Ayub Teaching Hospital Research Articles

Association of Obesity With Type 2 Diabetes Mellitus: A Hospital-Based Unmatched Case-Control Study.

Background The prevalence of type 2 diabetes mellitus (T2DM) and obesity is alarmingly increasing with the accessibility of the modern lifestyle. This study aimed to assess the association of obesity with T2DM among the patients visiting the Medicine Department of Ayub Teaching Hospital, Abbottabad, Pakistan. Method This hospital-based, unmatched case-control study was conducted from March 2022 to September 2022. A total of 200 patients (age ≥ 18) (100 casesand 100 controls) were recruited. Those patients with a history of T2DM were selected as cases, and those without diabetes were selected as controls after taking informed written consent. Patients with BMI ≥ 25 were considered obese. Data were collected through a non-probability convenience sampling technique using a self-structured non-validated questionnaire. Data were organized and analyzed through IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY). Results We found a significant positive association of obesity with T2DM with a crude odds ratio of 3.6 (95% CI: 2.0-6.6), a p-value of 0.000, and an adjusted odd ratio of 3.7 (95% CI: 1.9 - 7.1), with a p-value of 0.004 (adjusted for potential confounders, including gender, age group, stress, and status of physical activeness) using a logistic regression model. Conclusion It is concluded that obesity is strongly associated with developing T2DMand lack of physical activity, people over 45 years, and males with obesity have a higher chance of developing T2DM.

Mortality And Prognostic Factors In Patients Operated For Acute Epidural Hematoma.

Epidural hematoma is one of the most common surgical emergencies encountered in neurosurgery. This study was conducted to determine the mortality and prognostic factors in patients operated for traumatic intracranial epidural hematoma in a resource-constrained setting from a developing country. This retrospective study was conducted in the Department of Neurosurgery at Ayub Teaching Hospital Abbottabad from 1st January 2019 to 31st Dec 2021. Inclusion and exclusion criteria were created. The medical record of 116 patients admitted and operated on for traumatic extradural hematoma was retrospectively reviewed. Information was recorded using a standardized structured questionnaire. The outcome was measured in terms of the Glasgow coma outcome score. Out of 116 patients, 93 were male and 23 were female.19 (16.4%) patients were in the age range 0-5 years, 42 (36.2%) were in the age range 6-15, 35(31.0%) were in the age range 16-30, 11 (9.5%) were in the age range 31-45 years, 7 (6.0%) were in the age range 46-60 years while only one patient included in this study was above 60 years. Overall mortality was 4.3%. Mortality was higher in females and in those aged less than 5 years (3.4%). 4 out of 16 patients died with GCS less than 8, while none of the patients died when GCS was above 12. Mortality was significantly higher in the presence of associated lesions (4.4% vs. 0%) and anisocoria (2.6% vs.1.7%). Patients who operated within 6 hours of trauma resulted in better outcomes with a mortality rate of 0.0% and functional recovery of 57.8 % while for those who operated after 6 hours, mortality was significantly higher (4.3%) and functional recovery was significantly low (15.5%). Good surgical outcomes can be achieved with early operative intervention if indicated. Female gender, low preoperative GCS score, presence of pupillary dilatation, presence of associated lesions, delayed surgical intervention and age less than 5 years are significant predictors for poor outcomes.

Frequency and pattern of female genital tract malignancies in patients presenting with gynecological problems

