVS1-1, IVS1-1, Cd30, Cd30, Fr16, IVSII-1, Del619, and CAP+1 in the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi .Statistical tests were applied to compare Red Blood Cell indices and Haemoglobin A2 values among beta thalassaemia carriers and non-carriers.

RESULTS: Among those tested, 47.1% (n=58) were found to carry Beta thalassaemia mutations. The most prevalent mutations were IVS1-5 (n=19,15.4%) and Fr8-9 (n=19,15.4%) followed by Fr41-42 (n=08,6.5%). Subjects with mutations exhibited significantly lower mean corpuscular volume and mean corpuscular haemoglobin compared to those without mutations (p-value= <0.001). Beta thalassaemia mutations were seen more frequently when HbA2 was in range of 3.5-3.9% (n=37,63.8%), as compared to HbA2 that was 3-3.4% (n=21,36.2%) and this difference was found to be significant (p-value= <0.001). The CAP+1 mutation was associated (n=02,1.6%) with normal mean MCV and MCH compared to other identified mutations.

CONCLUSIONS: It is concluded that molecular study for the common beta thalassaemia mutations in Pakistani population plays a pivotal role in confirmation of borderline HbA2 thalassaemia carriers, specifically in areas with a high prevalence of the disease. Molecular testing for beta thalassaemia should be offered to all individuals with borderline HbA2 with values especially between 3.4‒3.9% and having microcytic hypochromic indices.

PMID:40121643 | DOI:10.55519/JAMC-04-14046

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):778-782. doi: 10.55519/JAMC-04-13466.

ABSTRACT

BACKGROUND: Antibiotic resistance is on an increasing trend, particularly in gram-negative bacteria. The production of metallo β-lactamase (MBL) puts the health sector at great risk as it further limits the treatment option for MDR strain. The current study aims to determine the prevalence, antibacterial sensitivity pattern, and molecular characterization of MBL in Uropathogenic E. coli from clinical samples of hospitalized patients in Khyber Pakhtunkhwa.

METHODS: From tertiary care hospitals in Peshawar, 250 Urine samples were collected from indoor hospitalized patients. Gold standard microbiological methods were used to identify UPEC from these clinical samples.For that,urine samples was inoculated onto Cysteine Lactose Electrolyte. Deficient (CLED) agar plate, and MacConkey Agar.Positive growth of E. coli identified through Gram staining, colony morphology, Biochemical Tests and E.coli 16srRNA gene amplification .Antibiotic sensitivity was determined by the disc diffusion method on Muller Hinton agar. For the detection of MBL production double disc synergy, and a combination disc test of the antibiotics were used. Furthermore, multiplex PCR was used for the molecular characterization of the MBL (blaIMP, blaVIM, and blaNDM) genes.

RESULTS: Of the 250 samples, only 110 samples were confirmed as Uropathogenic E. coli based on colonial morphology, biochemical testing, and molecular level by targeting the 16SrDNA. Female was found more susceptible to UTI compared to male. High prevalence was found in the age group 45-65 years. UPEC was found highly resistance to Ciprofloxacin (90%), followed by Cefotaxime and Ceftriaxone (86%), Ceftazidime and Augmentin (81%), Tazobactam (61%). while the lowest resistance was reported against Meropenum (20%) Imipenem (18%) and Amikacin (37%). PCR-based confirmed prevalence of MBL encoding genes was blaNDM (42%), blaVIM (32%), and blaIMP (26%).

CONCLUSIONS: The study proposed a higher prevalence of urinary tract infections (UTIs) in females aged group 54-65 years compared to males. An analysis of antibiotic sensitivity revealed Imipenem and Meropenem to be the most effective antimicrobial agents, while Ciprofloxacin, Cefotaxime and Amoxicillin were found to be the less effective. UPEC were found highly resistance to Ciprofloxacin 91%, and ceftazidime 86%, while comparatively less resistance to meropenem, and imipenem,20% and 18% respectively. Genotype BlaNDM of the MBL is highly prevalent (42%) among UPEC.Furthermore, the presence of MBL genes was detected in over 19% of UPEC, and in different combinations.The upraise of the MBLs resistance in uropathogenic E. coli is an alarming sign for clinicians to decide on treatment options for complicated UTIs.

PMID:40121642 | DOI:10.55519/JAMC-04-13466

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):773-777. doi: 10.55519/JAMC-04-13921.

ABSTRACT

BACKGROUND: Cardiorenal syndrome is the prevalent form of the syndrome in Pakistan. Despite the rising importance of CRS, more information is needed to understand comorbidities and hospital outcomes. This research study explores the prevalence, and In-hospital outcomes of patients admitted for Acute Decompensated Heart Failure at the tertiary care hospital of Islamabad at the age of above 18.

METHODS: This cohort study was conducted at the tertiary care hospital in Islamabad from January to June 2024. Data were collected from 200 known ADHF patients who visited the CCU (OPD) and ward through a structured questionnaire. The data were analyzed using SPSS version 25.

