Journal of Medical Sciences

July 2005

The abstracts of articles published in July 2005 issue are given below. Full-text articles are available here in portable document format (PDF) to be viewed online or offline by using compatible version of Adobe Acrobat Reader. You can download latest version of Adobe Acrobat Reader from the website of Adobe Inc., by clicking the icon shown on right.

Topics of the articles

1. MATERNAL OUTCOME IN ECLAPSIA

2. APPRAISAL OF CLINICAL FEATURES AND COLOR FLOW DOPPLER STUDIES IN DIAGNOSING DEEP VEIN THROMBOSIS IN CLINICALLY SUSPECTED CASES OF DVT

3. OUTCOME OF CLOSE REDUCTION AND CASTING IN CLOSE TIBIAL DIAPHYSEAL FRACTURE

4. STROMAL (MESENCHYMAL) TUMOR OF THE JEJUNUM — A RARE CAUSE OF MALENA (CASE REPORT)

5. VISUAL OUTCOME IN INFECTIVE ENDOPHTHALMITIS

6. EFFECTIVENESS OF FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF COLD THYROID NODULES

7. PREVALENCE OF EXCLUSIVE BREASTFEEDING IN INFANTS SUFFERING FROM DIARRHOEAL DISEASE

8. FREQUENCY OF MALE SEXUAL DYSFUNCTION IN A TERTIARY CARE HOSPITAL

9. PREVALENCE OF VARIOUS TYPES OF INTRA-ARTICULAR INJURIES DETECTED BY MAGNETIC RESONANCE IMAGING IN TRAUMA TO THE KNEE JOINT

10. EVALUATION OF SYNERGISTIC EFFECT OF CEFUROXIME AND CLAVULANIC ACID AGAINST ESCHERICHIA COLI

MATERNAL OUTCOME IN ECLAMPSIA

Shahnaz Nadir Jamil, Shahnaz Akhtar

ABSTRACT

Background: Our objective was to study the presentation and determinants of maternal outcome

Research Methodology: A cross sectional study was designed and data was collected over six months from 1-1-03 to 30-6-03 at a tertiary care hospital, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All cases of eclampsia (n = 50) admitted to Gynae “A” unit during the study period were included in the study. The variables included, patient’s age, parity, booking status, gestational age, location at the time of first seizure, number of fits, and seizure to hospitalization interval, mode of delivery and maternal complications.

Results: Among 2200 consecutive recorded deliveries, 50 women were eclamptic, yielding a frequency of 2.2%. The antenatal / intrapartum and postpartum incidences of eclampsia were 72%, and 28% respectively. All patients were unbooked and belonged to low socioeconomic class. A total of 19 maternal deaths occurred during the study period. Four out of these were due to eclampsia. Maternal mortality rate form eclampsia was 8% and accounted for 21% of the total maternal deaths during the study period. Maternal complications occurred in 20(40%) patients while 26(52%) patients had smooth uncomplicated recovery.

Conclusion: Eclampsia is still responsible for considerable morbidity and mortality for the mother and baby. HELLP (Haemolysis, Elevated liver enzymes, low platelet count) renal failure, coagulopathy and pulmonary edema are its serious complications. Prevention of eclampsia is a challenge. This challenge can be met only, if there is a willingness to invest more in maternal health. Improved antenatal care, early detection and aggressive management of severe pre-eclampsia will reduce the incidence of eclampsia and its dreadful complications.

Keywords: Eclampsia, Magnesium sulphate, mode of delivery, maternal morbidity and mortality.

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APPRAISAL OF CLINICAL FEATURES AND COLOR FLOW DOPPLER STUDIES IN DIAGNOSING DEEP VEIN THROMBOSIS IN CLINICALLY SUSPECTED CASES OF DVT

Mohammad Zahid, Mohammad Tahir, Rabeea Sadaf, Mah-e-Naz Khan, Ishaq Khattak

ABSTRACT

Background: Swelling of leg/s is a common presentation in the Out Patient Department, which can be due to deep venous thrombosis. A delay in the diagnosis of DVT can culminate in a life threatening condition. Therefore, to avoid the morbidity and mortality associated with deep vein thrombosis, an urgent diagnosis and management is essential. Therefore we decided to assess the role of clinical features and colour flow Doppler studies in the diagnosis of deep venous thrombosis.
Research Methodology: One-year cross-sectional study at Khyber Teaching Hospital Peshawar was carried out from January 2003 to January 2004. This study included 50-patients, admitted in medical wards of Khyber Teaching Hospital Peshawar, with a clinical suspicion of deep vein thrombosis. All cases had swelling and pain in lower limb/s with or without tenderness and or redness. Patients were selected according to the inclusion and exclusion criteria. In each case Colour flow Doppler Ultrasonography was performed on the whole length of the affected lower limb/s. The clinical features of patients with Doppler positive studies (having deep vein thrombosis) were compared to Doppler negative cases. The final diagnosis was established with the help of Colour Flow Doppler ultrasonography. The results were validated by subjective and objective improvement in
the clinical condition after anticoagulant therapy.

