King Edward Medical University Research Articles

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Background: Acute myeloid leukemia (AML) is an aggressive haematologicalmalignancy with highest incidence in older adults. AML accounts for approximately 25% of allleukemias in adults in the Western world, and therefore is the most frequent form of leukemia.Objective: The aim of study was to analyze the demographic and clinical features and frequencyof various subtypes of acute myeloid leukemia in adult age group in our population. Studydesign: Descriptive Cross sectional survey. Settings: The study was conducted in PathologyDepartment, King Edward Medical University, Lahore. Study Period: Five years September2007 to September 2011. Material and Methods: A five year data of patients diagnosed asacute myeloid leukemia was collected from September 2007 to September 2011 in PathologyDepartment, King Edward Medical University, Lahore. Patients on chemotherapy andradiotherapy were excluded from the study. Results: Among the 77 patients of Acute MyeloidLeukemia, Acute myeloid leukemia with maturation AML M2 (37.7%) was the most commonsubtype and the least common was Acute megakaryoblastic leukemia AML M7 (1.3%).Meanage for AML was 28 years (Range 15-75 years). M:F ratio was 1.5:1. Fever was found be the mostfrequent presenting feature followed by pallor, bleeding and gum hypertrophy in the descendingorder. More than 50% patients presented with hepatosplenomegaly. Lymphadenopathy wasseen in 30% of patients. Mean peripheral blood blast count was 29%. 12 patients (15.5%)presented with pancytopenia. Conclusion: The study showed male predominance in Acutemyeloid leukemia with mean age of 28 years and the most common subtype was AML- M2.

Pattern of skin diseases among patients attending a tertiary care hospital in Lahore, Pakistan.

ObjectiveThere has been a rise in the magnitude of dermatological diseases in the South East Asian region. This study aimed to determine the pattern of various skin disorders appearing in the Dermatology Department of a tertiary care hospital, which will help people to understand the scale of the rising incidence and possible preventive measures that can be undertaken to curtail it.MethodsAn observational study was conducted on all the patients who attended the Dermatology Department during a one year span. A thorough medical history with detailed cutaneous examination was carried out on every patient. Investigations and skin biopsies were performed, where required, for confirmation of diagnosis.ResultsA total of 95,983 patients presented in the outpatient Department of Dermatology, King Edward Medical University Mayo Hospital Pakistan. Out of this sample, 24,302 patients repeatedly came to the hospital for a follow up visit related to their diseases, while 71,681 were enrolled as new cases. This group comprised 58% females and 42% males; most patients were in the 20–40 years age group. Out of 71,681, eczema was diagnosed in 22,275 (31.07%), infections including bacterial, viral, fungal, sexually transmitted infections (STIs) in 20,178 (28.16%), acne 7910 (11.03%), drug reactions 4830 (6.74%), urticaria 2910 (4.06%), and pigmentary disorders such as lichen planus, melasma and vitiligo were reported in 2739 (3.82%) cases. In addition, psoriasis was reported in 2724 (3.80%), bullous disorders in 1187 (1.66%) and connective tissue disorders in 645 (0.90%). The majority of patients presented with advanced eczema and infectious diseases.ConclusionEczema was the most common skin disease seen in our study, followed by dermatological infections. The emerging challenges for dermatologists are to prevent and reduce these skin diseases that pose a major healthcare burden, as well as affect the quality of patients' lives.

Prognostic Value of p53 Expression Intensity in Urothelial Cancers.

To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers. Descriptive cross-sectional analytical study. Pathology Department, King Edward Medical University, Lahore, from January to December 2016. Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak (less than 15% cells) and strong (more than 15% cells). Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P ≤ 0.05 was taken as significant. Out of the 70 patients, 61 (87%) were males and 9 (13%) females. Out of 25 low grade lesions, 4 (16%) cases were p53 positive; and out of 45 high grade lesions, 41 (91%) cases were p53 positive. There was 33% (2/6 cases) positivity in Tis, 55% (16/29 cases) in T1, 72% in T2 (21/29), and 100% in T3a (5/5 cases) and T3b (1/1 case). Strong intensity of p53 staining was noted to be 5.4% (n=25) of low grade and 94.6% (n=45) of high grade tumors. p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer.

