Pakistan journal of Advances in Medicine and Medical Research

Lumbar Spinal Stenosis Due To Spodylolisthesis- Surgical Compared With Nonsurgical Treatment

2024-07-17T20:16:13+00:00

Background: Lumbar spinal stenosis with spondylolisthesis stands for severe pain and dysfunction because of the narrowing of the spinal canal and vertebral slip. With patients being treated either surgically or by other methods, distinction between the two is necessary to resolve controversies.

Objectives: To conduct a comparative analysis between surgery and non-surgery in the management of lumbar spinal stenosis with spondylolisthesis using observational and randomized control study groups.

Study Design: A Observational and randomized cohort comparative study

Place and duration of study : department of neurosurgery lady reading hospital Peshawar from jan-2020 to jan-2023

Methods: Based on the observational and randomized cohort study conducted in the period jan-2020 to jan-2023 in the Lady Reading Hospital, 604 patients were included in the study. Collectively, treatment embraced either surgical untethering or other mean. Specific patient outcomes such as pain relief and functional gain were measured during the follow-up which ranged up to 3 years.

Results: In terms of body pain, surgical intervention provided statistically significant and more superior results in a mean of 18. 1 as compared to nonsurgical management over 3 years of follow up, similarly for physical functions the mean improvement was of 18. 3 and for Oswestry Disability Index it was 16. 7.

Conclusion: The decision of preferring surgical intervention for the treatment of lumbar spinal stenosis with spondylolisthesis correspond to the maximum long term advantages of surgical over non surgical treatment principles focusing on the pain relief and functional recovery. Therefore, the present outcomes favour surgical management as the most preferred treatment approach with the adoption of individualised management plans following thorough clinical examinations of the patients.

Keywords: Spinal Stenosis, Spondylolisthesis , Surgery Outcomes

RNA Drug As Therapeutic Agents: A Review Based On Literature.

2024-07-17T20:24:33+00:00

Small RNA targeted drugs have received significant interest from the public and researches in the last decade due to their capability in treating different illnesses. RNA drugs corresponds to the small molecules which interact with and regulate the expression of particular genes at the level of RNA. Unlike ordinary small molecular chemicals, RNA drugs act directly on the nucleus and gene to produce very efficient and effective curative functions. Some of the RNA drugs are siRNA, ASOs, and mRNA, although the last one is used in vaccines. Both compounds, SiRNA and ASOs, act by attaching to the target mRNA chain and, as a result, the latter can be degraded or prevented from being translated into a protein. Onc the other hand, mRNA vaccines involve introducing a particular mRNA sequence into cells, and the outcome is that cells synthesize a certain protein that can be a viral antigen to spark an immune response. The RNA drugs have demonstrated quite significant outcomes with initial trials for diseases like cancer, genetic disorders as well as certain infections. For instance, siRNA based drugs are introduced for the treatment of hereditary transthyretin amyloidosis which is a rare genetic disease and ASO based drugs for spinal muscular atrophy. mRNA vaccines have also been developed to fight against the epidemic such as COVID-19. However, there are few major issues that have to be considered with regard to RNA drugs These are: These are; problems of drug delivery and stability; and issues to do with side or off-target effects. Despite of these hurdles, RNA drugs are a promising new category of drugs for diseases that can be treated by this technique. As the research work in the field of RNA medicine grows, the public might observe more RNA-based drugs being approved for the clinical use in the future years.

Keywords: RNA Drug, Therapeutic Agents, A Review

Managing Glycemic Control in Pregnancy: Comparing Antidiuretic Medications and Insulin Regimens"

2024-07-23T16:08:01+00:00

Background: The disease known as gestational diabetes mellitus, or GDM, was first identified as a result of reduced glucose tolerance during pregnancy. Glycemic management must be maintained to prevent negative effects for both the mother and the foetus. We evaluate the efficacy of insulin and anti-diabetic regimens in the treatment of GDM in this research.

Objectives:

to assess the effectiveness of insulin regimens and anti-diabetic medications in controlling blood sugar levels during pregnancy in relation to the family objectives of the patient, such as a healthy baby, and to provide medical professionals with information on the best ways to treat gestational diabetes mellitus.

Study design: A cross sectional study.