Introduction: Significant morbidity and mortality is caused by cancers in women all over the world. Cancers of the female reproductive organs are called genital tract cancers. They include cervical cancer, ovarian cancer, endometrial cancer, vaginal carcinoma, cancer of the fallopian tubes and gestational trophoblastic tumor. After breast carcinomas, they account for the second most common carcinomas in females. 
 Methodology: This cross-sectional study was conducted from 1 June 2018 to 31 May 2022. After taking written informed consent, 256 patients presenting to Gynae A Unit, Ayub Teaching Hospital, Abbottabad, were included in the study. Patients with a history of menstrual irregularities, vaginal bleeding, abdominopelvic pain or mass were included, while those presenting with other gynecological problems were excluded. The confirmed diagnosis was made based on histopathology reports by the consultant pathologist of the laboratory in the hospital after the patient's surgery.
 Results: Out of the 256 patients, 30 (11.71%) had female genital tract malignancies. The mean age was 48.79 years, and the standard deviation was 12.93 years. 17 patients (56.66%) had ovarian cancer, 5 (16.66%) had cervical cancer, 7 (23.33%) had endometrial cancer, and 1 (3.33%) had vaginal cancer. Ovarian cancer was the most common (56.66%), followed by endometrial cancer. Serous adenocarcinoma of the ovary was the most frequent type (26.66%). 
 Conclusion: The percentage of female genital tract malignancies in patients with gynecological problems is relatively high with serous adenocarcinoma of the ovary being the most common malignancy. Developing and implementing an effective policy regarding early cancer detection is necessary.

Association between Time to Thrombolysis and Left Ventricular Systolic Function in Patients with St-Elevation Myocardial Infarction: Unraveling the Relationship

OBJECTIVES To determine the association between time to thrombolysis and left ventricular (LV) systolic function in patients with ST-elevation Myocardial Infarction (STEMI). METHODOLOGY T This descriptive case series study compared the time to thrombolysis and LV systolic function of 149 STEMI patients. LV systolic function was evaluated following thrombolysis, and data were collected and analyzed using SPSS version 21.0 software. This study was conducted at the Ayub Teaching Hospital Cardiology Department in Abbottabad from August 2022 to January 2023. RESULTSThe study examined how LV systolic function and symptoms in STEMI patients related to when thrombolysis was administered. The 149 patients analyzed included 28 with normal LV function, 86 with mildly impaired function, 26 with moderately impaired function, and 9 with severely impaired function. In contrast to delayed thrombolysis, which was linked to higher levels of impairment, immediate thrombolysis was correlated with a higher percentage of normal LV function. The prevalence of patients with severely compromised LV function was also higher in those who received thrombolysis within 3 to 6 hours and 9 to 12 hours. LV function was correlated with the type of myocardial infarction, with varying degrees of impairment seen in AWMI and IWMI patients. Gender had no discernible effect on LV function. CONCLUSION Improved LV function is associated with early thrombolysis within hours of STEMI symptoms, highlighting the significance of prompt intervention and minimizing wait times for better patient outcomes.

AETIOLOGICAL FACTORS OF GRADE-III PROTEIN-CALORIE MALNUTRITION AMONG ADMITTED CHILDREN IN A TERTIARY CARE HOSPITAL

Background: Aetiological factors of Protein-Calorie-Malnutrition (PCM) in underdeveloped countries are an established fact. An increase in number of children with grade-III PCM secondary to myriad of reasons has been noted recently. This study aimed to recognize the aetiological factors of grade-III PCM among admitted patients of grade-III PCM in Ayub teaching hospital Abbottabad. Methods: Severe acutely malnourished (SAM) children 6?60 months of age were selected following non probability random sampling technique. The chosen patients were selected according to WHO criteria of PCM grade-III. Primary data was collected from patients admitted to inpatient facility, on a questionnaire from patients whose anthropometric measurements fell under the criteria of severe acute malnutrition (SAM) by WHO during their hospital stay. Results: Higher number of SAM children was due to reversible aetiological factors like inaccessible food, inadequate breast-feeding and weaning practices, and improper food choices for weaning, illiteracy, ignorance, poor sanitation and large family sizes that led to SAM. From 100 patients (52 males), primary malnutrition was the most common cause for grade -III PCM present in 45 patients (23 females). Conclusion: Primary malnutrition was the main aetiological factor for grade-III PCM, more common among females, perhaps due to cultural issues in our region. It was also the main contributing cause in the toddler age group. Pak J Physiol 2023;19(4):39–41

PREVALENCE AND RISK FACTORS OF HEMOPHILUS INFLUENZA TYPE B MENINGITIS: ROLE OF VACCINATION AND SOCIAL DEMOGRAPHY IN THE PATHOGENESIS

