Volume 7 Issue-2 Apr-June, 18

Policy drives practice and Health Services Research is at the intersection of policy, practice and patient outcomes. Health Services Research in relation to disability has to reform targets to add value to rehabilitation in a policy relevant context. Medical rehabilitation research is directed towards restoration and improvement of functional capabilities lost due to injury, disease or congenital disorders along with the development of new and improved assisted technologies. Fostering stake holders’ engagement in this regard ensures patient centered focus. The crucial information from all the pertinent fields for rehabilitation generates a hub of innovative strategies leading to commercialization in Health Services Research (HSR). The investigation revolves around current resources available in this field with identification of gaps for capacity building and connectivity between all the stake holders for a meaningful bonding, making health care reforms a reality. Rehabilitation is a vital component of health services. It includes a group of interventions which intend to optimize function in those disabled and suffering from diseases so that they can interact better with their environment by living, working and learning to their best capability.There is a growing need for rehabilitation today as populations age and the occurrence of non communicable diseases and injuries increase1. The World Health Organization (WHO) reported an estimated 15% of the world’s population suffering from mental or physical disabilities[2]. Rehabilitation research being a multidisciplinary venture requires strong collaboration among a good range of fields and specialties including a few such as ergonomics, biomechanics, and physical medicine, biomedical engineering and computer sciences. Rehabilitation researchers are practitioners and investigators in the science of recovery. The level of investigation could be molecular, cellular, tissues, organ systems, the whole body or psychological domains. WHO also recognizes rehabilitation as one of its key priorities in 2017 with focus on research to not only make the cost benefits of rehabilitation known and measuring its impact but also to identify the barriers in accessing rehabilitation facilities and their underutilization along with predicting the need for health professionals required in this area3.
Medical rehabilitation deals with a coordinated multidisciplinary approach to disability through a physician directing a management plan of disabling diseases and injuries. The strategy includes skilled rehabilitation nursing care, physical therapy, speech and audiology, prosthetic and orthotic devices, social, recreational and psychological services.For example, in stroke patients, physiotherapists assist in musculoskeletal issues where as speech therapists deal with language and swallowing, and occupational therapists help patients return to their daily activities2.

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Background:

Esophageal cancer is an aggressive disease with high mortality, mainly due to late stage diagnosis. Radiation therapy alone cannot cure patients who are either reluctant or medically unfit to receive chemotherapy or surgery. Moreover there is no evident optimal dose fraction schedule to treat these patients. We evaluated the outcomes of these esophageal cancer patients who were treated with moderate hypofractionation radiation therapy alone.

Method:

This retrospective study was conducted at Department of Radiation Oncology, Ziauddin University Hospital. A total of 52 patients from the year 2011 to 2015 were treated with moderate hypofractionation radiotherapy in two phases. In the first phase 30 Gy in 10 fractions were delivered and in the second phase 20 Gy in 10 fractions were given. We evaluated the treatment outcomes in these patients.

Results:

There were 27 (51.9%) males and 25 (48.1%) females with a mean age of 52.78 ±14.54 years. Mortality was observed in 47 (90.4%) patients with overall survival of 10.51 ±1.25 months. Overall survival was found to be significantly associated with grading (p-value = 0.030) andstages of cancer (p-value <0.001), and response to treatment (p-value = 0.031).

Conclusion:

According to this study, moderate hypofractionation radiotherapy alone has reasonable outcomes in esophagus cancer patients who are medically unfit or refuse chemotherapy or surgery due to personal choice.

KEYWORDS:

Esophageal Neoplasms, Survival Rate, Hypofractionated Dose, Radiotherapy.

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Background:

Enteric fever spread worldwide by Salmonella typhi (S. typhi). The causative agent, S. typhi is gram negative bacilli belongs to the family Enterobacteriaceae. It is a motile, facultative anaerobic bacilli. Multi-drug resistant (MDR) S. typhi is being accepted as most challenging enteric pathogen in developing countries like Pakistan. The accurate diagnosis of S. typhi is vital for treatment. This study evaluates frequency of S. typhi in blood cultures and antibiotic resistance against S. typhi. The study assist physician to decide better antimicrobial option to treat patients and also update resistant pattern of S. typhi. The aim of this study was to determine the frequency and antibiotic resistance pattern of Salmonella typhi isolated in blood cultures at tertiary care hospital laboratory.

