Nevin Manimala

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):484-487.

ABSTRACT

BACKGROUND: Psoriasis is a non-communicable, long-lasting disorder of the skin comprising various immunological inflammatory changes. Increasing evidence suggests that psoriasis is closely related to multiple organ systems, potentially arising due to underlying co-morbid conditions such as diabetes, hypertension, dyslipidaemia and obesity. Aim of this study was to know the frequency of metabolic syndrome in psoriasis patients.

METHODS: This cross-sectional study was conducted from May to November 2020 in a Tertiary-care hospital. Eighty patients diagnosed with psoriasis were selected using non-probability consecutive sampling. Informed written consent was obtained from each patient and a questionnaire was filled. Blood pressure, waist circumference, body surface area covered by psoriasis, Psoriasis Area Severity Index were recorded on initial visit. Fasting blood sugar, serum triglyceride and HDL cholesterol levels were advised. Patients were diagnosed to have metabolic syndrome if ≥3 out of 5 criteria for the modified version of National Cholesterol Education Program Adult Panel III were met.

RESULTS: There were 62 male and 18 female patients. A total of 39 patients (48.8%) met the criteria for metabolic syndrome. Amongst these, 26/62 (41.9%) males vs 13/18 (72.2%) females fulfilled the criteria. The mean BMI of males was 26.0 while those of females was 28.3, comparison of which demonstrated a noteworthy difference (p=0.04). A statistically significant (p=0.038) positive correlation (r) of 0.233 was observed between body surface area and BMI.

CONCLUSIONS: Metabolic syndrome is seen frequently in patients of Psoriasis. Female patients have a significant frequency of metabolic syndrome and tend to have a higher BMI than males.

PMID:34487662

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):456-461.

ABSTRACT

BACKGROUND: Evaluation of the educational environment is key to the delivery of high-quality medical education. Especially, when an institute is in the transition phase of curriculum. In curriculum transformation phase of Ayub Medical College Abbottabad, no such evaluation has been done. This study aimed to find the direction of Educational environment in the transition phase curriculum of Ayub Medical College Abbottabad and compare different domains of educational environment with gender, residency, pre-medical education’s medium of instruction, and doctors among sibling or parents.

METHODS: This descriptive cross-sectional survey was conducted among students of integrated and traditional curriculum of Ayub Medical College, Abbottabad from 1st December 2019 to 29th February 2020. By Non-probability convenience sampling technique, pre-validated Dundee Ready Educational Environment Measure questionnaire was used. Descriptive and inferential statistics were calculated in SPSS v22.

RESULTS: A total 149 (100%) participants, 66 (44.3%) males and 83 (55.7%) females with mean age of 20.5±1.07 years responded. Among total, 76 (51%) were from integrated curriculum and 73 (49%) were of traditional curriculum. Significant difference was found among different aspect of education environments and both classes.

CONCLUSIONS: The current transitional phase of curriculum at Ayub Medical College Abbottabad is more positive than negative. Some areas like student social-self-perception still need improvement. Moreover, gender and place of birth affect student’s perception about their learning environment.

PMID:34487656

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):451-455.

ABSTRACT

BACKGROUND: One of the frequent obstetric complications in first trimester is vaginal bleeding. It has an incidence of 16%-25%. Subchorionic haemorrhage is the most common cause of first trimester miscarriage associated with vaginal bleeding. The objective of the study was to determine the association of subchorionic hematoma (SCH) with preterm labour in pregnant females with threatened abortion.

METHODS: A Cohort Study was designed and conducted in the Obstetrics and Gynaecology Department, Zanana hospital, Dera Ismail Khan (D.I. Khan). A sample size of 418 subjects was equally divided into two equal groups. Non-probability consecutive sampling was used for collection of samples. Pregnant women presenting with sub chorionic hematoma were considered as cases while pregnant women without sub chorionic hematoma were considered as controls. The diagnosis of sub chorionic haemorrhage was established by ultrasound. Data was analysed by SPSS version 22.0 for description, i.e., frequencies and percentages were calculated for categorical variables and for continuous variables, mean±standard deviation (±SD) was calculated. To compare preterm labour in both groups Chi-square test was applied and p≤0.05 was taken as significant. Stratification was done with regard to age, gestational age, parity, history of hypertension, and weight to see the effect of these variables on preterm labour. Chi-square test was used for post stratification for both groups and p ≤ 0.05 was considered statistically significant and relative risk was calculated.

