Pakistan journal of Advances in Medicine and Medical Research

Nutritional Deficiencies, Vitamin D Levels, and other Risk Factors in Pediatric Tuberculosis Patients

Fri, 05 Jul 2024 00:00:00 +0000

Abstract

Background: Tuberculosis (TB) is a major world health challenge affecting more than 9 million people every year of which more than 1 million are children. It presents non-specific symptoms and for this reason has been described as a silent epidemic, especially in the diagnosis of childhood TB, especially in bacteriological confirmation. Understanding the risk factors of TB in children is therefore important.

Objectives: to describe socio-economic, environmental, and health related characteristics of childhood TB patients in Nowshera, Pakistan, and their risk factors in order to propose public health interventions.

Study design: A Cross-Sectional-Study

Place and duration of study: This research study was conducted in Nowshera Medical College / Qazi Hussain Ahmed Medical Complex situated in Nowshera, Khyber Pakhtunkhwa province of Pakistan over a period of eight months starting from 1st January 2023 to 31st August 2023

Materials and Methods: A cross-sectional study was carried out at the paeds ward and Biochemistry Department of Nowshera Medical College / Qazi Hussain Ahmed Medical Complex Nowshera from 1st January 2023 to 31st August 2023 and comprised of 130 patients. In this study, Convenience sampling (Non probability) was used. The data was collected by a structured questionnaire and analyzed by statistical package for the social sciences (SPSS version 24). Quantitative data were described by measures of central tendencies; mean and standard deviation and qualitative data were described by frequencies and percentages. Chi-square test was used to test the relationship between variables where the level of statistical significant was set at P ≤ 0. 05.

Results: Participants included mainly the study population of children aged 0-15 years, and the gender was equally split throughout boy 50% and girls 50%. A large percentage (69. 2%) were from low-income earners’ homes, and 66. 9% of the respondents were from rural areas. Subjects’ Body Mass Index (BMI) varied from less than 18 to more than 25. Of special interest, 43. 8% of the children with TB had not been administered BCG vaccination. The source of infection, that is, contact with an adult TB patient, was reported in 43. 8% while the rest were in the 56. 2 % who had no such history.

Conclusion: childhood TB in the population under study is significantly related with some factors namely; direct contact with TB patients, low economic status, crowded housing, poor ventilation and malnutrition.

Keywords: Tuberculosis, Nutritional status, Vitamin D, socioeconomic status

Histopathological Features of Oral Cancer: Diagnostic and Prognostic Indicators

Momina khadija Abbasi, Aiza saadia, Naila Abrar — Fri, 05 Jul 2024 00:00:00 +0000

Background: Oral cancer, mostly oral squamous cell carcinoma (OSCC) was shown to be one of the principal causes leading to a great health burden worldwide with significant morbidity and mortality

Objective: The objective of our research was to build an archetypal portrait of histopathological scenario in oral cancer and the clinical importance that can be leveraged as efficacious diagnostic markers for conducting precision diagnostics.

Study Design: A Retrospective Study.

Duration and Place of the Study: This study was conducted at Department Watim medical and dental college, Rawat, between 3^rd February 2023 to 2^nd January 2024.

Material and Methods: This research comprised of 200 patients having oral squamous cell carcinoma (OSCC) and other malignancies in oral region. Criteria for inclusion: patients having a histologically confirmed diagnosis of oral cancer with complete clinical records and enough biopsy tissue samples. The exclusion criteria were recurrent tumors, previous chemotherapy or radiotherapy and incomplete histopathological records.

Results: The study population was the 200 patients diagnosed with oral cancer. The mean age of our patients at the time of diagnosis was 58.4 ± 12.3. The age range was as follows; 16.0% of the patients were under 40, 53.5% patients were 40-60, 30.5% patients wer over 60. Well-differentiated tumors had a baseline HR 1.00, whereas the HR in moderately differentiated cases was 1.45 (95% CI: 1.10-1.90, p=0.02) and in poorly differentiated 2.10 (95% CI: 1.50-2.90, p<0.01).

Conclusion: Our study in oral cancer supplied a comprehensive assessment on the histopathological and IHC characteristic of it for revealing their diagnostic, and prognostic functions.

Keywords: Histopathology, Oral Cancer, Diagnostic Indicators, Prognostic Markers.

Formation of the Mandibular Condylar Cartilage in Human Specimens Between 10 and 15 Weeks of Gestation

Zahid Sarfaraz, Nighat Aar, Muhammad Qaseem, Saad Ahmed — Fri, 05 Jul 2024 00:00:00 +0000

Background: The study examines some morphological and histological factors that may contribute to condylar cartilage (CC) formation. The specimens used were consecutive sections obtained from 20 human fetuses ranging in age from 10 to 15 weeks. The vascular canals (VC) emerge in the CC and initiate the process of intramembranous ossification. The mandibular condylar cartilage is crucial for the growth and function of the mandible, and it also contributes to the development of the Temporomandibular joint. Understanding the development of mandibular condylar cartilage throughout the early stages of gestation is essential for detecting congenital craniofacial deformities.