Methodology:

All Blood culture samples were received from febrile patients. An automated machine, BACTEC 9240 were used for blood culture processing. Identification of S. typhi from positive cultures were done by the help of gram stain, colony morphology, biochemical tests, and serological testing. Antimicrobial susceptibility testing was performed through Kirby Bauer method on Mueller Hinton agar according to Clinical Laboratory Standard Institute guidelines. Data analysis was completed by using Statistical Package for Social Sciences (SPSS) version-20.

Results:

A total of 16010 samples of blood were cultured for bacterial isolation, Out of these, 411 (2.56%) turned out to be positive for S. typhi while 193 Isolates were MDR strains and 218 isolates were Non-MDR strains. None of the MDR strains were resistant to cefixime, ceftriaxone and aztreonam .

Conclusion:

This study indicated that resistance in S. typhi is progressively high against first line drugs which draw attention towards monitoring of antimicrobial resistance. Rational use of antimicrobials should be implemented on the basis of culture and sensitivity results.

KEYWORDS:

Enteric fever, Salmonella Typhi, Drug resistance

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Background:

Gonial angle is extensively used in orthodontics for the diagnosis of the growth pattern. Lateral cephalograms and panoramic radiographs both can be used to assess this angle. The aim of the study was to compare gonial angle measured from the panoramic radiograph and lateral cephalogram indifferent sagittal facial patterns.

Methods:

A comparative cross-sectional study was conducted at the Department of Orthodontics,Ziauddin College of dentistry, Karachi, from January, 2017 to August, 2017. A total of 140 subjects (60 males and 80 females) with ages ranging from 12 to 39 years were included. Sample was further divided into two groups according to their sagittal skeletal pattern, depending upon the angle formed by ANB on lateral cephalogram: i.e; Skeletal Class I: ANB 0-4° and Skeletal Class II with ANB > 4o. Gonial angle was measured on pre-treatment panoramic radiograph and lateral cephalographs of orthodontic patients. Pearson’s correlation coefficient was used to see the degree of correlation of gonial angle between panoramic radiograph and lateral cephalogram. Independent sample t-test was used to find difference in gonial angle between panoramic radiograph and lateral cephalogram in different sagittal facial patterns.

Results:

Mean age of male patients was 15.3±1.3 years and female patients15.4±0.8 years, respectively. There was no statistically significant difference found in gonial angle measured on panoramic radiograph and lateral cephalogram.

Conclusion:

Panoramic radiography can be used as an alternative tolateral cephalogram to assess the gonial angle in different sagittal facial patterns.

KEYWORDS:

Gonial angle, Sagittal facial patterns, Panoramic radiograph and Lateral cephalogram

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Background:

To determine the ureteric calculus in patients with renal colic using trans-abdominal ultrasound (US) and un-enhanced helical CT (UHCT). The aim of this study was to conduct an evaluation for efficacy of B-mode for diagnosing ureteric calculus in patients with renal colic by taking un-enhanced helical CT findings as gold standard.
Methods: This cross-sectional study was conducted at the department of Radiology, Dr. Ziauddin Medical University and Hospital, Clifton, Karachi from May 2013 to January 2014. Grey scale (B-mode) ultrasonography was used for the evaluation of all patients presenting with suspected renal colic followed by un-enhanced helical CT, standard, the finding of renal ultrasonography were compared.

Results:

Out of total 105 patients, ultrasonography showed calculi in 21 (20%) of the patients while CT findings showed calculus in 55 (52.4%) of the patients. Out of 21 patients with calculus in ultrasound, right side was involved in 13 (61.9%) and left side in 8 (7.6%) of the patients. Mean size of calculi on ultrasound was 1.46 + 1.14. hydronephrosis was observed in 59 *56.2%) while hydroureter in 43 (41%) of the patients. Out of 55 patients with calculus in CT, right side was involved in 19 (34.5%) and left side in 36 (65.5%) of the patients. Mean size of calculi on Ct was 0.81 + 0.74. hydronephrosis was observed in 59 (93.75) while dydroureter in 43 (91.5%) of the patients.

Conclusion:

For the diagnosis of small ureteral calculi B-mode ultrasonography is not a very sensitive test. However it can diagnose large ueroterol calculi especially in the proximal and distal ureter.

KEYWORDS:

Renal colic, ultrasonography, echogenic focus.