Response of lycopene in treatment of oral submucous fibrosis

Introduction: Oral Submucous Fibrosis (OSF) is a well-known precancerous condition with malignant transformation rate as high as 7.6%. It results in marked rigidity of oral cavity and an eventual inability to open the mouth. Although OSF has a high rate of morbidity but no reliable treatment modality for its management has been developed yet. Objective: To determine the frequency of positive response of oral lycopene in the treatment of patients with Oral Submucous Fibrosis. Methods:A descriptive case series of patients with OSF was conducted at our institution for a period of 6 months i.e.18-11-2014 to 18-05-2015 in the Department of Oral &amp; Maxillofacial Surgery, King Edward Medical University, Lahore. Data was collected by using non-probability sampling technique. After informed consent, all patients were prescribed lycopene 30 mg BD dose for a period of 6 months. Changes in mouth opening (IIO) was measured every month for each patient. Data was entered and analyzed using SPSS 20. Results: A total number of 100 cases were selected for this study. Mean age of the patients was 27.24±8.22 of which 53(53%) were male and 47(47%) were female cases. Positive response of lycopene was noted in 76(76%) of cases while 24(24%) did not respond to the treatment. No adverse effects reported during the treatment period as well as during follow-up. Conclusion: It is concluded that the lycopene can and should be used as a first line of treatment in the management of Oral Submucous fibrosis.

Diabetic: A Comparative Study

Background and Objectives: Type II diabetes mellitus (DM) is particularly common medical disorder and is leading cause of morbidity worldwide. The complication of DM is due to micro or macro vascular damage. The presence of an extensive microvascular circulation and abundant connective tissue in the lungs raises the possibility that lung tissue may be a target organ in diabetic patients and thus pulmonary function test can be affected by DM. This study was designed to compare pulmonary function test between Type II diabetic and non-diabetic individuals; and, with the duration of DM.Material and Methods: This cross sectional comparative study was conducted at King Edward Medical University, Lahore Pakistan. Total sample consist of 91 diabetic and 91 non-diabetic grouped as group A and group B. FEV1, FVC, FEV1/FVC ratio, and PEFR were compared within two groups and with the duration of DM.Results: Total 182 sample with mean age 53.1±5.90 years, with 91(50%) male and 91(50%) female. Group A and B had 91(50%) sample each. Mean value of FVC, FEV1 and PEFR showed statistically significant difference among the both group. Mean of FVC decreases significantly with the increasing duration of DM; although, is not significant with FEV1, FEV1/FVC ratio, and PEFR.Conclusion: Diabetic group showed significantly impaired pulmonary functions test as FEV1, FVC, and PEFR as compare to non-diabetic group.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4 (1): 19-26

A study of Galactin-3 on fine needle aspiration as a diagnostic marker differentiating benign from malignant thyroid neoplasm.

Background & Objective:Thyroid nodules are very common in our setup and their diagnosis on fine needle aspiration is not easy and is a taxing affair. It is a challenge to differentiate between follicular adenoma and follicular carcinoma without histology. Our objective was to investigate the role of Galectin-3 in fine needle aspirates of thyroid nodules as a prospective diagnostic marker and consequently its ability to differentiate benign from malignant neoplasms.Methods:The research was conducted at the department of Pathology, King Edward Medical University, in association with other teaching institutions of Lahore from June 2012 to July 2014.. Sixty cases of solitary thyroid nodules were included in the study. Haematoxylin and eosin staining of the fixed smears and Galectin-3 immunohistochemical staining of the sections prepared from the cell block was performed.Results:There were 60 patients in our study with a mean age of 33.35 years. The Bethesda system for reporting thyroid cytopathology was used to classify the smears and only categories IV, V and VI were included. On histological examination of the resected nodules there were 38.3% (23/60) cases of follicular adenoma, 46.6% (28/60) were of papillary carcinoma and follicular carcinoma made up to 15% (9/60) of all cases. Galectin-3 was negative in 100% (23/23) cases of follicular adenomas. Out of 37 malignant cases 65% lesions showed positivity, while 35% showed negativity for this immunomarker. Considering the malignant lesions, 75% cases of papillary carcinomas showed a positive reaction while only 33% of follicular carcinomas were positive for the immunomarker. This showed that the positive expression was more common in papillary as compared to follicular carcinomas.Conclusion:Galectin-3immunomarker is considerably expressed in malignant tumors, but it is not expressed in benign follicular lesions.