Place and duration of study. Department of endocrinology hmc peshwar from 10-Feb 2022 to july Feb-2022

Methods:The study used a cross-sectional methodology. To locate relevant randomised controlled trials comparing different insulin regimens and antidiabetic drugs in pregnant women with gestational diabetes mellitus (GDM), a thorough search was carried out across major electronic databases. Included were studies that reported on glycemic control outcomes, such as HbA1c levels, fasting blood glucose levels, and the incidence of unfavourable outcomes for either the mother or the foetus. Both the quality evaluation and data extraction were carried out separately by two reviewers. To analyse the effectiveness of various therapies while taking both direct and indirect evidence into account, a network meta-analysis was carried out. Sensitivity analysis were carried out to evaluate how solid the results were. Based on variables such maternal health condition and gestational age, subgroup analyses were carried out. The objective of the synthesised data was to enhance the outcomes for women with gestational diabetes mellitus (GDM) by offering insights into the relative effectiveness of insulin regimens and antidiabetic drugs in glycemic management during pregnancy.

Results:There were 100 participants in the research, with an average age of 28. The biggest impact on HbA1c levels was from insulin treatment (mean decrease = -1.5%), which was followed by oral hypoglycemic medications (mean reduction = -1.2%) and modifying one's lifestyle (mean reduction = -0.8%). The trends in fasting blood glucose levels were comparable. The results for mothers and foetuses, including birth weight and Apgar ratings, did not vary statistically across the treatment groups, suggesting that glycemic management is essential irrespective of the therapeutic approach.

Conclusion: Our study emphasises the value of individualised methods to treating GDM, with a focus on the effectiveness of oral hypoglycemic medications, insulin therapy, and lifestyle changes in achieving glycemic control. Further investigation into the long-term impacts on maternal and foetal outcomes is necessary to enhance clinical practice.

Keywords: gestational diabetes, glycemic control, antidiabetic medications, insulin therapy

A Comparison of Oral and Intravenous Treatments in Managing Spontaneous Bacterial Peritonitis

2024-07-23T17:39:14+00:00

Abstract

Background: In cirrhotics, spontaneous bacterial peritonitis (SBP) is a potentially fatal illness that requires immediate antibiotic administration. This meta-analysis aimed to examine the effectiveness of IV and oral antibiotics in patients with SBP.

Objectives: We compared the efficacy, safety, and cost-effectiveness of oral vs intravenous antibiotic therapy for the treatment of SBP using data from a retrospective cohort analysis.

Study design: Retrospective cohort study

Place and duration of study: A tertiary care Hospital in Peshawar from Jan 2022 to Jan 2023

Methods:At Tertiary Care Hospital Peshawar, a Retrospective Cohort Study was conducted including all patients diagnosed with SBP between January 2022 and January 2023. The patients were split into two groups based on the kind of antibiotics administered: Group B: patients in need of ampicillin, cephalosporines, or IV IV therapy; Group A: patients on oral antibiotics and ciprofloxacin/cotrimoxazole with norfloxacin (patient 44). Patients who were eighteen years of age or older were eligible for inclusion. Based on an ascitic PMN cell count of ≥250 cells/mm³ and positive bacterial cultures, they were diagnosed with hospital-acquired SBP. Secondary peritonitis and serious co-morbidities requiring non-study antibiotic therapy were excluded criteria.

Results:Group B, which received metronidazole orally, had an 85% resolution rate and an in-hospital mortality rate.The highest mortality rate and length of hospital stay were determined to be 10% and 7 ±3 days, respectively. With a 90% resolution rate and a roughly 8% overall mortality rate, Group B only needed to stay in the hospital for 10 (±4) days. 15% recurrences in Group A Group B: 12 percent recurrences

Conclusion:Oral antibiotics are statistically no different from IV in terms of mortality, length of stay, or other outcomes when used to treat SBP. The proven outcomes back up the introduction of oral therapy for individuals who qualify in order to improve adherence and save costs.