Objectives: Examine the stages of MCC development in human samples from fetuses at 10-15 weeks of gestation.

Study Design: A descriptive Cross-sectional Study.

Place and Duration of Study: Department of Anatomy and Obstetric Nowshera Medical College from 15th Nov 2020 to 1^st Jun 2021. The changes in the shape and size of the bones and the processes of bone formation should also be determined.

Methods: The current study is descriptive, cross-sectional, and involves post-mortem human fetal specimens aged 10-15 weeks. The specimens were obtained from the Department of Obstetrics of QHAMC after miscarriages and intrauterine deaths. The absence of external and congenital malformations was verified. Light microscopic and histological assessment was done with the aid of H&E-stained sections.

Results : Twenty fetal specimens were used in the study, with an average gestation period of 12. 5 weeks (±1. 5 weeks). Histological analysis revealed gradual chondrocyte maturation and the beginning of the ossification process. At ten weeks, MCC was comprised of undifferentiated mesenchymal cells. At twelve weeks, it is possible to observe the differentiation of chondrocytes and early ossification. At 15 weeks, the ossification stages of the CRL were at a superior level with the hypertrophic chondrocytes and mineralized cartilage. The p-values for differences in developmental stages between the gestational ages were less than 0. Hence, the differences were statistically significant.

Conclusion: The MCC in human specimens at 10–15 weeks' gestation undergoes considerable morphological transformation and commences the ossification process. Knowledge of these stages is essential in identifying and intervening in congenital craniofacial disorders. The authors recommend that future studies focus on investigating molecular processes that may contribute to the development of MCC.

Keywords: Mandibular condylar cartilage, Development, Gestation, Ossification

Determinants and Causes of Acute Kidney Injury: A Retrospective Study

Rahmat Ali Khan, Aysha Rahmat — Fri, 05 Jul 2024 00:00:00 +0000

Background: Acute Kidney Injury (AKI) stands out as a global public health issue defined by an individual's abrupt kidney dysfunction.

Objectives: sought to establish the predisposing factors and causes of AKI in one hundred patients. The following is a presentation of this broader study’s results, aimed at outlining the demographics and causes of AKI among this populace.

Study Design: A Retrospective Study

Place and duration of study. Department of Nephrology Miagul Abdulhaq Jahanzeb kidney hospital SWAT Six-month study period from May 1 to May 7, 2023

Methods: The current research was a cross-sectional, descriptive, and quantitative study conducted on 100 patients diagnosed with AKI during the period of one and half-year starting from January to July 2020 at Swat. Information was thus obtained from charts using patients’ demographic data, clinical features, laboratory investigations, underlying diseases, and outcomes. The study was conducted in compliance to established ethical procedures in order to protect the patients’ identities and data validity.

Results: This concerned a group of 100 patients, and the following observations were made on them: The demographic majority were male, and their average age was 55 years. Clinical presentation: Oliguria 45% of the patients, Edema 30% of the patients Fatigue 25% of the patients Laboratory Diagnosis Serum creatinine average was 3. 2 mg/dl. Blood urea nitrogen average was 45mg/d Underlying Conditions: Comorbidities included hypertension, diabetes mellitus, and sepsis. Of the above, hypertension was most common at 40% Others included diabetes mellitus at 35% and sepsis at 25% Outcomes: 60% of the patients recovered fully, 20% developed chronic diseases of the kidneys and the final 20% died.

Conclusion: This study also found that hypertension, diabetes, and sepsis are some of the major determinants that predispose people to AKI. Timely screening and addressing of these diseases should be a priority to help decrease the AKI rate and enhance the Peshawar individuals’ well-being.

Keywords: acute Injury, Determinants, Causes

Exploring The Prevalence And Underlying Causes Of Anemia In Hemodialysis Patients. A Cross-Sectional Study

Liaqat Ali, Mohmmand Shahzad, Faiza Hayat — Fri, 05 Jul 2024 00:00:00 +0000

Background: Anemia is a common complication among patients with chronic kidney disease (CKD), especially those

who are on hemodialysis. It also has a marked effect on their Quality of Life and with it, the morbidity-morbility. This research aimed to evaluate the frequency and incidence of anemia in hemodialysis patients at IKD

Objectives: to find out the incidence and etiological factors responsible for anemia in hemodialysis patients at IKD

Study design: a cross-sectional study

Duration and place of study. From 05- June 2023 to 05-Aug 2023 department of urology institute of kidney diseases Peshawar

Methods

This study was designed as a cross-sectional analysis on 200 hemodialysis patients of IKD Demographics, clinical parameters and laboratory values were collected. Anemia was characterized by an hemoglobin <13 g/dL in men and

<12 g/dL for women. Statistical Analysis: Descriptive statistics, including mean and standard deviation assisted by the p-value for determining significance.

