Tag: nevin manimala

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

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):734-737. doi: 10.55519/JAMC-04-13574.

ABSTRACT

BACKGROUND: The aim was to assess the clinical outcome of non-anatomic rotator-cuff repair in large tears not amenable to anatomic repair and to assess the preoperative factors that affect the result of such repairs. A retrospective case-series at Ghurki Trust Teaching Hospital, Lahore. Twenty-seven cases that underwent non-anatomic rotator-cuff repair at GTTH over the last 5 years and met inclusion criteria were assessed over a three-month study period (from 01/10/2023 to 31/12/2023).

METHODS: Outcome was assessed in terms of improvement in pain as per visual-analog-scale (VAS), UCLA, as well as Constant score. Furthermore, patients’ satisfaction was also assessed to measure subjective efficacy of the procedure.

RESULTS: Most commonly cases of rotator cuff tear present with pain, weakness, and restriction of shoulder range of motion. Pain improved significantly (p<0.001) from preoperative score of 3.68 to 1.45. Analysis of the objective assessment showed statistically significant (p=001) improvement in Constant score from a preoperative average score of 63.63 to a postoperative average of 77.27, with significant improvement (p=0.05) in each individual scoring criteria as well. The other scoring studied: UCLA also improved significantly (p=0.001) from 25.36 to 30.18. Despite this, on subjective assessment 40.9% of the sample was very satisfied and 27.3% were satisfied with the outcome.

CONCLUSIONS: Non-anatomic repair is very effective at treating the presenting complaints of the rotator cuff tear patients. Thus, alongside good clinical outcome, patient satisfaction can be predicted after the procedure.

PMID:40121633 | DOI:10.55519/JAMC-04-13574

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):730-733. doi: 10.55519/JAMC-04-13720.

ABSTRACT

BACKGROUND: Accurate and comprehensive documentation during emergency admissions is crucial for ensuring patient safety. This is especially important in high-risk environments such as neurosurgery. Traditional freehand clerking methods often result in incomplete or inconsistent records, potentially compromising patient care. This study aimed to evaluate the impact of introducing a structured surgical clerking proforma on the quality of emergency admission clerking in a tertiary care neurosurgery unit.

METHODS: A three-phase comparative audit was conducted, comprising an initial audit of traditional clerking methods (Cycle 1), the implementation of a surgical clerking proforma, and a subsequent re-audit using the proforma (Cycle 2). Data were collected retrospectively from 40 patient records in Cycle 1 and prospectively from 30 patient records in Cycle 2. The completeness of documentation was assessed across 31 key parameters, and statistical significance was determined using paired t-tests on simulated data.

RESULTS: The introduction of the surgical clerking proforma resulted in significant improvements in documentation completeness, particularly for parameters such as the Consultant Responsible and Reviewing Doctor, which saw increases of 30% and 32.5%, respectively (p<0.05). These improvements underscore the effectiveness of the proforma in standardizing and enhancing the reliability of clinical documentation.

CONCLUSIONS: The structured surgical clerking proforma significantly improved the quality of emergency admission documentation in the neurosurgery unit. The findings support the broader adoption of such proformas across various medical specialties to enhance the accuracy, consistency, and reliability of clinical records, ultimately contributing to improved patient care and safety.

PMID:40121632 | DOI:10.55519/JAMC-04-13720

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):726-729. doi: 10.55519/JAMC-04-13758.

ABSTRACT

BACKGROUND: Diabetes mellitus is a disease with many possible complications like macrovascular, i.e., stroke, coronary artery disease, peripheral artery disease, and microvascular, i.e., retinopathy, neuropathy and nephropathy. Many studies have been done in past to find the frequencies of these complications and their association with sociodemographic determinants of diabetic patients, but there was limited data available in our setup. This study was carried out to determine the frequency of micro and macrovascular complications of diabetic patients and their association with socioeconomic determinants at Ayub Teaching Hospital, Abbottabad.

METHODS: This cross-sectional study was carried out at Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2022 till December 2023 on 113 diabetic patients. The data was collected on micro and macrovascular complications of diabetes on a pre-designed structured proforma and analyzed by means of SPSS-23.

RESULTS: The most common macrovascular complication was coronary artery disease 10 (8.8%) while neuropathy 35 (31%) was the most common microvascular complication. Among macrovascular complications stroke was associated significantly with age (p=0.01) and duration of diabetes (p=0.032). Among microvascular complications neuropathy was associated with gender (p=0.047), nephropathy with smoking (p=0.02) and retinopathy with both gender (p=0.019) and smoking (p=0.017).

CONCLUSIONS: In this study there was significant association between, gender with neuropathy and retinopathy, smoking with nephropathy and retinopathy, stroke with age and duration of diabetes.

PMID:40121631 | DOI:10.55519/JAMC-04-13758

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):698-701. doi: 10.55519/JAMC-04-12375.

ABSTRACT

BACKGROUND: This audit primarily assesses compliance with the British Thoracic Society guidelines (BTS) for oxygen prescriptions in the Respiratory Department at King’s Mill Hospital. The results of this audit aim to guide the strategies to improve the oxygen prescription practices in the Trust.

METHODS: We collected the data on oxygen prescriptions, from the electronic prescribing system, of all the patients admitted in the three respiratory wards of King’s Mill Hospital over the period of one week. This data was then recorded and analysed using Audit management and Tracking© (AMAT).

RESULTS: The overall compliance score to BTS guidelines for oxygen prescription was 12.2%. Out of the 152 patients, only 8 (5%) had oxygen therapy prescribed and a target oxygen saturation range was identified. No patient had an identifiable oxygen delivery method on their prescription.

CONCLUSIONS: The current practices of oxygen prescription at the respiratory department of King’s Mill Hospital are suboptimal. These findings highlight the risk of serious potential consequences and the opportunity to implement safe prescribing measures for oxygen, like other prescribed medications.

PMID:40121625 | DOI:10.55519/JAMC-04-12375

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):686-691. doi: 10.55519/JAMC-04-13550.

ABSTRACT

BACKGROUND: Admission for heart failure poses a significant risk of readmission. Evaluating readmission rates in settings lacking chronic disease management programs could provide valuable insights to advocate for the establishment of such services.

METHODS: This study focused on patients admitted to the Cardiology Department of Ayub Medical Teaching Institute with acute decompensated heart failure. After excluding patients based on exclusion criteria, demographic and clinical data were recorded, including symptoms, signs, discharge medications, and readmission status within 6 months. Patients not readmitted were contacted via telephone at 1, 3, and 6 months. Readmission rates and time to first readmission or death were documented.

RESULTS: A total of 222 patients were enrolled, with 60% being males. All patients exhibited pulmonary congestion, with 85% classified as NYHA Class III or IV. Comorbidities included hypertension (59%), history of myocardial infarction (45.49%), and diabetes (38.28%). Within 6 months, 21% of patients were readmitted, and 13% died before readmission, resulting in an overall death or readmission rate of 34% at 6 months. No significant differences were observed between readmitted and non-readmitted patients regarding sex, age, creatinine levels, haemoglobin levels, sodium levels, or ejection fraction. Utilization of guideline-directed medical treatment was low.

CONCLUSION: The high rate of readmission or death among patients admitted with acute decompensated heart failure underscores the necessity for implementing multidisciplinary care to closely monitor these patients.

PMID:40121623 | DOI:10.55519/JAMC-04-13550