Results: Out of 50 patients, 25 had deep vein thrombosis while 2 had post-thrombotic sequellae. 23 patients although had signs and symptoms of deep vein thrombosis but none had venous thrombosis. Patients with all four classical features of DVT have two and half times greater chance of having DVT as compared to those with only two clinical features. This means that the classical features of DVT are sufficiently specific to DVT and when present should prompt investigations for its early diagnosis and treatment. The observed major risk factor in this study was postpartum period, accounting for 26% of the total Doppler proven DVT cases. 37% had DVT of spontaneous origin. All patients with DVT established on colour flow Doppler were started on anticoagulant therapy and all showed improvement in their clinical presentation. The study provides two valuable information i.e.

1. The four classical features of DVT are reasonably specific and when present provides a chance for an early diagnosis.

2. The overall accuracy of Colour Flow Doppler in this study is 100%.

Conclusion: Deep vein thrombosis is a clinical condition that can end in a life threatening state, “The
Pulmonary Embolism” which can be prevented by a timely diagnosis of DVT. All the four characteristic features (swelling, pain, redness and tenderness) of DVT, when present, increase the probability of its early diagnosis and hence provide a chance to embark a prompt management to escape the complications. Colour flow Doppler Sonography, the non-invasive technique, alone is enough to diagnose DVT as it has got a high sensitivity and specificity. This offers a clinician the most reliable and accurate method just short of Venography.

Keywords: Deep vein thrombosis, Pulmonary embolism, Color Flow Doppler Ultrasonography, Duplex Ultrasound, Ascending Venography.

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OUTCOME OF CLOSE REDUCTION AND CASTING IN CLOSE TIBIAL DIAPHYSEAL FRACTURE

Muhammad Shoaib, Muhammad Shabir, Ahmed Sohail Sahibzada, Raja Gul

Background: Tibial fracture is the most common long bone fracture especially in young people and has many treatment modalities i.e, close reduction and casting, open reduction and internal fixation with plates and screws and interlocking nails. Tibial fracture in adults may go in to malunion or nonunion if not treated properly.

Research Methodology: This is descriptive, study on 30 patients, (22 male and 8 female) conducted at orthopedic department, Lady Reading Hospital Peshawar and Ayub Teaching Hospital Abbottabad from January 2001 to December 2003. Patients included were of each gender, adults and close diaphyseal fractures who presented within 1 week after injury All fractures were treated with close reduction and casting under analgesia. Follow up was done for 6 months with assessment of radiological (healing) and clinical outcome (joint movement, leg alignment and length).

Results: Out of 30 patients 22 (73.33%) were male and 8 (26.66%) were female with age range from 14 to 60 years. Left side was involved in 18 (60%) and right in 12 (40%) patients. Healing time was 12 to 20 weeks in 25 (83.33%) patients i.e. excellent and good results, and out of remaining 5 patients 3 (10%) got hypertrophic nonunion. 2 (6.66%) patients had less than 5 degree external rotation. Knee stiffness in 4 (13.33%) patients and ankle stiffness in 3 (10%) patients was seen, which resolved with exercises.

Conclusion: Closed reduction and POP cast application is a safe, cost effective method for treating closed diaphyseal fracture of the tibia and gives excellent results regarding function of the limb and healing time.

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STROMAL (MESENCHYMAL) TUMOR OF THE JEJUNUM — A RARE CAUSE OF MALENA (CASE REPORT)

Ijaz Ahmad, Mazhar Khan, Attaullah Jan

ABSTRACT

Gastrointestinal stromal tumors are relatively rare neoplasms. They are the primary non-epithelial neoplasms of the gastrointestinal tract derived from pleuripotential mesenchymal cells. They are capable of either partial or terminal differentiation along a variety of cell lines1,2. They are the most common form of sarcoma of G.I tract3. Their common presentation is bleeding due to their vascular nature. This is a case report of a 43 year old male who presented with severe anemia and history of bleeding per rectum, on examination having a mass in the hypogastric region. Post operative biopsy reported the mass as a mesenchymal tumor of the jejunum.