RESULTS: The majority of the sample was diagnosed with Type 1 Cardiorenal Syndrome, which accounted for 30% of the total. Cardiorenal Syndrome Types 3 and 5 had a prevalence of 20% each among the patients, while Types 2 and 4 had a prevalence of 15% each. This suggests that Type 1 was more prevalent, but the other types were equally distributed. The mortality rate in the Hospital was highest for Type 5 CRS at 15% and Type 3 CRS at 13%. During this period, Type 2 CRS exhibited the lowest mortality rate. Type 3 CRS had the most extended average hospitalization duration.

CONCLUSIONS: It was concluded in our study that cardiorenal syndrome is the prevalent form among admitted patients with ADHF, and the government needs to increase awareness about health and health-related risk factors related to the communities.

PMID:40121641 | DOI:10.55519/JAMC-04-13921

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):768-772. doi: 10.55519/JAMC-04-13381.

ABSTRACT

BACKGROUND: Dental caries in the mixed dentition stage is a common problem leading to tooth decay and extractions. This study aimed to evaluate the pattern of caries among children of 6-15 years age presenting to Ayub College of Dentistry and its association with different factors such as age, dietary habits, snacking habits, and previous dental visits.

METHODS: It was cross-sectional research on 250 participants of 6-15 years presenting to Ayub College of Dentistry from November 2023 to April 2024. Dental caries was examined and DMFT index calculated with the help of questionnaires. DMFT was correlated with age, tooth brushing habits, gender, snacking habits, and previous dental visits. Data was analyzed using SPSS software version 22. Statistical correlation tests were applied to find the association between different variables such as age group, brushing habits, snacking habits and prevalence and severity of caries.

RESULTS: Dental caries was prevalent among 79.7 percent whereas the mean DMFT of sample was 5.82±4.48. There was a trend of higher DMFT scores among male population than females. A greater DMFT score of 4.2±1.8 was seen among children of 13-15 years followed by 10-12 years (3.8±1.7) and 6-9 years (2.7±1.5).

CONCLUSIONS: This study highlights the high prevalence of dental caries among children and adolescents and its association with brushing habits, snacking habits, age, gender, and previous dental visits. Regular dental check-ups, proper oral hygiene practices, and a healthy diet low in sugar are key factors in preventing dental caries in elementary school students.

PMID:40121640 | DOI:10.55519/JAMC-04-13381

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):764-767. doi: 10.55519/JAMC-04-13441.

ABSTRACT

BACKGROUND: This clinical audit aimed to assess the accuracy of allergy documentation within the Hospital Management Information System (HMIS) of the Gastroenterology and Pulmonology Wards at Lady Reading Hospital, MTI Peshawar. Proper documentation of allergies, including food, drugs, and other types, is crucial for patient safety to prevent adverse reactions.

METHODS: The clinical audit was conducted using the “HOPE” Hospital Management Information System (HMIS), donated by the Shaukat Khanum Memorial Trust. It involved a retrospective review of medical records for 20 patients from each ward across two audit cycles. In the first cycle, 10 patients were randomly selected from each ward, making a total of 20 patients. After identifying gaps in allergy documentation, interventions were implemented. A second cycle was then conducted to reassess documentation, selecting another set of 10 patients from each ward. Data collection involved checking if allergies were documented, and the results were recorded in an Excel sheet, marked as ‘Yes’ or ‘No’ for allergies. Data analysis was done using Microsoft Excel 2023 and the graphical representations were created in Microsoft Office Word 2023 and Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA). The audit aimed for a 100% documentation standard as per the HMIS reading manual.

RESULTS: In the first cycle, 70% (n=7) of patients in the Gastroenterology Ward and 60% (n=6) in the Pulmonology Ward had no documented allergies. After implementing the recommended interventions, the second cycle showed a remarkable improvement, with a 100% documentation rate achieved in both wards.

CONCLUSIONS: After implementing the recommendations, allergy documentation in the HMIS of Lady Reading Hospital MTI Peshawar significantly improved, which helped in preventing allergic reactions in patients admitted to the Gastroenterology and Pulmonology Wards.

PMID:40121639 | DOI:10.55519/JAMC-04-13441

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):759-763. doi: 10.55519/JAMC-04-13407.

ABSTRACT

BACKGROUND: Migration under hostile circumstances and taking refuge in another country is a process which can have a great toll on mental health of the affected individuals. Religious beliefs and closeness to God could be instrumental in bringing post-traumatic growth and positive changes in one’s life after any traumatic event. This study was carried out to evaluate the association of post-traumatic growth with use of religion and spirituality as a coping strategy among refugees residing in Azad Jammu and Kashmir.

METHODS: In this cross-sectional study, individuals who migrated from Indian Kashmir and got settled in the Thotha refugee camp at AJK were recruited during February to April 2024 for the study. Post-traumatic growth (PTG) was assessed via post-traumatic growth inventory. Religiosity as coping strategy was measured on brief religious coping scale (Brief RCOPE). Relationship of religious coping and other socio-demographic factors was correlated with PTG among the study participants.