Bacterial meningitis is a condition caused by a bacterial infection in the meninges that results in inflammation. The causative agent varies according to age and other related factors. Hemophilus Influenza type B (Hib) is the most common cause of meningitis in children. This study aimed to determine the prevalence of H. influenza meningitis, the role of vaccination, and demographic factors in the etiology of Hib meningitis. Using a cross-sectional design, the study was conducted at the Pediatrics department of Ayub Teaching Hospital, Abbottabad, for six months, from 19-9-2023 to 19-3-2024. After obtaining ethical approval from the IRB of Ayub Teaching Hospital Abbottabad, a cross-sectional study was conducted, and 143 patients who met the inclusion criteria were included in the study. Hib vaccination status was confirmed by history and the presence of a vaccination card. Cerebrospinal fluid (CSF) was collected and sent for analysis, including microscopy and culture. The mean age of the patients was 44.92±51.48 months, with a male-to-female ratio of 1.38:1. Seventy (49.65%) patients were fully vaccinated against the Hib virus. The study results showed that H. influenza growth on CSF culture was noted in 14 (9.79%) patients. The Hib positive status of these cases was significantly associated with gender, residential area, and socioeconomic class of the patient at p values of 0.005, 0.047, and 0.041. In conclusion, despite the use of conjugate vaccine, Hib remains a cause of meningitis, and the pathogenesis of Hib meningitis is associated with gender, residential category, and socioeconomic class of the patient.

Exploring The Link Between Obesity And Hypothyroidism.

Obesity and hypothyroidism are two common clinical conditions that are often connected. This connection is now more important because of an exceptional rise in the prevalence of obesity around the world. Both of these conditions have a noteworthy impact on human health and well-being. The main objective of this study was to determine the frequency of hypothyroidism in obese patients presenting at Ayub Teaching Hospital, Abbottabad. This cross-sectional study was carried out on 242 patients in the Department of Medicine of Ayub Teaching Hospital, Abbottabad from 1st March to 31st August 2022. SPSS version 23.0 was used for data analysis. In this study, 242 obese patients were included. The mean age of the patients was 39.55±9.361 years. The mean BMI was 41.62±8.099kg/m2 ranging from 31 to 61kg/m2, the mean TSH level was 3.04±2.604mU/l, the mean T4 level was 8.53±2.215pmol/L and the mean T3 level was 1.2195±0.35795nmol/L. Out of a total of 242 patients, 34 (14.0%) were male and 208(86.0%) were female patients. Patients found with overt hypothyroidism were 11 (4.5%), subclinical hypothyroidism were 31 (12.8%) and euthyroid were 200 (82.6%). The proportion of hypothyroidism among the obese patients was quite less in our setup and not significantly associated with age and gender of the patients.

Pattern Of Breast Cancer: Experience At Ayub Teaching Hospital, Abbottabad.

Breast cancer is the most common malignancy found in females all over the world and the second leading cause of cancer death in European countries. The purpose of this study was to find out the pattern of disease presentation in our region where a proper tumour registry system is lacking. This descriptive study was carried out in the Department of Surgery, Ayub Teaching Hospital Abbottabad, from July 2021 to June 2022. All female patients with biopsy-proven breast cancer were included in the study: benign lumps, refused to enrol, and those who were lost to follow-up were excluded. A total of 87 patients with carcinoma breast were included: 92 % (n=80) had invasive ductal carcinoma. Axillary lymph nodes were involved in 88.5% (n=77), 75.8% of the tumours, (n=66), were Grade 2, 34.5% (n=30) were in the 40-49 years age group, and 30 % (n=27) of the disease was categorized as Stage III or IV. In 55 % (n=48), the tumour was on the right side and in 39% (n=34), the upper outer quadrant was involved. Most of the patients, 90.8% (n=79), were married and had used contraceptive measures. Only 19.5% of patients (n=17), had a history of nipple discharge and 56% (n=49) had a positive family history: 71% (n=62) had nipple retraction, and 54% (n=47), proved to be ER PR positive. Our patients presented late: axilla was commonly involved and a third had advanced disease. Screening and community awareness programs may help in early detection. Hormone use for contraception needs to be weighed carefully. Better data collection may help in designing screening and care programs.