RESULTS: The age range was from 18-40 years in group A with a mean age of 29.08±2.88 years while it was 28.41±2.94 years in group B. Mean gestational age was 13.99±3.15 weeks in group A and 11.42±3.37 weeks in group B. Mean parity was 0.91±1.14 in group A and 0.78±1.09 in group B respectively. Mean weight of subjects in group A was 68.31±10.27 and 67.55±10.09 Kg in group B. Majority of the patients were of 18-30 years in both groups (group A; 78.5% and group B; 78.9%). History of hypertension was noted in 33% in group A and 12.9% in group B. In group A, preterm labour was seen in 40 (19.1%) patients as compared to 61 (29.2%) patients in group B, (p=0.02, R.R=0.65).

CONCLUSIONS: Subchorionic hematoma in patients with threatened abortion during the first half of the pregnancy may not increase the risk of preterm labour.

PMID:34487655

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):447-450.

ABSTRACT

BACKGROUND: Serum Lactate Dehydrogenase (LDH) is an easily available bio marker used to determine prognosis in various Myeloproliferative Neoplasms (MPN). Its utility in Polycythaemia Vera (PV) is yet to be accessed. The purpose of this study was to determine the frequency of raised serum LDH in patients with JAK2 V617F positive PV patients and its clinic-pathological association.

METHODS: A cross-sectional study using non probability consecutive sampling was conducted at our institute from July 2018 to June 2019. Adult patients of either gender, newly diagnosed with JAK-2 V617F positive PV were included. Patients’ demographics, clinical characteristics and baseline CBC and LDH levels were analysed. Stratification was done with regards to age, gender, diabetes mellitus, hypertension, splenomegaly and thrombosis to see the effect of these modifiers on patients with raised LDH by using Chi Square test. p-value≤0.05 was considered as significant.

RESULTS: Forty patients were inducted in the study with male to female ratio of 2:1. Twenty-two (55%) patients had raised LDH levels and showed significant association with diabetes mellitus (p=0.001), splenomegaly (p=0.001) and thrombosis (p=0.018).

CONCLUSIONS: This study observed raised LDH levels in almost half of JAK2 V617F positive PV patient. It warrants a larger scale study and suggests the value of plasma LDH to be used as a future prognostic marker in PV.

PMID:34487654

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):431-436.

ABSTRACT

BACKGROUND: Breast cancer is the most common malignancy worldwide. Surgical treatment of axilla is a part of treatment of locally advanced breast cancer. Conventional knot tying plus electrocautery and advanced compressive energy sources are used to reduce the continued axillary serous fluid discharge when drains are in place and seroma formation afterwards.

METHODS: This double-blind comparative study was carried out from April 2018 to October 2019. In total 180 patients undergoing axillary dissection for treatment of locally advanced breast cancer were recruited. Patients were divided into two groups (C and H) depending upon method of dissection used for axillary surgery.

RESULTS: For most participants, amount of axillary drain volume in Group C was between 400-700 ml (in 48.9% participants) and for Group H more than 700 ml (in 44.4% participants). This difference is not statistically significant (p=0.288). Duration of hospital stay (p=0.003) and duration of drain placement was significantly longer (p=0.019) for most participants in Group H. More hospital visits were required for the said group. There was statistically significant co-relation between immediate complications and haemostasis techniques (p=0.003) with more incidence of Seroma noticed in Group H than in Group C.

CONCLUSIONS: Current study shows limited benefits of using ultrasonic scalpels in breast cancer surgeries. Variables such as BMI, Age and chemotherapy need to be controlled in order to derive a true comparison.

PMID:34487651

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):416-424.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a multisystem disorder and haematological abnormalities are frequently documented in affected patients.

METHODS: This retrospective study included 549 patients hospitalized with COVID-19 from 1st June to 15th July 2020 at Pak Emirates hospital, Rawalpindi Pakistan. p<0.05 was considered statistically significant.