Corneal Endothelial Cell Loss after Phacoemulsification with and without Trypan Blue 218 Assisted Staining of Anterior Lens Capsule

PURPOSE: To study the mean loss of corneal endothelial cell in patients undergoing cataract surgery with phacoemulsification with and without trypan blue. STUDY DESIGN: Randomized controlled trial PLACE AND DURATION OF STUDY: Institute of Ophthalmology, Mayo Hospital/ King Edward Medical University, Lahore. From 1-1-2016 to 30-5-2017 MATERIAL AND METHODS: 152 patients presenting to the Institute of Ophthalmology were included in study. Patients diagnosed with cataract were selected for surgery. The patients were divided into two groups A and B. Group A patients underwent phacoemulsification with trypan blue aided central curvilinear capsulorhexis while Group B patients underwent phacoemulsification without any aid of trypan blue. Patients with any corneal opacity were excluded from study. Specular microscopy was done on all patients before and three months after surgery. On specular microscopy, corneal endothelial count, hexagonality and coefficient of variation were noted. Specular microscopy and recording of findings was done by researcher. RESULTS: Endothelial cell loss was observed in both the groups but it was more in the Group A (74.3421±0.6332)as compared to the Group B (37.0658±2.6891) (p 0.000). CONCLUSION: Phacoemulsification decreases corneal endothelial cell count both with and without trypan blue. The decrease in corneal endothelial cell count was more when phacoemulsification was done with trypan blue but it did not lead to corneal decompensation. KEY WORDS: Phacoemulsification, Trypan Blue, Corneal Endothelial Cell Count.

The Opioid Epidemic: What Pakistan can Learn from the US

The Opioid Epidemic: What Pakistan can Learn from the US

FEEDING PATTERNS AMONG INFANTS IN URBAN SLUM AREAS OF LAHORE

Objective: The present study was designed to determine the feeding patterns and associated limitations in a cohort of 210 infants.&#x0D; Design: Cross sectional study through quantitative and qualitative data during their first year of life.&#x0D; Place and Duration of Study: It was conducted in Govt Kot Khawaja Saeed Teaching Hospital affiliated with King Edward Medical University. Duration of study was 1 year from 1st March 2016 to 28th February 2017.&#x0D; Patients and Methods: Practices related to the feeding of milk and weaning foods of 210 infants were assessed in a defined community of Lahore; 160 Infants from outdoor (Group 1) and 50 infants from immunization clinic (Group 2).&#x0D; Results: 98.5 % of mothers started breast feeding. Exclusive breast fed was only 40% among them, 38% percent infants were given supplemental bottle feeding during first month. The most common reason for starting supplemental feed was perceived “insufficiency” of breast milk (60%) and work load of mother. The mean age for weaning was 4.2 months, while 36% could not be weaned up to one year of age. Weaning was earlier in infants of poor socioeconomic class. The main reason of failure of weaning was rejection of semisolid feed by infant.&#x0D; Conclusion: The exclusive breastfeeding was observed in a small proportion of infants. In most cases, weaning was inappropriate and delayed. There is a great need to educate the mothers for early and exclusive breastfeeding for their infants and the use of proper weaning techniques.

Prevalence and Risk Factors of Low Back Pain Among the Office Workers of King Edward Medical University Lahore, Pakistan

Prevalence and Risk Factors of Low Back Pain Among the Office Workers of King Edward Medical University Lahore, Pakistan

Outcome of Management of Vascular Malformations of Lip.

