Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.

Iniencephaly

Iniencephaly is an uncommon form of neural tube defects which is characterized by retroflexion of the head and absence of neck as a consequence of defective closure of the vertebral body and arch. Multiple identified risk factors for its causation include environmental, genetic and drugs. We report a case of 38-year-old woman with prior history of still birth and abortions who presented at 35 weeks of gestation with lower abdominal pain and high blood pressure. Mother had consanguineous marriage. Her hypothyroidism was untreated in the first and second trimester. She delivered an iniencephalic baby girl via emergency c-section with multiple malformations at 38 weeks gestation secondary to fetal cardiac deceleration. Baby survived for less than 18 hours. In this case, proper antenatal care and follow up visits were needed along with postnatal genetic and pathological evaluation including assessment of risk factors. Appropriate management is important to prevent complications and recurrence in subsequent pregnancies.

Effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats.

ABSTRACT Background: Central obesity a worldwide metabolic and cosmetic problem poses significant health risk. Ajwa date seed has antioxidant property and its high fiber content may prevent fat absorption and reduce fat deposition. Objective: To evaluate the effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats. Methodology: Thirty-six healthy rats of four weeks age were divided into three groups and followed for 12 weeks. Group A (normal control) received regular diet. Group B (HFD control) received high fat diet, while group C (HFD+Ajwa group) received high fat diet along with 2% Ajwa date seed powder. Body weight was measured weekly. Blood sample was drawn for the estimation of serum IL-6 and leptin levels by ELISA method at 12th week. After which rats were euthanized; perinephric fat was removed and weighed in grams. Results: HFD+Ajwa group gained less body weight as compared to HFD control group (p value = 0.012). There was a remarkable reduction in perinephric fat weight (p value ≤ 0.001) and level of IL-6 in HFD+Ajwa group (p value ≤ 0.001) as compared to HFD control. There was no significant difference in serum leptin level of the rats of all groups (p value = 0.567). Conclusion: Ajwa date seed can prevent visceral adiposity and gain in body weight. Moreover, it has anti-inflammatory effect; but no significant effect on satiety hormone. Key Words: Obesity, Visceral fat, P. dactylifera L (Ajwa date) seed, IL-6, Leptin.

Psychological Impact of Covid-19 on Dental Surgeons and Students

Background: Since the start of January 2020, COVID-19, has been a serious health risk concerning the wellbeing and welfare of people worldwide. Health care workers are prone to more psychological problems because of their direct contact with infectious patients. Owing to the disruption of educational activities worldwide, stress was common among students. The objective of this study was to determine the psychological impact of COVID-19 pandemic on dental surgeons and dental students. Methods: The survey was conducted at Islamic International Dental Hospital form February 2021 to July 2021. A total of 400 questionnaires were sent to students and dental surgeons, however 340 completely filled questionnaires were returned. Questionnaire using the Depression Anxiety Stress Scale (DASS-21) was used to assess the psychological influence. Data was compiled and independent sample t -test and Pearson’s correlation were applied using the Statistical Package for Social Sciences SPSS version 23 to determine difference of means considering p<0.05 as cut off for significance. Results: The means of stress score, anxiety score and depression were 2.24+0.5, 3.56 +0.06 and 2.83+0.06 respectively. Pearson’s correlation among the dimensions of DAS scale showed that Depression, Anxiety and Stress were positively and significantly correlated with each other. Conclusion: There were high levels of Depression, Anxiety and Stress among dental students during COVID-19 Pandemic.

Internet Use and Its Addiction Among Medical Students in Hyderabad, Pakistan

Background: With the advances in information and technology, internet addiction appears as a serious obsessive condition that has numerous dreadful effects on human physical and mental health. The objective of the study was to determine the level of internet addiction among medical undergraduate students of Isra University, Hyderabad. Methods: A cross-sectional survey was conducted at the Isra University, Hyderabad from August to December 2019. All medical (MBBS) undergraduate students of either sex were included. A stratified sampling technique was used for the selection of participants. A structured 5-point Likert scale questionnaire for the internet addiction test was adopted from Dr. Kimberly Young and used for the collection of participant’s information and measurement of their level of addiction. Results: A total of 263 undergraduate medical students participated in the study. The majority (56.65%) were males while 51.71% were from the age group 21-22 years. Over two-thirds (85.17%) of participants were found to be internet addicts. Of these internet addicts, 63.84% were mild or minimal internet addicts while 12.05% were severely addicted participants. A statistically significant difference (p<0.05) was observed between gender, age groups, year of study, and current residential status of participants. Conclusion: Internet addiction was highly prevalent among undergraduate medical students, specially in the age group (19-20) years, hostlers, 2nd year of study and males