RESULTS: Median age was 60 years (range 12-94 years), males 442 (80.5%) and females 107 (19.5%). There was no patient with mild illness, 181 (32.9%) had moderate, 158 (28.7%) severe and 210 (38.2%) patients had critical disease. Patients with severe and critical disease had lower absolute lymphocyte count (ALC) and platelets (p<0.001 for both) while higher white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and lactate dehydrogenase levels (LDH) levels (all p<0.001). Overall survival of study cohort was 83.2% (n=457). Median haemoglobin and platelet count were significantly lower (p<0.001) while WBC, ANC, NLR, prothrombin time (PT), activated partial thromboplastin time (APTT), ferritin, IL-6, LDH were significantly higher (p<0.001) for patients who died. On multivariate logistic regression analysis WBC count>10×109/l (odds ratio [OR] 2.19 [95% CI 1.3-4.2] p=0.01), NLR>9 (OR 3.4 [95% CI 0.87-6.8], p<0.001), platelets<150×109/l (OR 3.9 [95% CI 1.4-9.8] p<0.001), CRP >100; (OR 4.1[95% CI 0.78-10.9] p<0.001) and ferritin >1000 (OR 5.3 [95% CI 1.9- 13.5], p<0.001) were associated with increased risk of death in patients with COVID-19.

CONCLUSION: Monitoring of haematological, coagulation and inflammatory parameters provide reliable, convenient, rapid and cost-effective method for predicting disease severity, complications and prognosis of COVID-19 patients.

PMID:34487649

J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):368-375.

ABSTRACT

BACKGROUND: COVID-19 pandemic has severely affected the entire world. However, its severity and mortality rate are lesser in developing countries, including Pakistan. This study aims to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia.

METHODS: This cross-sectional study was conducted at two centres of Sindh, Pakistan. 521 HRCT chest performed from 1st May to 31st July 2020 were included and marked as “COVID-19 group”. 761 HRCT chest performed during the first six months of 2019 were retrospectively evaluated to determine the prevalence of prior pulmonary tuberculosis and marked as the “pre-COVID-19 group”. Previous pulmonary tuberculosis was documented as evidenced by clinical history, ATT intake and HRCT findings. Chi-square test was used to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia. A p-value of ≤0.01 was considered statistically significant.

RESULTS: In the “COVID-19 group”, 4.9% (n=26) patients had prior pulmonary tuberculosis. In the “pre-COVID-19 group”, 9.8% (n=75) patients had prior pulmonary tuberculosis with a confirmed history of tuberculosis in 8.9% (n=68) and without documented history in 0.9% (n=7) cases. A significant p-value of 0.001 was obtained with a confidence interval of 99%.

CONCLUSIONS: Prior pulmonary tuberculosis might have a protective effect against COVID-19 pneumonia which could be due to developed antibodies secondary to exposure to prior tuberculosis or BCG vaccination. Our results warrant further consideration due to the potential public-health benefits that can be achieved in our fight against the novel pandemic.

PMID:34487640

J Appl Clin Med Phys. 2021 Sep 6. doi: 10.1002/acm2.13419. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to verify the effectiveness of polylactic acid (PLA) template puncture route planning by comparing preoperative and postoperative dosimetry using computerized tomography (CT)-guided implantation of ¹²⁵ I radioactive seeds.

METHODS: A total of 28 patients who underwent ¹²⁵ I seed implantation between January 2018 and June 2019 were selected for the statistical study of seed dosimetry. All patients received preoperative treatment planning system (TPS) planning, of which 13 patients in the experimental 3D template group underwent intraoperative puncture and implantation using the PLA template planning route. The other 15 patients in the traditional control group underwent intraoperative puncture and implantation using CT images for guidance. By calculating the dose-volume histogram, preoperative and postoperative D90 values and postoperative V90 values were compared between the two groups.

RESULTS: The mean D90 values in the template group before and after surgery were 136.06 ± 7.10 and 134.72 ± 7.85 Gy, respectively. There was no statistically significant difference. The preoperative and postoperative mean D90 values in the traditional group were 132.97 ± 8.04 and 126.06 ± 9.19 Gy, respectively, which were statistically significantly different. The mean postoperative V90 values in the template and traditional groups were 93.80 ± 1.34% and 88.42 ± 6.55 %, respectively, showing a statistically significant difference.