RESULTS: A total of three hundred and thirty participants were included in this study with mean age of 44.89±14.81. Majority of participants were male (n=237 (71.8%), married (n=260 (78.8%) and Unemployed (n=103 (31.2%). Participants who were ≤45 years old, single, employed, did not use illicit drugs and had more income had high PTG mean scores (p-value<0.05). The PTG scores of the study participants and Positive Religious coping score had positive correlation while PTG scores had negative correlation with Nnegative religious coping (r=-0.238, p-value <0.001).

CONCLUSIONS: Post-traumatic growth was observed in individuals who were lining as refugees in camps at AJK. Individuals who were young, single, well paid and did not used illicit drugs had more chances of having PTG. Positive religious coping also increased the chances of having post-traumatic growth in individuals after migration and taking refuge in another country.

PMID:40121638 | DOI:10.55519/JAMC-04-13407

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):755-758. doi: 10.55519/JAMC-04-13192.

ABSTRACT

BACKGROUND: There is significant discussion over the most effective surgical approach for treating lumbar spondylolisthesis, despite the recommendation of a number of surgical approaches. The aim of this study was to explore the Outcomes of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in managing single-level lumbar spondylolisthesis.

METHODS: the current study was conducted at the department of orthopaedic and neurosurgery at Hayatabad Medical Complex, Peshawar from January 2022 to February 2023 after taking approval from the ethical committee of the institute. Those individuals who had experienced a single-level condition with a low-grade categorization (grades I or II) in the Meyerding grading system were included in the study. A total of 52 patients were enrolled in this study and were divided in to group A and B. 26 received PLIF, and were placed in group A while 26 had done TLIF and were placed in group B. The two groups’ mean operating times, blood loss, VAS scores for back and leg discomfort, and complications were compared.

RESULTS: A total of 52 individuals were enrolled in this investigation, distributed evenly into two groups. The mean age of the participants was 35.14±7.76 years. Out of 52 patients male were 30(57.6% and 22(42.30) were females. Patients in group B underwent TLIF while patients in group A got PLIF. With respect to the results for the two groups, individuals in the group A had mean operative time 126.44±12.03 minutes and Group B had a considerably shorter duration of 113.32±8.48 minutes (p<0.05). In group A, the average blood loss was 440±76.33 cm3 but Group B experienced a much lower value of 371.40±39.2 cm³ (p<0.05). Concerning postoperative VAS leg pain, there was no difference between the two groups (p>0.05) while group B experienced considerably less postoperative pain in the back on the VAS than group A did (p<0.05). Dural tear was noted in 4 participants in group A, while 2 in group B. 3 patients in group A experienced a neurologic impairment, but in group b there was no neurologic deficit noted. 3 individuals in group A experienced wound infections, whereas none of the patients in group B did.

CONCLUSIONS: Based on our research, TLIF is better than PLIF in terms of functional result and rate of complications in patients with grade I/II single-level lumbar spondylolisthesis.

PMID:40121637 | DOI:10.55519/JAMC-04-13192

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):749-754. doi: 10.55519/JAMC-04-14131.

ABSTRACT

BACKGROUND: Amphetamine use disorder (AUD) is a public health concern on a global scale and is a rising epidemic in Pakistan. Cognitive Behavioural Therapy (CBT) is a well-established treatment for substance use disorders, but its efficacy may be dependent on what is known as socio demographic and behavioural variables. The aims of this study are to provide evaluation of efficacy of CBT for AUD in Pakistani population and to find whether the presence of factors like education, job, duration of addiction, residence, age, family support, smoking and alcohol intake may affect treatment outcomes.

METHODS: A quasi-experimental design was applied with 100 participants recruited from outpatient treatment centers and rehabilitation centers in Pakistan. A culturally adapted CBT program was delivered to 50 participants along with treatment as usual and standard treatment as usual (TAU) was given to control group with 50 participants. Addiction Severity, anxiety, depression, psychological wellbeing, quality of life, as well as relapse rates were measured using pre-test and post-test assessments. Descriptive statistics, paired t-tests, ANOVA, multiple regression and survival analysis were completed to analyze the data.

RESULTS: The frequency of amphetamine use from pre to post change from 5.8 to 2.3 days per week (p<0.001) and ASI, addiction severity index scores from pre to post change from 30.2 to 18.7 (p<0.001) was significant in the CBT group. On the behavioural as well as on the psychological measures, improvements were observed, as evidenced by a decrease in the BDI from 22.4 to 14.1 (p<0.001) and a decrease in the GAD-7 from 18.5 to 11.3 (p<0.001). Significantly higher Quality of Life (WHOQOL-BREF) scores improved from 45.3 to 62.0 (p<0.001). But the TAU group also got better, just not as much as the CBT group. Positive associations were found with socio-demographic factors (such as higher education, stable employment and strong family support) and negative associations with unemployment, longer duration of addiction and regular alcohol intake.

CONCLUSIONS: Both the effectiveness of CBT and its suitability to reduce amphetamine use, enhance psychological wellbeing, and improve quality of life among individuals with AUD in Pakistan were demonstrated. The significance of incorporating social demographic factors, and behavioural factors in the development of CBT interventions to ensure maximal treatment effect is underscored.

PMID:40121636 | DOI:10.55519/JAMC-04-14131