To describe the characteristics and outcome of management of vascular malformations of lip. The Department of Plastic Surgery and Burn Unit, King Edward Medical University, Mayo Hospital, Lahore, from January 2009 to December 2013. A prospective case series of 38 patients with vascular malformation of lip was performed. Demographic information and clinical features were noted. Treatment employed, complications, functional, and cosmetic outcome were recorded. Surgical debulking was performed as definitive treatment in all patients and nonsurgical techniques were added as adjuvant modalities in 18 patients. Sclerotherapy was performed for venous malformations in 10 patients. LASER was performed in 8 patients with capillary or combined malformations. Arterial malformations were managed surgically without embolization. Postexcision defects were closed primarily in 36 patients with Abbe flap in 1 and nasolabial flap in another patient for reconstruction. Of 38 patients included in the study 20 (53%) were males with mean (SD) age 18 (6) years. Twenty-one percent were high and 79% low-flow malformations (29% venous, 16% capillary, and 34% combined). Lower lip was involved in 70% patients with 95% having difficulty in eating and 87% abnormal speech. Referring diagnosis was incorrect in 35% patients. Postsclerotherapy and postexcision pain scores were mean (SD) 5 (1.26) and 4 (1) respectively. All patients had improvement in eating and speech with restoration of normal muscle function in mean (SD) 5.63 (1.2) weeks. Ninety-five percent patients were satisfied with their outlook. One patient had recurrence at 1 year follow-up. Surgical debulking with proper use of adjuvant procedure for vascular malformations of lip produces best functional and aesthetic results with minimal complications.

Mentoring among Pakistani postgraduate resident doctors

BackgroundMentorship is the key to career success, improving job quality and productivity; however, several barriers are prevalent in many academic institutions. Low/middle-income countries are particularly facing difficulty dealing with poor...

Frequency of Restrictive Pulmonary Function in Type 2 Diabetes Mellitus

Objectives: The aim of this study was to determine the frequency of restrictive pulmonary dysfunction in type 2 diabetic patients.Study Design: Cross – sectional Study.Setting: Outpatient clinic of Department of Medicine, King Edward Medical University, Lahore.Subject and Methods: One hundred and seventy patients of Type 2 Diabetes Mellitus, presented in outpatient department of Mayo Hospital, Lahore with inclusion and exclusion criteria were included in the study. After taking informed consent, pulmonary function tests were performed. Patients were explained about the risks and benefits while their identity was kept confidential. The demographic information of the patients like name, age, sex, height and weight were collected. Digital spirometer was used to perform pulmonary function tests. FEV1 / FVC Ratio more than 80% or normal, was considered as restrictive defect and Ratio less than 80%, was considered as obstructive defect. All collected information was s recorded on pre-designed Performa (attached). Effect modifying factors like duration of type 2 diabetes mellitus and smoking status (smoker and non smoker) were address through data stratification.Results: In this study, we included one hundred and seventy type 2 diabetic patients. The mean age was 54.32 ± 19.08 years. There were 122 (71.8%) males and 48 (28.2%) females. The mean height was 161.59 cm. The mean FVC was 107.78 ± 20.31. The mean FEV1 was 94.09 ± 27.72. The mean FEV1 / FVC% was 104.762 ± 24.93. In 28 (16.5%) cases restrictive pathology was observed, 3 (1.8%) cases had obstructive pathology and 139 (81.8%) cases had normal lung function tests.Conclusion: In this study we concluded that the target organ for diabetic injury was lung. It was responsible for restrictive diseases of lung. More research work required to rule out pathophysiologic mechanisms and clinical significance.