THE EFFECT OF ACUTE KIDNEY INJURY IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

This study aims to determine the frequency of acute kidney injury (AKI) in patients who undergo percutaneous coronary intervention (PCI) and its impact on elderly patients. To achieve this, 80 patients admitted to Ayub Teaching Hospital from March 2019 to August 2020 for PCI were studied for AKI after the procedure. The primary endpoint was mortality from all causes, while the secondary was mortality due to major cardiovascular events. The results showed that out of the 80 patients, 29 developed AKI, with a higher incidence observed in the older age group. These patients reported a higher rate of congestive heart failure, increased C-reactive proteins, and an increased rate of major adverse cardiovascular events, which was 39.43%. Furthermore, all-cause mortality was higher in patients suffering from AKI. In conclusion, this study highlights that one-fourth of elderly patients undergoing PCI face a higher risk of AKI. Further research is required to mitigate the mortality and morbidity associated with AKI in this vulnerable group.

Assessment of Serum Urea and Creatinine Levels in Diabetic Patients

Diabetic nephropathy is the leading cause of renal morbidity which occurs when chronic diabetes destroys the filtering system of the kidneys. Serum urea and creatinine are widely used as renal function test parameters. This study aims to assess the level of serum urea and creatinine in diabetic patients and their relationship with each other. The study was conducted in Ayub Teaching Hospital from September 15 to December 20, 2019. A total of 176 samples from confirmed diabetic patients were analyzed including 85 female and 91 male patients. Also, 83 control samples were taken for this study. Serum urea and creatinine levels were assessed to evaluate diabetic nephropathy in diabetic patients. SPSS (version 23) was used for statistical analysis. Pearson correlation analysis was used to check the relationship of blood sugar level, creatinine, and urea. Descriptive statistics (mean ± SD) were measured for the continuous variable. Scatter plot diagrams were added for the easy visualization and interpretation of the data. The significant level was set at p < 0.05. Out of the 176 diabetic samples, 32 had abnormally high serum creatinine and 66 had abnormal serum urea. In controls, one individual had high creatinine and three individuals had high serum urea. A significant increase in both urea and creatinine levels was observed in diabetic samples. Both serum urea and creatinine showed a strong positive correlation with the level of glucose and remained statistically significant (p < 0.01). Similarly, blood glucose level showed a strong correlation with the renal function test parameters. Hence, it was concluded that serum urea and creatinine are important parameters to assess kidney function in diabetes mellitus.

EGFR-1 Expression in Meningioma: Insights into Gender Distribution and Grade

Objective: Meningioma is the most common primary brain. Histopathological grading (from I to III) is essential for prognostication and therapeutic decisions. EGFR-1 overexpression has been implicated in tumor progression and poor outcomes in various cancers. However, its role in meningioma pathophysiology and gender disparities remains unclear. This study aimed to determine the expression of EGFR-1 in grade I and grade II meningioma and explore associations with clinicopathological parameters. Materials & Methods: This cross-sectional study was conducted at Ayub Teaching Hospital in collaboration with the Neurosurgery Department, Histopathology Laboratory of Ayub Medical College, and Health Diagnostic Laboratory. Non-probability consecutive sampling technique was used to include meningioma patients aged 23-54 years after obtaining ethical approval. Data was collected from medical records, and histopathological examination and immunohistochemical analysis were performed on meningioma tissue samples. Statistical analysis was conducted using SPSS Version 25, and associations between clinicopathological parameters and EGFR-1 expression were evaluated using appropriate tests. Results: We included 39 meningioma patients, with a female predominance of 22 (56.4%). The majority had grade I tumors (89.7%). EGFR-1 expression was observed as severe 30 (76.9%), moderate 7 (17.9%), and mild 2 (5.1%). No significant association was found between gender and meningioma grade or EGFR-1 expression. However, a significant association was observed between meningioma grade and EGFR-1 expression in grade I tumors (p = 0.049), but not in grade II tumors (p = 0.248). Conclusions: A significant correlation between meningioma grade and EGFR-1 expression in Grade I meningioma suggests that EGFR expression could serve as a prognostic biomarker.

Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma

Objective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients. Material & Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality. Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were <40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery >4 hours post-injury had higher mortality (18.2%) vs. <4 hours (8.5%). 14/43 GCS <8 patients survived, with no deaths when GCS >12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness <10mm and only 1 survived with a thickness >16mm. 25/29 died with midline shift >11mm. Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS>9, normal pupils, hematoma width <1.5cm, midline shift <1cm, and surgery within 4 hours.

Inculcation of Professionalism in House Officers Through Mentoring by Senior Residents; A Pilot Project in Obstetrics & Gynecology

Objectives: To evaluate the effectiveness of mentoring of house officers on their transition towards their professional life, preparation for the workplace, and improving their learning through standardized training and assessment during their rotation in Obstetrics & Gynecology.
 Methodology: The project mixed method study was implemented in Gynae C Unit of Ayub Teaching Hospital, Abbottabad from 1st May 2022 to 31st May 2022. A mentorship program was initiated as a one-month pilot project to train house officers of Obstetrics & Gynecology and inculcate professional values and practices relevant to the discipline. Thereafter, a mixed method study was conducted to evaluate the program having qualitative semi structured interviews from mentors and mentees as well as quantitative formative assessment.
 Results: House officers appreciated the program for acquiring knowledge and overcoming difficulties at work, as well as relieving stress and anxiety and suggested formal training of mentors. Mentors said that the program helped to develop their leadership and communication skills.
 Conclusion: Mentoring had a positive effect on house officers learning and overall satisfaction despite some challenges and limitations.

Frequency of mandibular fractures in children presenting with maxillofacial trauma.

Objective: To determine the frequency of mandibular fractures in children presenting with maxillofacial trauma. Study Design: Cross Sectional. Setting: Department of Oral and Maxillofacial, Ayub Dental Section at Ayub Teaching Hospital, Abbottabad. Period: 05 December 2018 to 05 June 2019. Material & Methods: A total number of 166 children from both genders between the ages of 1-12 years with a history of trauma to mandible were added to the study through consecutive non-probability sampling. All the particulars of these patients like age, gender, date of trauma, cause of trauma, pattern of trauma, associated injuries were noted down on a format designed for the study and X-rays of all the patients were taken. Results: The Mean±SDs of age in this study was 5.34+1.867. Out of these patients 96 (57.8%) were male while 70 (42.2%) were females. The results show that 66 (39.8%) patients had symphysis, 48 (29%) patients had parasymphysis, 32 (19.2%) patients had angle/body, 20 (12%) patients had condyle fractures. Associated injuries were also present in 103 (62%) patients. Conclusion: The most common type of mandibular fracture in children was symphysis followed by parasymphysis, angle/body and condyle fractures. Early identification and treatment of such pediatric mandibular fractures will help to minimize hospital stay thus reducing financial burden on patients.

BACTERIOPHAGE COCKTAIL EXHIBITED SUPERB ANTIBACTERIAL AND ANTIBIOFILM ACTIVITY AGAINST SELECTED UROPATHOGENS

Urinary tract infections (UTIs) are most abundant bacterial infection worldwide. Approximately 150 million urinary tract infections occur every year globally. The predominant pathogens involved in etiology of UTI are Escherichia coli followed by Staphylococcus spp., Pseudomonas aeruginosa, Proteus spp., Klebsiella spp., Acinetobacter spp., Enterobacter spp., Citrobacter spp., and Enterococcus spp. It is estimated that uropathogenic E. coli (UPEC) cause 80% of UTIs cases. The over use of anti-microbial agents has extraordinarily amplified the rise of multidrug resistant (MDR) uropathogens. Biofilm formation by UPEC is also a major cause of antimicrobial resistance. To curb harmful ripple effects of antibiotic resistance we need to identify alternative treatment procedures. Bacteriophages are bacterial viruses that can invade and infect bacteria. Phage therapy is considered as best alternate to combat several antimicrobial resistant pathogens, including MDR uropathogens. The aim of this research was to isolate and characterize lytic bacteriophages from sewage water and to identify antibacterial and antibiofilm activity of isolated bacteriophage against UPEC. Hazara University Mansehra was the subject of the research. Bacterial samples of UPEC were collected from Ayub Teaching Hospital Abbottabad and Punjab University Lahore. Various biochemical tests including Gram staining, oxidase and catalase test were performed to identify UPEC. The isolated bacteriophages were confirmed by spot assay and plaque assay against the host bacterial strain. The phages were purified by serial dilution up to 5-6 times repeatedly. For morphological studies electron microscopy was performed. The specificity, lytic activity and efficient bacterial growth reduction ability of isolated phages in this study emphasize that these phages could be a suitable therapeutic agents for treatment of MDR infections.