Results

Out of 200 Patients had a mean age of 58.4 years (SD =12.6). 85% of patients had anemia, with a mean hemoglobin

10.2 g/dL (SD 1.4) in anaemic patient's. The main causes of anemia were iron deficiency (60%), inflammatory states (40%) and erythropoietin resistance(alone or in combinations) for 25%, respectively. Anemia prevalence was significantly associated with all the comorbidities and with increased duration of hemodialysis.

Conclusion

Anemia is highly prevalent among hemodialysis patients at IKD, most often attributed to iron deficiency and inflammation. Treatments are effective as long the condition can be caught early and so, regular monitoring is vital for a more positive prognosis. Additional investigation is necessary to improve anemia care in this population.

Keywords: Anemia, Hemodialysis, Prevalence, Causes

Effectiveness of Different Oral Hygiene Practices in Preventing Periodontal Diseases among Diabetic Patients

Ahmed Khan, Muhammad Naeem, Raham zaman — Fri, 05 Jul 2024 00:00:00 +0000

Background: Diabetes mellitus is a vicious system and exacerbates multitude of periodontal diseases due to impaired immune immune response, defense systems and their ability to repair. The realization that diabetic patients face a higher risk for severe periodontal complications underscores the importance of good oral hygiene practices and regular dental maintenance to manage their periodontal health.

Objectives: The purpose of this study was to assess the efficiency in inflammation control on different oral hygiene maneuvers brushing, flossing and mouthwash among dental diabetic patients with general or severe periodontitis.

Study Design:: A Cross-Sectional Study.

Duration and place of study. Department of Oral and maxillofacial surgery Bacha Khan college of dentistry Mardan from 05 jan 2023 to 05 jan 2024

Method: Divided 150 diabetic patients into three groups brushing only, flossing and antimicrobial mouthwash with regular tooth brushing. Mechanical and antimicrobial control were performed for 6 months, and gingival index (GI), plaque score/PI, periodontal pocket depth PPD of all health was conducted.

Results :The mean age of the participants was 52.4 years (SD, 6.8 years). A mean reduction of 1.2 (SD = 0.4) for Group A (brushing only), a mean reduction of PI: 1.6(SD =3 /PI :11 ) was the maximal where as with combination agent i.e, mouth wash more effect is seen than manual oral hygiene method which showed significant difference in reduces plaque adhesion, it reduced by this intervention album group B and final additional use floss did not add apparent benefit to this from resistance he last completed due along [Table/Fig-5]. Differences in effectiveness between the oral hygiene practices also reached statistical significance (p<0.01).

Conclusion: The best method that can be employed to prevent periodontal diseases in a patient undergoing treatment for diabetes is brushing, flossing and recommended mouth wash which constitutes of antimicrobial properties. Periodontal complications can be prevented in this population by highlighting the fundamentals of oral hygiene practices.

Keywords: Diabetes, Periodontal Disease, Oral Hygiene, Prevention

Understanding The Effectiveness Of Virtual Reality In Medical Training A Prospective Observation Study.

Allah Noor, Arif Ullah — Fri, 05 Jul 2024 00:00:00 +0000

Background: Most traditional medical education and training do not involve encouraging experiences of learning through play and play inasmuch as they should for the learner. As a medium, Virtual Reality (VR) enables practice with realistic consequences and enables mistakes that can be costly in the real word and this may improve the learning process.

Objectives: The purpose of this study was to assess what Virtual Reality (VR) training has to offer medical students in terms of knowledge endowed, skills developed and confidence gained as well as to compare the outcomes of using VR against conventional training in HMC and MMC Hospital Peshawar

Study Design: A Prospective Observation Study.

Place and Duration of Study: Department of Ent HMC Peshawar for the period of 5th July,2022 to 5th December 2022

Methods: Of 200 medical students, 120 students engaged in VR training from January up to December of the year 2022. Some of the topics included in the program where the anatomy, surgeries as well as emergency. The evaluation of the effectiveness of the training was done by comparing pre-training and post-training tests, practical tests, and the questionnaires filled in by the groups.

Results: Out of 200 students with a mean age of, 22. 5 years ± 2. Knowledge retention for the year was increased by 35( percentage)% (p< 0. 01). The over-all competency, in particular the Practical competencies showed an improvement of 40% (p < 0. 01). Confidence increased were seen received; 85% of students felt more ready to face real life situations. The feedback received for the training done in the VR platform was positive as the participants appreciated the fact that the training was fun and informative.

