pjmd issue jan mar 17

Neurosurgery demands highest degree of accuracy and precision. A surgeon’s dexterity may be tested to the human limit when it comes to negotiating with delicate structures inside cranial cavity. Robotic devices can help surgeons cross these human limits and achieve better precision and less invasiveness. With enhanced accuracy, precision and dexterity it is possible to work through small corridors and trajectories causing minimal injury to the normal brain. Unfortunately however, robotics in neurosurgery is not as advanced as it is in other surgical specialties like gynecology and urology…..

Background:

Body dysmorphic disorder (BDD), once known as dysmorphophobia, is a mental disorder in which the person afflicted is engrossed with an imagined imperfection in their appearance that is actually normal or is very minor.

Methods:

The cross-sectional study was conducted in Karachi at Ziauddin University targeting female students between the ages of 17– 25, using an adapted questionnaire which was used to diagnose BDD and determine the role of media in influencing their self-image.

Results:

Out of the 180 students included in this study, at least 9.4% were highly concerned about one or more than one physical attributes, while 2.8% showed extreme concern. 6.1% met the DSM-V criteria for BDD. The most frequent foci of concern were: Being too fat or too thin (35%), skin (24.4%), hair (15%), teeth (14%) and nose (14%). 24.4% of the students got sad/angry/depressed because of their appearance .The study also showed that 42% of the subjects spent 1-2 hours watching television every day, and 13.9% watching 3-7 hours of television per day. 46.7% also regularly visit entertainment/beauty websites or read entertainment magazines. 22.8% were extremely satisfied with their appearance, as opposed to 4.4% which were extremely dissatisfied.

Conclusion:

Our results show that BDD is widespread amongst female college students. The body features of concern were recognized and the influence that media, either through the use of beauty magazines or television/movies on self-image was estimated.

Key Words:

Body Dysmorphic disorder (BDD), Females, Frequency, Risk factors

Background:

Risk of scar defect is inversely correlated with lower uterine segment thickness. The study aims to assess the diagnostic accuracy of sonographic measurement of the lower uterine segment thickness near term in predicting uterine scar defect in women with prior Caesarean section and ascertain the best cut-off value for predicting uterine rupture in our country.

Methods:

This observational case series study was carried out at Department of Gynecology and Obstetrics, Ziauddin University and Hospitals from January 2015 to June 2015. Women carrying singlet on pregnancy of 36-38 weeks with history of previous C-section were included in the study. Lower uterine segment measurement was done by transabdominal ultrasound at 36-38 weeks gestation and these women are followed up to the time of delivery.

Results:

A total of 180 patients based on inclusion criteria were recruited in the study. Significant association (p=.001) was found between LUS thickness values measured during pregnancy and status of scar at the time of delivery. No significant association was found between scar thickness and mode of delivery (p= .390). Scar dehiscence was noted in only one study participant.

Conclusion:

We support the proposition that antenatal measurement of lower uterine segment measurement in women with previous caesarean section is a reliable tool in deciding which women should be given a trial of labor.

Key Words:

Previous Caesarean Section, Lower Uterine Segment (LUS), Ultrasound Measurement, Pakistan

Background:

The DSM-IV outlines a panic attack as a distinct period of intense fear or discomfort which is accompanied by a minimum of 4 out of 13 listed somatic or cognitive symptoms. This is often associated with a sense of impending doom and the urge to escape which may leave ones psychological and physical functioning impaired. These are all signs of several Anxiety disorders. The aim of the study is to investigate the incidence of Panic attacks amongst patients presenting to an Emergency Department in a tertiary care hospital of Karachi, Pakistan.

Methods:

This cross-sectional study was conducted at the Emergency Department, Ziauddin University Hospital Clifton. Patients included in the study were those who had no previous co-morbid or psychiatric disorders except for Panic attacks, and who displayed a minimum of four signs for a Panic attack according to the DSM -4 criteria of Panic attacks. Patients included in the study were between the ages of 15-50 years. The total sample size fitting the aforementioned requirements came to 1506 patients.

Results:

The prevalence of Panic attacks amongst patients in the Emergency Department was an astonishing 9.49%. Division according to sex demonstrated a female predominance at 62.9% while males made up 37.1% of the total. The age group which was most effected was 30-34 years of age. Variation with relevance to time of day displayed that 44.8% of cases presented in the night time followed by evening and morning.

Conclusion:

It is evident that Panic attacks are a common finding amongst patients in an Emergency Department, be it due to new onset Panic Disorder, social phobias or other causes .Keeping the prevalence of mental disorders in mind, specifically Anxiety Disorders of which Panic attacks are a subset, further research into the causes, immediate and comparatively effective treatment needs to be done as well as emphasis on accurate diagnosis at the primary care level.