Keywords: Oral antibiotics, Systematic & individual, IV therapy

Changes in Blood Vessel Morphology in Erythematous Skin of Atopic Dermatitis Patients

2024-07-24T02:53:02+00:00

Background: Atopic dermatitis is an inflammatory skin disease characterized by erythematous changes and abnormalities in microvasculature. Regarding the research questions, this cross-sectional study conducted from January 5 to July 5, 2019 at Watim Medical and Dental College, Rawat and the findings on observed vascular alterations supposed to present the mean age, standard deviation and p-value as follows:

Objectives: , the morphology of the blood vessels in the erythematous skin of the patients with AD and controls matched based on their age will be examined.

Study Design: A Cross-sectional study.

Place and Duration of Study: from 05-Jan-2019 to 05-Jan-2020 in the Department Pathology, Watim Medical and Dental College Rawat, Pakistan.

Methods: This descriptive cross sectional study recruited the patients from the Department of Pathology, Watim Medical and Dental College, Rawat over a period of six months from January 5, 2019 to July 5, 2019. Adult patients, comprising 100 in number, diagnosed to have atopic dermatitis were used in the study. The patient ages were noted down and dermoscopy of the morphological changes occurring in the blood vessels at erythematous lesions were observed. Descriptive statistics were used in a bid to calculate mean age, standard deviation as well as the p-value. This research study was reviewed and cleared by the Institution’s ethical committee before its conduct.

Results: Patients 100 Patients were selected for the study, Moreover the patients diagnosed with atopic dermatitis were between the age group of 18-65 years with mean age of 35. 4 years (SD 12. 7), refer to the table 1. Morphological assessment of blood vessels in erythematous skin showed that 60% of the patients were having abnormal morphological pattern whereas 40% of patients demonstrated normal morphology (table 2). Co-relating and comparing the normal and altered Vascular architecture mathematical statistics revealed the fact with P-values equal to 0. 045 (Table 4). The findings of increased vascular alterations in lesions of atopic dermatitis evident from the results in Table 5 indicate that blood vessel alterations are associated with the severity of skin condition rashes.

Conclusion: our study identify that extensive vascular changes at the skin of those with atopic dermatitis while stressing on the importance of these changes in disease progression. Targeted therapies for the aforementioned vascular changes could be promising in the future as compared to the ones that address mere clinical manifestations.

Keywords: AMD, Vasculature, Redness of the Skin, Swelling.

Comparative Study of Cognitive Decline in Elderly Patients Using Benzodiazepine vs. Non-Benzodiazepine Anxiolytics

2024-08-01T18:04:27+00:00

Background: Among elderly patients with the anxiety disorders, anxiolytic prescriptions, including benzodiazepines and non-benzodiazepine sedative agents are frequently used. However, these medications are known to have the risk of having serious effects on cognition. The main purpose of the current research is to determine a comparative rate of dementia in elderly patients on benzodiazepines or non-benzodiazepine anxiolytics.

Objectives: First of all, the efficacy of benzodiazepine and non-benzodiazepine anxiolytics will be compared with helping of short-time memory, attention, and main executive abilities in the elderly patients.

Study Design: A Observational prospective cohort study

Place and Duration of Study: Department of Pharmacy, Lady Reading Hospital-Peshawar, starting from: 05 January 2021 till: 05 July 2022.

Methods: This study was conducted on 150 elderly patients provided with either benzodiazepines or non-benzodiazepine anxiolytics with equal division of the groups into 75 each. The patients’ cognitive function was evaluated by Mini-Metal State Examination (MMSE), Montreal Cognitive Assessment (MoCA) at the beginning and after six months of medication. The participants’ demographic characteristics showed that the mean age was 70. 5 years, with 5. 3 years standard deviation. The results of systematically cognitive tests were analyzed with one-way ANOVA to compare them, while ‘p-value less than 0. 05’ was established as significant.

Results: Compared with non-benzodiazepine anxiolytics users, the patients on benzodiazepines received lower cognitive scores. Pre and post intervention mean MMSE score in the benzodiazepine group were 26. 2(± 2. 0), 22. 8 (± 2. 9) respectively (t= 6. 245; p < 0. 01) and non benzodiazepine groups 26. 5 (± 2. 1), 24. 7 (± 2. 7) respectively (t = Likewise, pre-treatment and post-treatment mean MoCA scores for the benzodiazepine group were 24. 4 (± 2. 3) and 20. 9 (± 2. 6) respectively and for the non-benzodiazepine group the scores were respectively 24. 8 (± 2. 4) and 22. 5 (± 2. 5).