Clinico-pathological Spectrum of Pyogenic Granuloma in Patients Presenting at Ayub Teaching Hospital, Abbottabad

Background: Oral Pyogenic Granuloma (OPG) is a type of oral mucosal lesion that is distinguished by its rapid development, friable nature, and vascular proliferation. Aim: To examine the demographic and histopathological features of patients diagnosed with oral pyogenic granuloma. Study design: The cross-sectional study. Methodology: This study was conducted in the Dentistry Department of Ayub Medical College, Abbottabad following the acquisition of a comprehensive medical history through a pre-established form, pertinent clinical information pertaining to the patients, including age and lesion location, was collected. All excisional biopsy specimens were collected. Following preservation in 10% neutral buffered formalin, the gathered specimens underwent preparation for paraffin embedding. The histopathological findings that were assessed and documented included the observation of ulceration, inflammatory cell infiltration, vascular proliferation, fibrosis, and epithelial alterations. Data was analyzed in SPSS. Results: The 51 patients who were a part of the research had a mean age of 31.14+SD and were all female. The bulk of the patients were between the ages of 26 and 35. Lesion diameters varied from 0.5 to 3 cm, with 1.1 to 2 cm being the most common size range. 78% of the cases involved pregnant females. The most common site was the gum mucosa, lips, tongue, and palate were the next most typical locations for OPG. The majority of patients had pseudoepitheliomatous hyperplasia, mild chronic inflammation, and fibrosis, in addition to lobules of capillary sized blood vessels according to histopathological examination. Conclusion: Oral Pyogenic Granuloma is predominantly seen in young females, and is mostly associated with pregnancy and most common site is gum mucosa. The histopathological findings demonstrate characteristic features such as pseudoepitheliomatous hyperplasia, chronic inflammation, and fibrosis. Understanding these features contributes to accurate diagnosis and management of this lesion. Keywords: Oral Pyogenic Granuloma, lobular capillary hemangioma, pseudoepitheliomatous hyperplasia.

Frequency of Inferior Alveolar Nerve Damage After Open Reduction and Internal Fixation in Mandibular Fractures

One of the most frequent injuries to the maxillofacial region is mandibular fracture. Numerous places experience fractures. The inferior alveolar nerve is often injured as a result of mandibular fractures. Objective: To ascertain how frequently patients in the oral and maxillofacial department of the Ayub Teaching Hospital in Abbottabad experienced inferior alveolar nerve injury following open reduction and fixation of a mandibular fracture. Methods: This was a Descriptive case series carried out at Oral and Maxillofacial Department, Ayub Teaching Hospital, Abbottabad after approval from the IRB of the institution and CPSP vide number (CPSP/REU/DSG-2018-010-2532). Using the formula to evaluate proportion with absolute precision and the following premises, the sample size was determined to be 96 using the WHO software for sample size computation in health studies: The expected percentage of inferior alveolar nerve injury following fixation in mandibular fracture is 45%, the confidence level is 95%, and the absolute precision is 10%. Results: The mean age of participants was 35.81±5.63 years with range from 26 to 45 years. Most common age group was 36-40 years and 41-45 years (n=26, 27.08%) followed by 26-30 years (n=23, 23.96%). There were 70 (72.92%) males and 26 (27.08%) females in the study. Majority (n=88; 91.67%) of the patients were given general anesthesia while the remaining (n=8; 8.33%) received local anesthesia. Perioperative inferior alveolar nerve injury was observed in 56 (58.33%) patients while permanent inferior alveolar nerve injury was diagnosed in 39 (40.63%) patients. Conclusions: Damage to inferior alveolar nerve is a frequent problem of open reduction and fixation of mandibular fracture. However, utmost care should be exercised to reduce its occurrence in patients with mandibular fracture.