CONCLUSIONS: The preoperative TPS plan for the experimental group guided by the PLA template was almost the same as that for the final guided particle implantation. The dose parameters in the experimental group were also better than those in the traditional group, making the use of the presented PLA template more efficient for clinical applications.

PMID:34487634 | DOI:10.1002/acm2.13419

Vet Ophthalmol. 2021 Sep 6. doi: 10.1111/vop.12929. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare intraocular pressure using the Icare® TONOVET Plus rebound tonometer in healthy brachycephalic and nonbrachycephalic cats.

ANIMALS STUDIED: Both eyes of 78 healthy cats were investigated in this study. Cats were divided into two groups: brachycephalic (n = 39) and nonbrachycephalic (n = 39).

PROCEDURES: Nose position and muzzle ratio were photographically recorded and analyzed. Physical and ophthalmic examinations were performed. Intraocular pressure was measured using the Icare® TONOVET Plus rebound tonometry instrument. Quantitative mean values were statistically compared using an unpaired t-test at a significance level of p < .05.

RESULTS: Mean values of the nose position and muzzle ratio were significantly lower in the brachycephalic group (20.14 ± 5.43%, 9.61 ± 3.29%) compared with the nonbrachycephalic group (29.21 ± 4.30%, 13.97 ± 6.01%). The mean intraocular pressure for brachycephalic cats (15.76 ± 0.50 mmHg) was significantly lower (p < .001) than for nonbrachycephalic cats (18.77 ± 0.49 mmHg).

CONCLUSIONS: Intraocular pressure was significantly lower in brachycephalic cats using the Icare® TONOVET Plus rebound tonometer. Intraocular pressure values obtained in this study could be used as a guideline for measurements obtained using this tonometry device in healthy brachycephalic and nonbrachycephalic cats.

PMID:34487613 | DOI:10.1111/vop.12929

J Magn Reson Imaging. 2021 Sep 6. doi: 10.1002/jmri.27911. Online ahead of print.

ABSTRACT

BACKGROUND: Corticospinal tract (CST) injury has been shown to exert a major influence on functional recovery after ischemic stroke.

PURPOSE: To evaluate the prognostic value of CST injury estimated using a recent developed tractometry-based method.

STUDY TYPE: Prospective.

POPULATION: Forty-eight patients with CST damage induced by stroke lesion who underwent brain magnetic resonance imaging within 7 days from onset.

SEQUENCE: Diffusion-weighted imaging (b = 1000 seconds/mm² ) and diffusion kurtosis imaging (DKI) spin-echo echo-planar sequence with three b-values (0, 1250, and 2500 seconds/mm² ) at 3.0 T.

ASSESSMENT: A recently developed approach that combines tract segmentation and orientation mapping was used for CST-specific tractography and tractometry. CST injury was estimated using the proposed method with diffusion metrics extracted from DKI sequence and with the first principal component (PC1) of the metrics. We also calculated the weighted lesion load (wLL) for comparison. Clinical evaluation included the National Institutes of Health Stroke Score in the acute phase and the modified Rankin scale at 3 months post-stroke. The correlations between CST injury and initial motor impairment, as well as the prognostic values of CST injury for functional outcomes were evaluated.

STATISTICAL TESTS: Pearson correlation and logistic regression. Area under the receiver operating characteristic curve. P < 0.05 was considered statistically significant.

RESULTS: CST injury calculated with diffusion metrics except fractional anisotropy all showed significant correlations with initial motor impairment. PC1 achieved the largest correlation coefficient (R = 0.65) compared with wLL and other diffusion metrics. In addition to wLL, DKI_AK, AFD_total, and PC1 maximum all showed predictive values for functional outcomes.

DATA CONCLUSION: Structural injury to CST is important for the assessment of the extent of injury and the prediction of functional outcome. The method proposed in our study could provide an imaging indicator to quantify the CST injury after ischemic stroke.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 1.

PMID:34487595 | DOI:10.1002/jmri.27911