Conclusions: Benzodiazepine is more clinically linked with the increased rate of cognitive decline in elderly patients as compared to non-benzodiazepine anxiolytics. Therefore, these results support the use of treatment precautions when using anxiolytics for elders and weighing the possibility of reducing anxiety with the potential of yielding short-term memory loss.

Keywords: cognitive performance; Anxiolytics, elderly

Histological Analysis of Enamel Microstructure in Response to Dietary Habits: Comparative Study A cross Different Populations

2024-08-02T04:22:07+00:00

Background: The protective role of enamel against physical and chemical injury is well documented. Despite being classified as connective tissue, with its composition and microstructure dominated by hydroxyapatite crystals it is the hardest in the human body

Objective: The purpose of this study is to investigate the histological changes in enamel microstructure that occur when distinct populations follow different food habits.

Study Design: This study employs a comparative cross-sectional design.

Duration and Place of the Study: This study was conducted at Department of pathology Watim medical and dental college, Rawat , from 3^rd June 2022 to 2^nd May 2023.

Material and Methods: A sum of 300 dental examples were acquired from members having a place with one or the other, High Carbohydrate Diet Group (n=95): people accounting their principle dietary consumption high-carb nourishments like grains/pay/aries and starches. High-Proteins Diet Group (n=108): participants who had the highest consumption of protein-rich foods, such as meat products, legumes and dairy. Mixed Diet Group (n=97): People with intermediate consumptions of carbohydrates, proteins and fats Subsequently, study participants were determined to best represent the two diet groups based on dietary surveys and medical histories.

Results: In total, 300 participants are considered in this research, with the mean age of the group on HC totals 3.5 ± 1.3 years, HP group 3.4 ± 9.2 years, and MD group 3.6 ± 1.1 years. The gender distribution also shows similar characteristics, males are 55.8% in HC group, 46.3% in HP group, and 52.6% in MD group; females are 44.2%, 53.7%, and 47.4%, respectively. Concerning the age range, the major cluster is 26-35 years old and 36-45 years old cohorts, which proves the majority of the middle ages.

Conclusion: Our results indicate that decomposition is a major factor affecting the surface morphology, structure and health of enamel.

Clinical Audit Evaluation of Septic Shock Management in Medical Unit, Ayub Teaching Hospital A Retrospective Analysis and Comparison with Updated NICE Guidelines

2024-11-25T10:28:05+00:00

Background: Septic shock is a critical condition requiring prompt and effective management to improve patient outcomes. This clinical audit evaluates the adherence to updated NICE guidelines for septic shock management in the Medical Unit at Ayub Teaching Hospital.

Aims & Objectives: Evaluate the proportion of septic shock patients among all admissions. Assess adherence to updated NICE guidelines for septic shock management. Analyze demographic Distribution of septic shock patients. Review management practices including oxygen administration, blood cultures, fluid resuscitation, serum lactate measurement, broad-spectrum antibiotics, and norepinephrine support. Evaluate patient outcomes (recovery vs. mortality).

Methods: A retrospective analysis was conducted from Jan 10, 2023, to March 10, 2023, involving 34 septic shock patients out of 450 total admissions. Data were collected on demographics, management practices, and patient outcomes. Adherence to key components of the NICE guidelines, including oxygen administration, blood cultures, fluid resuscitation, serum lactate measurement, broad -spectrum antibiotic use, and norepinephrine support, was assessed.

Results: Of the 34 patients, 59% were female, and 88% were over 50 years old. The most common cause of sepsis was urosepsis (44%). Adherence to guidelines varied: oxygen administration (65%), blood cultures before antibiotics (53%), fluid resuscitation (50%), norepinephrine support (45%), serum lactate measurement (56%), broad-spectrum antibiotics (50%), and urine output monitoring (62%). The overall mortality rate was 59%.

Conclusion: Significant deviations from NICE guidelines were observed, particularly in timely antibiotic administration, fluid resuscitation, and norepinephrine support. These deficiencies likely contributed to the high mortality rate. Recommendations include staff train ing, protocol improvements, and continuous audits to enhance guideline adherence and patient outcomes.

Keywords : Septic shock management, NICE guidelines, adherence, mortality