Volume 5 Issue-2 Apr-June, 16

May his soul rest in peace
Prof Naeem Jafarey was well known for his status as pioneer in medicine and eminent pathologist when he joined as director of postgraduate studies at the newly established Dr Ziauddin postgraduate institute of medical sciences. He was born on 4thof May 1929, in Allahabad in India, to an illustrious family. He graduated from King Edward Medical College in Lahore in 1955, the prestigious and the oldest institution in Pakistan. He showed his inclination towards medical research when he joined Mayo Hospital as medical officer of Pakistan Medical and research council in Lahore. He subsequently moved to USA and was trained at New York State University and obtained certification of American Board of Pathology. He retired as professor of pathology from Jinnah Postgraduate Center (JPMC) and he was also one of the founding members of Basic Medical Sciences institute at JPMC, which was established with collaboration with University of Alabama, USA. He retired from JPMC in 1989…

Read More

Background:

Hypercalcemia is relatively common in patients with cancer, occurring in approximately 20 to 30 percent of cases. As ionized calcium is not routinely estimated in most of the clinical laboratories and calcium status of the patients is being assessed by estimation of total calcium. This may result in up to 30% cases to remain undetected for hypercalcemia. The diagnosis of hypercalcemia of malignancy if made early and managed properly, could reduce this debilitating complication and objective of this study was planned to find out the prevalence of hypercalcemia of malignancy in patient with solid tumors through measurement of ionized calcium.

Methods:

73 patients diagnosed with solid tumors were included in the study. Informed consent was obtained and a proposed Performa included demographic data, Type, size, stage of tumor, duration of disease. Ionized calcium levels were performed for detection of hypercalcemia. All the patients included in the study were adult of more than 18 years and no one was suffering from hematological malignancy or with acid base disorders.

Results:

A total of 73 patients, 36 females and 37 males, with mean age of 54.47 ± 15.98 were included (range 39-90 yrs in females, 19-83 yrs in males). 16 patients were suffering from Hypercalcemia of malignancy while 57 had normal ionized calcium levels.

Conclusion:

Hypercalcemia of malignancy has been detected in 21.92% cases of solid tumors in our study. Further larger studies are needed to validate our data and also it is also required to find out which type of tumor is more prone to Hypercalcemia.

Key Words:

Hypercalcemia of malignancy, ionized calcium, solid tumors

Read More

Background:

Acute Kidney Injury is not a single disease but rather a syndrome comprising of multiple clinical conditions. The high rate of morbidity associated with AKI poses a burden on both the public as well as private sector. Small changes in serum creatinine concentrations associated with a substantial increase in the risk of morbidity. Therefore, detection of even small changes in kidney injury has an important prognostic value to avoid chances of hemo-dialysis and the associated risks which can result in both better outcomes as well as lowering financial burden on the patient as well as the state.

Methods:

A sample size of 100 patients was included as calculated by taking reported incidence of 36%. Patient’s baseline and maximum creatinine was taken during ICU stay together with urine output monitoring during first 48 hours. Staging of acute kidney injury (AKI) was done by Acute Kidney Injury Network (AKIN) criteria. Outcome of renal failure was assessed on the basis of full, partial and no recovery.

Results:

Out of 100 patients, 52% were in stage 1, 32% were in stage 2 and 16% were in stage 3. AKI was common in females; present in 37 males and 63 females; (p value <0.05). Full renal recovery was achieved in 62 patients (62%) of AKI; 25 patients (25%) were partial recovered, and in 13 patients (13%) recovery could not be achieved. Recovery was significantly lower (25%) and potentially greater in stage1 (79%).The chi square between outcome and acute kidney injury revealed statistical significant value (p value <0.001). Hemodialysis requirement was significantly higher in AKI stage3 (62%) than AKI stage1 (4%); (P < 0.001). There were no significant differences in duration of ICU stay, age and mortality.