Association between Academic Learning Strategies and Annual Examination Results among Medical Students of King Edward Medical University

Learning style is the composite of cognitive, affective, and physiological characteristics that serve as relatively stable indicators of how a learner perceives, interacts and responds to the learning environment. Felder – Solomon Index of Learning Style (ILS) includes Sensitive/Intuitive, Visual/Verbal and Sequential/ Global, Active/reflective. The learning strategies are a major indicator of exam performance of students.Objective: To find the association between academiclearning strategies and annual examination results among medical students of King Edward Medical University.Study Design: Cross – sectional study design.Study Setting and Duration: King Edward Medical University and 3 months.Materials and Methods: The study was conducted among the 3rd, 4th, and 5th year medical students of KEMU Lahore. Informed consent was taken. A total of 300 students, 100 each from 3rd, 4th and 5th year were taken. 132 males (44%) and 168 females (56%) were part of the study. Simple Random sampling (non-pro-bability sampling) was used.Results: The overall dominant learning strategies among students of King Edward Medical University were sensing/SNS (64.3%), visual/VIS (80.7%), sequential/SEQ (63.7%) and Active/ACT (50.3%). Chi squared test for individual learning combinations against achiever types showed no significant association between academic learning strategies and annual exam performance (p value &gt; 0.05). Results also showed that females performed better academically than their male counterparts.

Salivary gland tumours - a three years experience at King Edward Medical College, Lahore

Salivary gland tumours make an important part of oral &amp; maxillofacial pathology. Only few studies have been done in Pakistani population. The aim of this study was to describe morphological types of salivary gland tumours diagnosed at King Edward Medical College/ Mayo Hospital, Lahore during the years 1999-2001 and to compare their demographic data with those previously published. Material &amp; Methods: This descriptive cross-sectional study was carried out at King Edward Medical College/ Mayo Hospital, Lahore. It reports 117 cases of salivary gland tumours diagnosed at Pathology Department during 1999-2001. Results: Of the 128 specimens of salivary glands, 117(91.4%) were confirmed as salivary neoplasms. Out of them, 62.7% were benign and 37.6% malignant and a slight female predominance (58.1%) was found. The most common location was the parotid gland (65.8%) followed by minor salivary glands (19.6%). Majority oft he t tumours was diagnosed during 3rd to 5 decades of life. Median age for benign tumours was 33 years (range 1-78) and a female predominance (58.9%) was seen again. Median age for malignant neoplasms was 45 years (range 9-70) with a female predilection ( 56.8%). However, 4 out o f 5 patients with Warthin`s tumour were men. Pleomorphic adenoma was the most frequent tumour (51.3%), followed by mucoepidermoid carcinoma (25.6%), adenoid cystic carcinoma (7.7)), Warthin`s tumour (4.3%) and monomorphic adenoma (2.6%). Two cases each of oncytoma &amp; adenocarcinoma were recorded. Rare categories (single case each) of salivary tumours included lipoma, acinic cell carcinoma, basal cell adenoma, capillary haemangioma, metastatic carcinoma and non Hodgkin`s lymphoma. Conclusion: The principal site of salivary tumours was the parotid gland and females were most affected. Pleomorphic adenoma was the most frequent finding. The results of this study are comparable with other studies.

Retinoblastoma; bone marrow infiltration - A study of 30 cases

Thirty patients of Retinoblastoma presenting in the Haematology Department of King Edward Medical College, Lahore were included in the study to find out the bone marrow involvement. The patients underwent bone marrow aspiration and peripheral blood examination was also done. The aspirates were screened for the presence of tumor cells. Of the patients studied 21(70%) were males while 9(30%) were females giving a male to female ratio of 2.8:1. Maximum number of patients were in the 2-3years age group. Twenty seven patients had unilateral Retinoblastomas while three patients had bilateral disease at presentation. The bone marrow of three patients showed presence of tumor cells.

Clinical outcome of management of acute myeloid leukemia with idarubicin plus cytarabine

A prospective study was conducted at Department of Clinical Oncology, King Edward Medical College / Mayo Hospital, Lahore from July 2003 to June 2004 to evaluate the effect of Idarubicin plus Cytarabine in chemo naive Acute Myeloid Leukemia (AML) patients. A total of 15 consecutive patients were enrolled with age group 15-58 years. Patients were classified according to French American British (FAB) classification. Induction therapy with Cytarabine as continuous infusion for 7 days and Idarubicin was given on day 1-3. For assessment of response, all patients were subjected to bone marrow examination fifteen days after completion of Induction chemotherapy. Consolidation Therapy with high dose Cytarabine was given on days 1, 3 and 5. Cytarabine was repeated after 28 days for 4 cycles in patients with complete remission after induction therapy. A remission induction rate of 66.7% was observed. Four patients died because of complications. One patient lost to follow up. Idarubicine and cytarabine is effective r egimen for achieving complete remission in AML Chemo-naive patients.