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Background:

Early pain after laparoscopic cholecystectomy is a process which includes different pain components; laparoscopic cholecystectomy is characterized by a short hospital stay, hence, pain control on the day of surgery is increasingly important. This study was designed to observe the analgesic effect of intraperitoneal bupivacaine instillation in early post-operative period following laparoscopic cholecystectomy.

Methods:

In this Double-blind Randomized clinical trial, 100 participants were selected. These were divided in two groups: Group-1 received 20 ml of 0.25% bupivacaine solution which was instilled in the sub diaphragmatic, hepatic spaces (10ml at each site) at the end of the operation. Group 2 (Placebo) was instilled with 20ml isotonic saline (0.9%) in a similar manner. Post-operative pain free intervals and duration was observed at the time of analgesia administration for 10 hours.

Results:

The mean time of first complaint of pain in group-1 was 5.14 ± 2.89 hours while mean time in group-2 was 1.80 ± 2.01 hours (p- value 0.001). The mean intensity of pain on VAS over 10 hours was higher in the placebo group (mean 6.42) compared to the Bupivacaine group (mean 3.46). All patients, 100%, in placebo group required rescue analgesia within 6 hours after surgery while only 68% in bupivacaine group required analgesia during the same postoperative period.

Conclusion:

Patients instilled with intraperitoneal bupivacaine had decreased intensity of pain. Secondly, following surgery complain of pain in Bupivacaine group was after a significant lapse of time compared to placebo group.

KEYWORDS:

Pain; Bupivacaine; Cholecystectomy

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Objectives:

To develop interest in laboratory based genetic research in undergraduate medical students and to identify the effectiveness of hands on laboratory exposure in culminating interest and confidence in students to pursue further skills and evidence based medicine before they begin clinical rotations in the 3rd year of medical college.

Methods:

A two-month long study was conducted that included lab work and data collection through an online form. Out of 120 MBBS students initially registered, only 100 filled out the form. The experiment was conducted over three hours under faculty supervision. The participating students had no prior experience of the materials/methods, safety precautions, equipment, procedure, expected outcomes and application and relevance to clinical practice.

Results:

Out of 100 participating students, 81 were second year and 19 from third year. The difference in response to research opportunity between 2nd and 3rd year medical students was highly significant (p value <0.001). Out of 100, 96 students were seeking opportunities to participate in research. However, 73 students had no previous knowledge of bench work. The remaining 27 students had prior laboratory experience at school but were not familiar with DNA extraction or related equipment. The increase in confidence (97%) to handle the equipment was highly significant (p value 0.0008).

Conclusion:

The introduction to laboratory skills in pre-clinical years was found to be effective as shown by the difference in initiative among 2nd and 3rd year medical students (p value <0.001). Incorporation of laboratory based research module is recommended in preclinical years of the medical undergraduate curriculum.

KEYWORDS:

Medical Students, Laboratories, Evidence-Based Medicine, Research

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BACKGROUND:

Staple-line reinforcement is traditionally used in laparoscopic weight loss surgery in order to reduce bleeding and leakage. The purpose of this study was to find out the role of buttressing material Seam Guard (GORE) ® for staple-line reinforcement and its financial implications in our setup.

METHODS:

A prospective comparative study was done of morbidly obese patients who underwent weight loss surgery (Laparoscopic Sleeve Gastrectomy) over an 8-year period. Patients were enrolled in three groups; Group A received staple-line reinforcement throughout Group B only had partial reinforcement (at the fundus and pyloric end) and Group C were the ones on whom no reinforcement was used. The staple line was reinforced with Seam Guard (GORE) ®strips.

RESULTS:

A total of 364 patients, with a mean preoperative BMI of 53.3 kg/m2 (range = 37.8–68.9), underwent LSG. 146 patients were in Group A, 105 in Group B and 113 in Group C. None of the patients in all three groups had leak.

CONCLUSION:

Staple line reinforcement reduced surgical complications compared to standard stapling of the stomach for a Gastric Sleeve. No statistical significance was observed in the rates of bleeding or leaks between any of the groups. Thus the additional cost of the buttressing material such as Seam Guard (GORE) poses a financial burden on the patient considering the economic realities of our setup.

KEYWORDS:

Bariatric surgery, cost effectiveness, gastric resection.

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Background:

Most researches on Gastrointestinal (GI) disorders are conducted in secondary health care settings, yet majority patients present at a primary health care level. Functional dyspepsia (Idiopathic or non ulcer dyspepsia) constitutes a tremendous workload in primary care. This study aims to assess the knowledge of general practitioners regarding functional dyspepsia.