Key Words:

Panic attack, Anxiety, Emergency Department, prevalence, Pakistan, DSM-IV

Background:

Disabling hearing loss is a major health issue all over the world. It is however found to be worse in the developing countries according to WHO. It is said that one in five Africans now operate smartphones which can be effectively use for hearing loss screening purposes. The purpose of the study is to evaluate the use of uHearTM an iOS-based application on iPhone as a hearing loss screening tool.

Methods:

This is a prospective hospital base study carried out in ENT clinic between January 2014 and December 2015 after obtaining the hospital ethical committee approval. Consented adults that could operate iphone were recruited for the study by convenience sampling. Subjects had a conventional audiometric test after which they were made to complete the iPhone uHearTM test using the headphones supplied with the device in a quiet room. Hearing loss at frequencies of 250Hz–8000Hz were determined with a threshold of >40 dB considered as ‘Failed screening’ and a p-value of <0.05 was considered significant.

Results:

Ninety eight ears of 49 patients were tested, males 26 and females 23 with male to female ratio of 1.1:1. There was a statistically significant difference between pure tone thresholds recorded with the iPhone and that of the audiometer at lower frequencies. However, there was no statistically significant difference between these thresholds recorded at higher frequencies.

Conclusion:

The uHearTM ‘app’ on iPhone is effective in detecting high-frequency hearing loss, and can be use in hearing loss screening programmes.

Key Words:

uHearTM, iPhone, hearing, screening, tool.

Background:

Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The main objective is to study the prevalence, risk factors and management of cases of ectopic pregnancies at tertiary care hospitals over a three year time period.

Methods:

This is a retrospective study of cases of ectopic gestations managed in tertiary care Hospital Karachi from July 2013 to July 2016. Information was taken from case notes, theater and labor ward registers, and the cases what we managed.

Results:

During the study period, we admitted total number of 3113 gynecology cases from 2013 to 2016 out of which 76 pregnancies turned out to be ectopic pregnancies with different presentations. Majority of these presented at the age group of 20-30 years and found more in primigravida. History of infertility was found to be the highest risk factor and tubal pregnancy remained the most common site of ectopic pregnancy.

Conclusion:

Ectopic pregnancy is a major challenge in gynecological practice and was found more in primigravida. Most of the cases usually present late that makes the tubal conservation treatment inapplicable. Use of modern diagnostic techniques by the clinicians will assist in early diagnosis and treatment prior to tubal rupture which will ultimately lead to reduction in maternal morbidity and mortality associated with the condition

Key Words:

Ectopic pregnancy, tubal pregnancy, mortality, B- HCG

Background:

There has been an increase in the occurrence of infections due to Extended Spectrum Beta lactamases (ESBL) producing bacteria. ESBLs exhibit an enhanced capacity to hydrolyze the extended spectrum Beta-lactams, which has led to an increase in the antibiotic resistance capability of uropathogenic microorganisms. This study was aimed at determining the production of beta lactamase and extraction of beta lactamase genes from urinary tract infection due to Escherichia coli.

Methods:

Plasmid curing was carried out using sub inhibitory concentration of 0.10 mg/ml of acridine orange to determine the location (plasmid-borne or chromosomal) of the drug resistance marker(s). Beta-lactamase test was performed using the Starch Paper Method, while DNA extraction, genomic gene analysis and polymerase chain reaction were done to determine the presence and analysis of beta lactamase genes.

Results:

Ninety-eight (98) Escherichia coli isolates analyzed, thirty-one (31) were plasmid mediated and of this, Sixteen (16) was resistant to amoxillin, six (6) to augmentin, three (3) to nitrofurantoin and six (6) to tetracycline. Results further revealed that out of the E. coli isolates that were plasmid mediated only nine (9) were beta lactamase producers. None of the ESBL producing E. coli contained SHV beta-lactamase genes. However, three (3) and five (5) strains of ESBL producing E. coli contained TEM and CTX-M beta-lactamase genes respectively.

Conclusion:

This study shows that the resistant of urinary tract infection (UTI) isolates to beta-lactams were due to production of TEM and CTX-M beta-lactamases. Identification of these genes provides for accurate treatment and further understanding of the mechanism of resistance.

Key Words:

Extended Spectrum Beta-lactamase, Escherichia coli, Antibiotics, Plasmid mediated..

Background:

Pseudomyxoma Peritonei is a rare disease. It is identified operatively by gelatinous ascites accompanied by mucinous material in the peritoneum, usually arising from appendix and ovary. Other sites from where it may arise are colon, gallbladder, pancreas or stomach. The clinical presentation is inconsistent and preoperative diagnosis is often difficult. The focus of this study is to consider the clinical, histopathological aspects and survival of pseudomyxoma-peritonie in a tertiary care hospital of Karachi.

Methods:

A single center Ziauddin University and hospital, histopathology database from 2006-2016 was looked up retrospectively for the incidence of pseudomyxoma-peritonie on biopsy and reviewed patient’s record. All cases operated on the basis of clinical presentation and radiological findings. Diagnosis made incidentally on histopathology, originated from three different sites.