Academic Performance, Self Efficacy and Perceived Social Support of Visually Impaired Students

AbstractObjective:The present study investigated the relationship between academic performance, self efficacy and perceived social support of visually impaired students.Sample:A purposive sample consisting of 60 visually impaired students was selected from three institutions in Lahore, comprising boys and girls in equal number.Instruments: Translated versions of Multidimensional Perceived Social Support Scale by Zimet, Dehlam and Farley and Generalized Self Efficacy Scale by Jerusalem were used for the purpose of data collection.Results:Significant correlation was found between academic performance, self efficacy, and perceived social support. Gender differences were found in academic achievement. Girls secured a higher percentage of marks than boys.Conclusion:Visually impaired students can make King Edward Medical University/ Mayo Hospital, Lahore significant educational attainments if they are provided support. This in turn will add to their self efficacy which may lead to even greater achievement. Educational institutions need to design and set up support networks by involving faculty and students for promoting higher achievement and selfreliance in visually impaired students.

Vaginal Hysterectomy: study of 75 cases

Objectives: To evaluate the outcomes of vaginal hysterectomy in respect of operative, post operative complications. Study design: Lady Aitchison Hospital affliated with king Edward medical college Lahore, from January 2004 to December 2005. Patients and methods. Out of total 215 hysterectomies performed,75 were vaginal for different conditions. Results: The results showed, that at the age of 50 yrs prolapse [48%] was the main indication, while menorrhagia [36%] was the main indication at age of 40 - 50 yrs. Between 30 - 40 yrs Menorragia with prolapse [16%] and below 30 yrs complete prodencia was the indication. 8% intraoperative complications were, 4% operative haemorrage, 1.3% visceral injury, 2.7% return to theature. The post operative complications were maternal death 1.3%, fistula formation (1.3%), return to theature (6.7%), retention of urine (5.3%), pelvic heamatoma (4%), and granulation tissue (2.7%). In 80.1% of cases hospital stay was less than 72 hours Conclusion: Vaginal hysterectomy was the safest, low cost procedure in benign conditions with a few intra / post operative complications.

Morphological evaluation of non neoplastic lesions of the thyroid gland

Objective: This study was conducted to see the frequency of non neoplastic lesions of thyroid glands in patients who underwent thyroid surgery at Mayo hospital, Lahore. Study design: It was a descriptive cross sectional study. Place and Duration of study: It was a retrospective and prospective study commencing from Ist July 1999 to 30th June 2002 and was conducted at Pathology Department King Edward Medical University, Lahore. Materials and methods: All thyroid samples submitted and reported at the Department of Pathology, King Edward Medical University, Lahore during a three year period commencing from Ist July 1999 to 30th June 2002 were included in this study. Results: Out of the total number of 1136 thyroid surgical specimens, 855 specimens (75.26%) were shown to comprise of non-neoplastic lesions and were more common in females (77.2%) as compared to males (22.8%) giving a male to female ratio of 1:3.4. Regarding non neoplastic lesions maximum comprised of diffuse(74%) and multi nodular goiters (16% ). Others consisted of inflammatory conditions (5%), hyperplastic nodules(4%) and simple colloid filled cysts 1%. Inflammatory conditions included Hashimotos` thyroiditis (67.3%) deQuervain`s thyroiditis (granulomatous thyroiditis) (16.3 %), Lymphocytic thyroiditis (11.7%), and Riedel`s thyroiditis(4.7%). Conclusions: Non neoplastic thyroid lesions are more common than neoplastic lesions, especially in females. The frequency of diffuse colloid goiter was very high, while among inflammatory lesions Hashimotos` thyroiditis was the commonest lesion. Most of the cases of hypothyroidism were associated with iodine deficiency.