Non-Motor Symptoms and their associated factors in Parkinson’s Disease

Aim: To find the frequency of Non Motor Symptoms in patients with Parkinson’s Disease (PD) and describe their association with different factors like age, gender and duration of disease. Methodology: A cross sectional observational study was carried out in Rehman Medical Institute, Peshawar for the period of 1year. All patients of idiopathic Parkinson’s disease (PD) were included. 13 Non motor symptoms (NMS) were evaluated and noted in predesigned proforma. Data was entered and analyzed by SPSS 22. Results: Mean Age was 62.10±10.01 years. 58.82%(n=40) were males. 47.05%(n=32) belong to urban residence. Mean duration of illness was 4.52±3.82 years. NMS were found in 100% (n=68) patients. Among NMS, sleep disturbance was the most common symptom found in 77.9% (n=53) followed by constipation that was present in 75%(n=51) of patients. Depression was significantly associated with advance age (P value 0.01) and in those taking treatment of motor symptoms of PD (P value 0.02). Perspiration was significantly more with longer duration of illness (P value 0.006) and advance age (P value 0.04). Orthostatic hypotension was associated with longer duration of disease. (P value 0.04) There was no other significant association found. Conclusion: NMS were seen in all the patients presenting to Neurology OPD in our study. The most common NMS was sleep disturbance followed by constipation and depression. Autonomic disturbance were associated with longer disease duration while depression was associated with old age.

Antimicrobial activity by solvents extracted from Ocimum basilicum herb against multidrug resistant gram negative rods.

ABSTRACT: Background: Failure of treatment with antibiotics occurs due to increase in number of Multidrug resistant gram negative bacteria, worldwide. The objective of this study was to find out the antimicrobial activity of crude ethanolic extract and its further three fractions by Ocimum basilicum leaves against multi drug resistant gram negative rods. Material and Methods: This descriptive study was conducted in the Department of Microbiology, University of Health Sciences, Lahore from 1st july 2016 to 30th june 2017. Total 80 multidrug resistant gram negative rods were included in this study. Agar dilution method was performed to determine MIC of crude ethanolic extract and different fractions i-e n-hexane, chloroform and ethyl acetate of Ocimum basilicum leaves against multidrug resistant gram negative rods i-e ESBLs and carbapenemase producers. Muti-inoculater was used for inoculation. Results: The mean MICs of crude ethanolic extract, n-hexane fraction, chloroform fraction, and ethyl acetate fraction of Ocimum basilicum against ESBLs were 100.0±8.00, 168.13±8.00, 176.88±8.00 41.75±8.00 respectively. Similarly, the mean MICs of crude ethanolic extract, n-hexane fraction, chloroform fraction, and ethyl acetate fraction of Ocimum basilicum against carbapenemase producers were 77.50±8.00, 113.75±8.00, 132.50±8.00 and 29.50±8.00 respectively. Conclusions: Ethyl acetate fraction and crude ethanolic extract from leaves of Ocimum basilicum showed good antibacterial effectiveness against ESBLs and carbapenem resistant organisms than other fractions. This finding may also promote the effective use of O. basilicum herb and its components in modern medicine.

Transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus (GDM) in preterm pregnant women receiving antenatal steroids

OBJECTIVE:To determine the frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids. METHODOLOGY:This descriptive cross-sectional study was carried out in Maternal and Child Health Center unit 1 (MCH-1) at Pakistan Institute of Medical Sciences Islamabad Pakistan from January 2017 till August 2017. A total of 365 pregnant women presenting to emergency and outpatient department with preterm labor (alive morphologically normal babies), with preterm premature rupture of membranes (PPROM) and other conditions which require early delivery including preeclampsia, IUGR requiring preterm delivery, severe oligohydramnios, antepartum hemorrhage(APH), women receiving two doses dexamethasone and all those with BSR>126mg/dl were included in the study. Multiple pregnancies, advanced preterm labor (cervix > 5cm dilated), gestational diabetes mellitus (GDM) or type I/II diabetes mellitus (DM), chorioamnionitis and taking any medication that affects glucose metabolism were excluded from the study. After ethical approval, informed consent was taken from study participants. Blood sugar levels before the commencement of 1st dose of dexamethasone were noted. Blood sugar profile (fasting, 2 hours after lunch, 2 hours after dinner) were carried out. 2nd dose of dexamethasone was given after 12 hours of 1st dose. Profile was carried out till euglycemia or 5 days if sugars remain deranged. Patients having deranged levels for greater than 5 days were advised 75 g oral glucose tolerance test(OGTT) and labelled as having impaired glucose tolerance or gestational diabetes mellitus. RESULTS: In our study, 57.57%(n=213) were between 18-30 years, 42.43%(n=157) were between 31-40 years of age, mean age was calculated as 28.92+5.54 while mean gestational age was 31.19+1.92 weeks. Frequency of transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM) in preterm pregnant women receiving antenatal steroids revealed 62.16%(n=230) had transient hyperglycemia, 9.46%(n=35) had impaired glucose tolerance, 2.16%(n=8) had gestational diabetes and 26.22%(n=97) had no blood glucose abnormality. CONCLUSION: We concluded that the frequency of abnormal glucose levels increases in preterm pregnant women receiving antenatal steroids. Therefore, single blood sugar level done routinely before dexamethasone therapy are insufficient to judge the glucose metabolic status and should be closely monitored during the use of antenatal corticosteroids. KEYWORDS: Preterm delivery, antenatal steroids, transient hyperglycemia, impaired glucose tolerance and gestational diabetes mellitus(GDM)