Keywords: Stromal Tumors, Pleuripotential Cells, Sarcoma, Haematochezia.

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VISUAL OUTCOME IN INFECTIVE ENDOPHTHALMITIS

Ibrar Hussain, Naimatullah Khan Kundi

ABSTRACT

Background: Endophthalmitis is the syndrome of inflammation or infection of the ocular cavity and its adjacent structures that causes severe sequel such as visual loss. It is potentially most devastating complication of intraocular surgery or trauma. Despite major advances in asepsis, surgical techniques and antibiotic therapy, it remains a major concern for any ocular surgeon. In all good centres of the world the stress is on measures to prevent endophthalmitis, therefore, its occurrence is rare in such centres. Once it occurs, it is very difficult to treat and outcome is poor. We conducted this study to find out frequency and outcome of infective endophthalmitis in North West Frontier Province of Pakistan.

Research Methodology: It is a descriptive observational study, conducted at Department of Ophthalmology, Khyber Teaching Hospital, Peshawar Pakistan, over a period of two years (From January 2001 to December 2002). All patients with infective endophthalmitis admitted in our unit during the study period were included in study. Their files were retrieved and related information regarding age & sex distribution and anatomic & visual outcome was filled in a prepared Performa and final results compiled.

Results: During two years of study 114 (4.5%) admissions of the total were due to infective endophthalmitis. 70% of these patients were males and 30% were females. About 25% of these patients were in pediatric age group i.e., < 15 years, 38% were above 60 years and rest between 16 and 60 years. Regarding final outcome 61 (53.5%) eyes improved with some vision ranging from perception of light to 6/60. Twenty-one (18.4%) eyes had no perception of light with intact eye ball, 21 (18.4%) underwent evisceration and 11 (9.6%) became phthisic.

Conclusion: It can be concluded that infective endophthalmitis is relatively more frequent and its outcome is poorer in our setup.

Key words: Infective endophthalmitis, Visual outcome.

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EFFECTIVENESS OF FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF COLD THYROID NODULES

Afzal Khan, Mah Muneer Khan, Shoab Shah

ABSTRACT

Background: Thyroid nodules occur in 4-15% of adult population. The major challenge faced by a clinician is to determine whether a thyroid nodule is benign or malignant.

Research Methodology: This study was designed to determine the effectiveness of Fine needle aspiration cytology in diagnosing the pathological varieties of thyroid nodule presenting in a teaching hospital. 48 consecutive non-randomized patients presenting with thyroid nodule were included in the study and underwent fine needle aspiration cytology.

Results: 12.5% (6) cases were subsequently diagnosed as having thyroid malignancy (Papillary/ Follicular). Further stratification showed that 18% of cases with multiple nodules and 7.7% of cases with solitary nodules had malignancy.

Conclusion: Fine needle aspiration cytology is a cost effective and efficient tool in diagnosing early thyroid malignancies.

Keywords: Cold nodule, Thyroid cancer

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PREVALENCE OF EXCLUSIVE BREASTFEEDING IN INFANTS SUFFERING FROM DIARRHOEAL DISEASE

Tariq Ayub, Nadeem Khawar

ABSTRACT

Background: Diarrhoeal diseases are among the most common causes of global childhood morbidity and mortality, specially in the developing countries. Exclusive breastfeeding plays a vital role in the prevention of diarrhoeal disease. The objective of this study was to find the prevalence of exclusive breastfeeding in infants suffering from diarrhoeal disease and to compare the severity of diarrhoeal disease among exclusively breastfed, partially breastfed and non-breastfed infants.

Research Methodology: A hospital based, retrospective study was carried out in the department of
Paediatrics Khyber Teaching Hospital Peshawar and Lady Reading Hospital Peshawar. One hundred infants aged 0-6 months suffering from diarrhoeal disease were randomly selected from OPD and indoor patients. Relevant history with special reference to breastfeeding was taken and relevant clinical examination was done. All the data was evaluated.

Results: Among the 100 cases of infantile diarrhoea 19 (19%) were exclusively breastfed, 56 (56%) were partially breastfed and 25 (25%) were non-breastfed.