Conclusion: the study showed that the application of VR training improves the general performance, practical expertise, and student satisfaction. The availability of peripheral information in VR makes it useful in courses for medical education; the incorporation of virtual reality in clinical teaching provides students preclinical experience to prepare for clinical practice.

Keywords: Virtual Reality, Training, Simulink, Health, Education

Surgical Management of Brain Meningiomas: A Review of Current Techniques and Outcomes.

Naeem Ul Haq, Syed Nasir Shah, Ikram Ullah — Fri, 05 Jul 2024 00:00:00 +0000

Background: Surgical treatment of brain meningiomas is a challenge because of their various sites, sizes and effects on surrounding neural structures.

Objective: This review aims to integrate the current surgical techniques and results in the management of brain meningiomas.

Study Design: The study is a systematic review and meta-analysis.

Setting and Duration of Study: The study was carried out at the Department of Neurosurgery,Bacha khan medical college Mardan , for six months, from 8^th October 2023 to 8^th April 2024.

Methods: A systematic literature search was undertaken to identify recent studies as well as clinical trials about surgical therapy for brain meningioma. It also highlights on microsurgical techniques, endoscopic approaches, advancement in neuro-navigation and intraoperative monitoring.

Results: The inclusive criteria were met by 52 studies which consisted of 18 randomized control trials (RCT) ,24 observational studies and ten meta-analysis. The total number of patients included in these studies was 8420 who underwent surgery for brain meningiomas. Gross total resection (GTR) rates ranged between 70% -95%. Recurrence after GTR varied from5%-15% over a five year follow up period.

Conclusions: Over time, management of Brain Meningiomas has changed due to advancements in technology and technique. Although microsurgical excision remains vital in therapy, endoscopic approaches as well as modern intraoperative adjuncts have widened the neurosurgeons’ armamentarium leading to improved patient outcomes.

Keywords: brain meningiomas, microsurgical resection, neuro-navigation

Assessment And Enhancement Of Venous Thromboembolism Prophylaxis Protocols In Medical Unit Of Ayub Teaching Tertiary Care Government Hospital, KpK, Pakistan

Fri, 05 Jul 2024 00:00:00 +0000

Background : Venous thromboembolism (VTE) refers to the formation of blood clots within the venous system, a serious medical condition with potentially life-threatening consequences. The risk of developing VTE significantly increases during hospitalization due to factors such as reduced mobility and underlying illness. Therefore, it is crucial to perform timely risk assessments and implement appropriate prophylactic measures to prevent the occurrence of this preventable complication in hospitalized patients.

Aim and objectives: In developing countries, data on VTE prophylaxis remains limited, and in Pakistan, VTE prevention is often overlooked in research and clinical practice. This clinical audit was undertaken to assess current practices in VTE risk assessment and prophylaxis, with a focus on identifying gaps and evaluating the impact of educational interventions. By enhancing awareness and adherence to standard protocols, the aim is to improve patient care and reduce the risk of preventable complications."

Methodology: We used the National Institute for Health and Care Excellence (NICE) guidelines for VTE prophylaxis as our audit standard. In Phase A, conducted from January 20 to February 30, 2024,Data was collected using a customized proforma by prospectively reviewing the medical records of 180 patients, admitted to the Medical Unit of Ayub Teaching Hospital. Following an educational intervention aimed at improving adherence to guidelines, Phase B was conducted from march 4 to april 10, 2024, reviewing an additional 150 patients to evaluate any changes in practice

intervention: For the intervention phase, findings from Phase A were presented during the monthly ward meeting, which was attended by the Head of Department, consultants, registrars, postgraduate residents, interns, and nursing staff of the medical unit. The session focused on educating healthcare providers about the risk factors associated with VTE and the critical need for timely prophylaxis. Additionally, educational posters were strategically displayed throughout the ward to reinforce the importance of adhering to VTE prophylaxis protocols.

Results: In Phase A, of the 180 patients assessed, 27 (15%) underwent risk assessment for VTE. Among those eligible for prophylaxis, only 18 patients (22.2%) received the appropriate prescriptions. Following the educational intervention, Phase B included 150 patients, where significant improvements were observed: all 150 patients (100%) were risk assessed for VTE, and 112 patients (75%) received the prescribed prophylaxis. This indicates a substantial improvement in adherence to VTE prophylaxis protocols after the intervention.

Conclusion: The audit revealed a lack of adherence to standard VTE risk assessment and prophylaxis prescribing practices initially. However, the implementation of a targeted educational intervention significantly improved compliance, leading to enhanced patient care regarding VTE prevention. This outcome underscores the value of clinical audits as effective tools for improving clinical practices and promoting better patient outcomes.

keywords: VTE prophylaxis, prevention, hospitalized patients, patient safety and quality improvement, venous thromboembolism, clinical audit process.