Results:

Total 1388 appendectomies were performed, 749(53.96%) were male, and 639(46.03%) female. Carcinoid tumor was present in 11(0.79%) and 3(0.21%) were of pseudomyxoma-peritonie variety. In the later 3, two were males and one was a female with ages in 42, 85, 52 years respectively. All three-patients came to the emergency with variable presentation. The preoperative diagnosis was of a perforated appendix, large mesenteric cyst and in the third-case a large cystic-cum-solid abdominal mass. Histopathology confirmed pseudomyxoma-peritonie. The primary sites diagnosed were appendix, pancreas and ovary.

Conclusion:

Pseudomyxoma-peritonie is a challenging task to diagnose clinically. On the basis of case series, this intra-peritoneal tumor has varied presentation. Patients usually present in late stage of disease with mucinous tumor cells implanted in the peritoneal mesothelium and in clinically apparent ascites.

Key Words:

Pseudomyxoma-peritonie, Mucinous tumor, Appendiceal tumor, Peritoneal carcinomatosis, Rare entity

Background:

Crime on gunpoint has increased in metropolis of Karachi in last many years with increasing mortality & morbidity so what could be done to minimize it and how we can proceed further to make Karachi a peaceful city. The objective of this study is to evaluate whether more firearm laws & associated firm restrictions over the availability of fire arm weapons is required to minimize fire arm fatalities

Methods:

It is a cross sectional descriptive study for retrospective analysis of all firearm related deaths and injuries, reported to authorized medico –legal sections of Karachi ,located in Civil hospital , Abbasi Shaheed & Jinnah Post Graduate Medical center . The study period is 8 years, extending from 1st January 2007 to 31st December 2014.All medico legal cases & postmortems due to firearm weapons reported and / or sent by police are examined & autopsies done in authorized medico legal sections are included in this study. All cases referred for treatment purposes from outside Karachi are excluded.

Results:

Total 208241 medico legal cases referred during study period out of which 14.03% (n=27638) cases were identified as firearm weapons injuries. Maximum cases of firearm were reported in Abbasi Shaheed Hospital 37.9% (n= 10478) while minimum cases 29.3% (n=8107) in Civil Hospital Karachi. Postmortems conducted on fire arm weapons deaths were 37.7% (n=4246) in Abbasi Shaheed Hospital Karachi. Male dominated with 91.74% (n=10325) of post mortems over female with 8.26% (n=928) only.

Conclusion:

The study concluded that homicidal firearm injuries contributed as one of the major cause of death. The age group of 21-25 years was most affected. The most commonly targeted body part was chest & abdomen .The use of fire arm weapons & resultant mortality is increasing day by day. The easy availability of weapons, unemployment, poor socio-economical conditions & the use of youth by Political parties & other criminal groups, for their perverted purposes are main factors behind increased homicidal killings. All these issues are required to be addressed seriously.

Key Words:

Mortality, Morbidity, Firearm, Post mortem, Medico legal cases.

A lump in the breast in any age group of women leads to the great anxiety. High frequency, high-resolution USG helps in its evaluation. However, it could be difficult to distinguish all benign from all malignant solid breast masses using USG criteria. Short-interval follow-up can be suggested. Ultrasound breast can also identified unsuspected occult masses in mammographicaly heterogeneous parenchyma breast. Various studies in past had discussed differentiating features b/w benign and malignant breast lesion. The American College of Radiology classified the breast masses in BIRADS-US classification. An exploration of literature search was determined utilizing the electronic databases of Pub Med, Google scholar, Elsevier from 200 to 2016 for English-language articles. The search terms utilized were breast masses. The titles and abstract of articles were evaluated Entire text and reviews were appraised when the abstracts meet to the inclusion criterion. This review included all articles that were used for the advancement of information about breast masses.

Key Words:

Breast ultrasound, Breast mass, ACR BIRADS-US criteria

Gleason’s scoring system was introduced by Dr. Donald Gleason in 1960 and till date it is widely accepted to score the prostate adenocarcinoma. This remained the best predictor for treatment and prognosis of the patients. This system depends upon the histological features of the prostate adenocarcinoma and morphological patterns. The most common and second most common patterns identified on biopsy are used to be added up to score the prostate adenocarcinomas. However, certain limitations, in particular to scores; 7, 8 and 9 along with Gleason’s relation to tumor variants, is having a large impact on prognosis and course of treatment. To overcome these limitations, John Hopkins university proposed a new scoring system for the prostate adenocarcinoma in 2013, consisting of 5 grade groups. Grade Group 1=Gleason score≤6, Grade Group 2=Gleason score 3+4=7, Grade Group 3=Gleason score 4+3=7, Grade Group 4=Gleason score 4+4=8, Grade Group 5=Gleason scores 9 and 10. The updated grade groups provide proper scoring for the prostate adenocarcinoma to address the present limitations.

Key Words:

Prostate cancer, Grading, Prognosis, Gleason grade.