Conclusion:

Our study showed the morbidity and mortality associated with rising creatinine with increasing stages of acute kidney injury. Recovery in stage 1 was significantly higher and lower in stage 3 and therefore emphasis is required on early diagnosis and timely management of AKI that can prevent patients from distressing and life threatening problems.

Key Words:

Acute Kidney Injury Network, Risk Injury Failure Loss End-Stage Kidney classification, Acute Kidney Injury, End-stage renal disease, Glomerular filtration rate, Renal Replacement Therapy.

Read More

Background:

To assess the satisfaction levels of employees in a health care organization at Karachi, Pakistan.

Methods:

A cross sectional survey was conducted on 598 employees working at University and tertiary care hospital for a period of 5 months. Purposive sampling technique was used for collection of data. All employees working for at least one year at any level of management were included in the study. Part time employees, visiting staff, those absent at the time of data collection and those who refused to consent were excluded from the study. Self administered questionnaires were utilized for the purpose of data collection. Entire analysis was performed using SPSS version 20. P value less than 0.05 was taken as significant. For descriptive statistics frequency and percentages were calculated for categorical variables while mean and standard deviation for numerical variables. Analysis of Variance was applied to see association between different groups. The study was approved by the ethical review board.

Results:

Majority 69.4% (n=415) employees were found to be satisfied. Upper management was seen to have slightly lower scores of satisfaction compared to middle and lower management levels. Between clinical & non-clinical side there was also no significant difference observed in the satisfaction level. Satisfaction levels were seen directly proportional to age and length of service. When overall benefits were seen non clinical side 61% (n=84) were found to be more dissatisfied than clinical side 40% (n=53).

Conclusion:

Study findings conclude that majority employees were satisfied. However most were dissatisfied with the overall benefit package and vacation policy.

Key Words:

Employee satisfaction, Management, Tertiary care hospital

Read More

Background:

Currently most of the medical schools are incorporating innovative medical curricula in their bachelor programs. Most of the institutions are moving towards a more student centered approach to learning and assessment. Physiology being one of the mandatory basic science disciplines is also experiencing these changes. Student learning is always related to the teaching methodologies being used. Student’s perception of the various teaching methodologies is useful in improving the quality of learning in medical education and to evaluate the student perception of different learning modalities in physiology in an integrated curriculum.

Methods:

Study was conducted on 100 medical students of 1st and 2nd Year. Participating students were explained the purpose of study. Based on the teaching methods practiced in the department of Physiology at Ziauddin Medical College, a survey questionnaire was prepared and given to the participants. The questionnaire consisted of questions enquiring about the preference of different learning/ teaching methods and the reason for the preference.

Results:

Majority of the students of 1st and 2nd year MBBS selected Problem based learning (PBL) 48% lecture 40% and small group session 7 % and other teaching method 5%.

Conclusion:

Problem based learning was found to be the preferred learning modality to study physiology and lecture was the most helpful method in preparing for exams.

Key Words:

Perception, Physiology, Teaching Tools, Learning, Integrated Curriculum

Read More

Background:

Laparoscopic Cholecystectomy is one of the most commonly performed routine operation in modern general surgery. All surgical specimens are routinely sent for histopathology. A wide spectrum of variations is seen under the microscope. Rarely, carcinoma is discovered on histopathological examination. The purpose of the article was to identify and elaborate the major histopathological findings of gallbladder after laparoscopic cholecystectomy in a tertiary health care hospital in Pakistan.

Methods:

This was a retrospective study and included histopathological specimens of gall bladder after cholecystectomy from February 2004 to April 2013. Data was analysed using MS Excel and SPSS 19.0.

Results:

Total number of cases: 8376, Chronic Cholecystitis: 7705, Acute or chronic cholecystitis with empyema, mucocele or gangrene: 554, Adenocarcinoma: 91, Adenomatous polyp: 3, Squamous cell carcinoma: 5, Papillary carcinoma: 3, Clear cell carcinoma: 4, Adenosquamous carcinoma: 2, Xanthogranulomatous changes: 54, Dysplasia: 13 and Cholesterosis: 1050.