Methods:

Data was collected through a cross sectional study in 2016, targeting 18 towns of Karachi. Multistage sampling technique was employed. A total of n=250 general practitioners were inducted in the study. Data was collected through self administered questionnaire developed from the ROME III guidelines of functional dyspepsia. Descriptive analysis was carried out through SPSS 21.

Results:

From the total n=250 general practitioners only 17.5% were able to correctly identify the correct definition of functional dyspepsia. Less than 1% knew that ROME III guidelines are being followed for management of functional dyspepsia. The diagnostic criterion for functional dyspepsia was known to only 15% general practitioners. Only two alarm signs were identified by the participants of the study.

Conclusion:

The average number of patients seen by General Practitioners is high yet their knowledge is weak and practices are not according to the standard guidelines

KEYWORDS:

Dyspepsia, General Practitioners, functional Gastrointestinal disorder, Primary health care

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Objectives:

To assess the prevalence of anxiety, to determine various factors associated with anxiety among undergraduate students.
Methods: Descriptive cross sectional study done at different Institutions of Abbottabad from December 2016 to August 2017. Samples of 137 students selected by using non-probability convenient sampling technique, and were included in our study. A self-administered questionnaire was used as a tool for data collection which was analyzed using SPSS-21.0.

Results:

Out of 137 undergraduate students, 31(22.6%) were males and 106(77.4%) were females, 62(45%) students were boarders and 75(55%) were day scholars, mean age was 20.80±1.5 years. 42(30.7%) were normal, 27(19.7%) were suffering from mild anxiety, 48(35.0%) from moderate anxiety while 20(14.6%) students from severe anxiety. Among normal students 11(8.0%) were male and 31 (22.6%) were female. In mild anxiety 6(4.4%) were male and 21(15.3%) were female, 11 (8.0%) males and 37(27.0%) female were suffering from moderate anxiety while in severe anxiety 3(2.2%) were males and 17(12.4%) were female. It is clearly showing that anxiety is more prevalent among females than males. Other Demographics showed that 51 were feeling home sickness, 12 students were cigarette smokers. 54 students were using self- medication during exam, 37 students in the sample faced financial difficulties and 106 students had chosen career of their own choice while others didn’t.

Conclusion:

Our study concludes that anxiety is highly prevalent in undergraduate students. Moreover prevalence of anxiety was high among female students compare to males, in day scholars and medical students as compared to students of other fields.

KEYWORDS:

Anxiety, Undergraduate students, Universities, day scholars

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There is global increase in resistance among bacterial species that lead to critical infections. Most of the Gram-negative bacteria are labelled as multi drug resistant. Among all different species, the Pseudomonas aeruginosa (P.aeruginosa) is one of the leading causes of life-threatening infections. It has become difficult to treat P.aeruginosa infections in current scenario as antimicrobial resistance has increased against antimicrobial drugs. So it has become a challenge to select optimal antibacterial drug or regimen for the patient treatment to prevent further resistance.
Ceftolozane/tazobactam (C/T) is a novel combination of broad spectrum antibacterial agents that is 5th generation cephalosporin antibiotic and β-lactamase inhibitor. It is considered a best choice for the treatment of complicated infections including ventilator-associated bacterial pneumonia, nosocomial pneumonia, urinary tract infections and intra-abdominal infections.
Ceftolozane/tazobactam possess sensitivity of about >90% against β-lactam resistant strains of P.aeruginosa. This combination is superior to various other antibiotics and antibacterial regimen so it has initiated a new chapter in an era of complicated infections.
This review appraises the comparison of different broad spectrum antibiotics like levofloxacin, meropenem and tobramycin and antibacterial combinations including tazobactam/cefepime, ceftazidime/avibactam, tazobactam/piperacillin, with the Ceftolozane/tazobactam combination. This article also evaluates the effect of C/T if given in combination with other drugs like daptomycin, metronidazole and amikacin.

KEYWORDS:

Critical infections, Multi drug resistant, P.aeruginosa, Ceftolozane/tazobactam.

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Fusion of two teeth is rare developmental disorder which is encountered by a clinician. It is commonly reported in deciduous dentition. The fused crown appears broader and usually an esthetic concern. This condition usually reveals a decreased teeth count. Unilateral occurrence of fusion in permanent mandibular anterior teeth is a rare phenomenon. Hence this case report is presented.

Key Words:

fusion, gemination, double teeth, mandibular

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