Conclusion: The prevalence of exclusive breastfeeding was much lower (19%) as compared to the partial breastfeeding (56%) and non-breastfeeding (25%), among the infants suffering from diarrhoeal disease.

Keywords: Diarrhoeal disease, Breastfeeding.

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FREQUENCY OF MALE SEXUAL DYSFUNCTION IN A TERTIARY CARE HOSPITAL

Mohammad Younas Khawaja

ABSTRACT

Background: There has been little research carried out in the types and frequency of sexual dysfunction in the Pakistani population although clinical observations are that such problems are relatively common. The study was carried out to assess the frequency of sexual dysfunction in male patients presenting to a teaching hospital with minor ailments.

Research Methodology: This is a hospital based randomised descriptive study. The study was done at Ayub Teaching Hospital Abbottabad from November 2004 to January 2005. One hundred male patients coming to male filter clinic of the hospital for minor ailments were randomly selected. The subjects were administered Arizona Sexual Experience Scale for Men to assess their sexual functioning.

Results: Erectile dysfunction (21%) and premature ejaculation (13%) were found to be the two most common sexual dysfunctions.

Conclusion: Sexual dysfunction among males is relatively common.

Keywords: Prevalence, Erectile dysfunction. Premature ejaculation. Sexual Dysfunction.

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PREVALENCE OF VARIOUS TYPES OF INTRA-ARTICULAR INJURIES DETECTED BY MAGNETIC RESONANCE IMAGING IN TRAUMA TO THE KNEE JOINT

Munir Ahmad, Zeenat Ayub, Noor-ul Hadi

ABSTRACT

Background: Injuries to the menisci and ligaments are common in knee joint trauma. Magnetic Resonance Imaging has emerged as the primary investigation for evaluation of the knee joint because of its high resolution, non-invasive nature and accuracy. The purpose of the study was to find out the most frequent abnormal findings in knee joint injuries on Magnetic Resonance Imaging.

Research Methodology: This descriptive study was conducted in Radiology Department of Postgraduate Medical Institute Hayatabad Medical Complex Peshawar from January 2003 to June 2004. Forty patients referred for knee MRI to the radiology department having knee injuries were included in this study. MRI of the knee was performed and abnormal findings in each case were recorded.

Results: Out of 40 cases, 30 (75%) were male and 10 (25%) were female. The age ranged from 12 to 60 years. 25 patients had accidental injuries and 15 had sports injuries. 60% had joint effusion. ACL tear was seen in 44% and PCL tear was demonstrated in 7% cases. 28% of cases had MM tear while 12% had LM tear. MCL injury was seen in 25% while LCL injury was seen in 12% of cases. Bone bruises and synovial cyst was seen in 6% and 5% of cases respectively.

Conclusion: The most common injuries were accidental and the most frequent lesion was ACL tear and medial meniscus tear.

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EVALUATION OF SYNERGISTIC EFFECT OF CEFUROXIME AND CLAVULANIC ACID AGAINST ESCHERICHIA COLI

Abdul Jalil, Abdul Wadood, Riaz Naseem

ABSTRACT

Background: β-lactamase mediated resistance is the most common mechanism which renders the β-lactam antibiotics ineffective against bacteria including Escherichia coli. The development of resistance has led to the widespread empirical use of higher generation cephalosporins and it is likely that the third generation cephalosporins are also losing their efficacy by the same mechanism. The present study was conducted to evaluate the and microbial effect of cefuroxime with and without a β-lactamase inhibitor named clavulanic acid, against Escherichia coli.

Research Methodology: An institution based analytic observational study was carried out at Department of Microbiology, Khyber Medical College, Peshawar. β-lactamase producing Escherichia. coli were identified and cultured in Mueller Hinton medium in petridishes. The antibiotic disks containing cefuroxime alone and in combination with clavulanic acid were placed in the same petridishes about 24-30 mm apart. The zones of inhibition were measured according to NCCLs zone diameter criteria using disk diffusion method.

Results: A total of 40 β-lactamase producing bacteria were isolated. The zones of inhibition surrounding the disks containing both cefuroxime and clavulanic acid were larger than those containing cefuroxime alone.

Conclusion: In this study it was found that the synergistic antibacterial effect of the combination of cefuroxime and clavulanic acid was far more than the cefuroxime alone against Escherichia coli.

Keywords: Cefuroxime, Resistant Escherichia coli, Clavulanic acid.

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