Conclusion:

Considering the evidence from our study and the evidence from the literature reviewed, it can be concluded that prevalence of all kinds of gall bladder disease, benign or malignant including carcinoma is no different from the rest of the world. Routine histopathology of gall bladder can be omitted without compromising patient safety as proven and practiced by many centers across the globe.

Key Words:

Histopathology, Gallbladder, Laparoscopic Cholecystectomy

Read More

Background:

To find an association between presence of Chronic disease with Oral Health.

Methods:

It was a cross sectional study conducted in the Dental OPD of LCMD Karachi in 2014. Three hundred participants were enrolled in this study through consecutive sample technique. Data was collected using the self administered questionnaire along with the assessment of oral health examination, which was carried out by the Researcher and data was analyzed on SPSS version 20.

Results:

It was observed that 59% (n=176) suffered from chronic diseases and when oral examination was conducted, it was revealed that 39% (n=117) had mobile teeth (P value= 0.001), 39.3% (n=118) had missing teeth P value=(0.001) , 60.8% (n=115) had bleeding gums, 60.2% (n=112) had halitosis, 60.2% (n=71) had dry mouth, 61.3% (n=84) had oral ulcers,60.6% (n=117) had complain of food deposition and 60% (n=90) had tooth spacing due to periodontal diseases.

Conclusion:

It was concluded from this study that majority of participants with chronic diseases had poor oral health which needs immediate attention by the medical practitioners during the treatment of chronic diseases and as well as dentists should counsel the patients for maintenance of oral health. It still remains a chicken egg dilemma regarding the temporal sequence of events as many oral pathogens share a common factor with NCDs.

Key Words:

Association Non communicable Diseases, Oral Health

Read More

Fibroids or leiomyoma of myometrium are the most common benign tumor in females. There are currently many modalities, both medical and surgical, for the management of fibroid in today’s practice such that it is often confusing as to which treatment to apply to which patient. Fibroid patients often present with a variety of symptoms and demographic aspect. Therefore a single guideline is not sufficient to encompass the case management for a specific Fibroid patient. Similarly the incidence of uterine sarcoma in patients undergoing fibroid treatment is thought to be minimal, but there is a current debate whether this risk is underestimated. The novel approach towards fibroids has allowed greater extent of uterine preservation but at the cost of decreased direct histological access, hence resulting in delay of diagnosis, especially in the case where uterine sarcoma is a possibility. Therefore gynecologists have to face the clinical dilemma to diagnose accurately and choose the most suitable treatment from the vast array of options available for each patient. The purpose of this article is to reconsider the different methods of treatments available and apply the most tailored treatment in each patient. This is a platform to better counsel for fibroid patients and their management.

Key Words:

Fibroid uterus, case management, Ulipristal, Aromatase inhibitors, Invasive procedures.

Read More

The predominant salivary glands are parotid, submandibular, and sublingual glands. Innumerous small salivary glands are present in the buccal cavity, pharynx, and the larynx, which are not identified on usual radiologic studies. Frequently used radiology imaging comprise of plain radiography and conventional sialography. Nowadays, high-resolution ultrasonography (HRUS) is being progressively used for the salivary gland imaging. Hence, the significance of cross-sectional studies like computed tomography (CT) and magnetic resonance imaging (MRI) have transformed the imaging of the salivary glands. Different changes in radiologic studies have led to increase sensitivity in the detection of disorders that include the significant salivary glands. Ultrasonography, plain radiographs, sialogram, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy /positron emission tomography (PET) all considered as involving in the programming of future treatment, surgical or otherwise. We reevaluate the techniques applied for the chief salivary glands imaging, and its application. An exploration of literature search was determined utilizing the electronic databases of Pub Med, Google scholar, Elsevier from 1970 to 2015 for English-language articles. The search terms utilized were salivary gland imaging. 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 salivary gland imaging.

Key Words:

Salivary glands; Parotid, Submandibular, Sublingual glands

Read More