Mental Health Impact On Patients of ESRD On Renal Replacement Therapy: A Cross Sectional Survey Using Beck and Deck Inventory

Introduction: Chronic kidney disease (CKD) affects approximately 8 to 16% of population worldwide. With increasing incidence of diabetes mellitus and an aging population, CKD is putting an enormous burden on health care resources. The prevalence of CKD in Pakistan has been estimated to vary between 5%-12.5%. Depression can be found in 25% to 42% of hemodialysis patients. There are no previous studies done in Pakistan to know the mental health impact in End- stage renal disease (ESRD)patients undergoing dialysis. Aims &Objectives: To assess the mental health impact on patients of ESRD on renal replacement therapy using Beck and Deck inventory in our population. Place and duration of study: Department of Medicine, Ayub Teaching Hospital, Abbottabad from February 2019 to July 2019. Material & Methods: 97 patients were enrolled using non-probability, consecutive sampling. Patients having CKD and on dialysis for 3 months from both genders from ages 15 to 60 years were included in the study. Patients were assessed using DSM-IV/BDI criteria for presence of depression. Data was entered and analyzed using SPSS version 20 Results: Of the 97 patients included in the study 57 (58.8%) were male and 40 (41.2%) were females. The mean age of patients was 45.00 ±14.82 years. The mean length of time since the patients were on dialysis was 20.47 ±22.81 months. Hypertension was the commonest cause of CKD (75.3%). The mean BDI score was 15.25 ±7.46. The number of patients who had no or minimal depression was 40 (41.2%). The number of patients having mild, moderate and severe depression was 57 (58.8%) patients. Single patients were more likely to be normal (77.8%) compared to married individuals (37.5%). Of the patients who were on dialysis for more than 48 months, 75% were normal with no element of depression. Of the patients who were on dialysis for less than a year, 59.6% had depression. This was statistically significant. Conclusion: Depression is more prevalent in ESRD patients on hemodialysis. It is more prevalent than found in other major illnesses and in the general population. It should be recognized earlier so that these patients can be treated, and they can have a better quality of life.

Extensively Drug-Resistant Enteric Fever In Children: Surging Threats Of Antimicrobial Resistance And Possible Solutions.

Enteric fever is an infectious disease caused by Salmonella enterica including Salmonella Typhi and Paratyphi A and is associated with potentially serious outcomes, especially in developing countries. The study was conducted with the aim to present the clinical features, laboratory characteristics and antibiotic susceptibility in patients with culture-proven extensively drug-resistant (XDR) enteric fever and to explore drug combinations as a possible solution for the growing problem of antimicrobial resistance. This descriptive cross-sectional study was conducted in the Paediatric unit of Ayub teaching hospital. Patients admitted with culture-proven XDR enteric fever were included. Patient characteristics were documented on a predesigned proforma. Response to antimicrobial agents including ceftriaxone and levofloxacin, azithromycin and meropenem and meropenem alone was assessed. Data was entered and analyzed using SPSS version 26. A total of 53 patients participated in this study. The majority of patients 36 (67.9%) were male and above 5 years of age(n=38,71.7%). The mean age of the participants was 7.08±3.02 years. The major presenting features included fever, anorexia and pain abdomen in 53 (100%), 51 (96.2%) and 41 (77.4%) respectively. The mean duration of symptoms prior to hospitalization was 8.92±3.361 days. Of the total patients, 32(60.4%) responded to the initial therapy with ceftriaxone and levofloxacin, 11(20.8%) patients responded to meropenem alone and 10 (18.9%) patients responded to meropenem and azithromycin in combination. There was no statistically significant difference in mean duration to show response in patients receiving either of the treatments (p=0.484). Paediatric patients with XDR enteric fever mainly presented with fever, anorexia and pain abdomen and showed good response to therapy with the combination of ceftriaxone and levofloxacin inspite of the apparent resistance on blood culture and sensitivity.

Effect of seasonal changes on frequency of eclampsia in patients presenting to Ayub Teaching Hospital.

Effect of seasonal changes on frequency of eclampsia in patients presenting to Ayub Teaching Hospital.