Nighat Bakhtiar, O. Shakeel, Saleema Begum, Syed Irfan Kabir, A. Syed
{"title":"Initial Experience of Laparoscopic Distal Pancreatic Resections: A Single Institution Study with Fifteen Consecutive Cases","authors":"Nighat Bakhtiar, O. Shakeel, Saleema Begum, Syed Irfan Kabir, A. Syed","doi":"10.51253/pafmj.v73i6.8963","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.8963","url":null,"abstract":"Objective: To review the initial experience of outcomes of a consecutive series of laparoscopic distal pancreatic resections are performed at a dedicated cancer hospital. Study Design: Case series. Place and Duration of Study: Department of Surgical Oncology at Tertiary Care Hospital, from Mar 2013 to Feb 2021. Methodology: A retrospective review of consecutive series of patients in which distal laparoscopic pancreatic resections were performed. Data was collected through the Hospital information system (HIS), an electronic hospital database. All patients were discussed in a multidisciplinary team prior to surgery. Results: Fifteen patients, including 4(26.6%) males with a mean age of 49.27±15.2, were planned for laparoscopic distal pancreatectomy. Pathologically, 12(80%) tumours were malignant, while three were benign. The procedure was converted to open in 3 patients. The mean operating time was 4.6±0.57 hours, with an estimated blood loss of around 183±28. 8mls.Mean hospital stay was 5.3±1.5 days. One patient developed a Grade A pancreatic fistula. Recurrence in the liver occurred in two patients, which was managed by systemic adjuvant therapy. However, one of them died later on because of sepsis. Conclusion: A laparoscopic distal pancreatectomy is a safe approach for distal pancreatic tumours, with minimal complications and fast recovery in appropriate cases.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139140351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Post Banding Ulcer Haemorrhage: a Contributor to Morality in Patients with Liver Cirrhosis","authors":"Shahida Perveen, Omar Ahsan, Batool Butt, Atif Abbas, S. Asif, Syeda Fatima Hassan","doi":"10.51253/pafmj.v73i6.8835","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.8835","url":null,"abstract":"Objectives: To evaluate the frequency, risk factors and mortality of post-banding bleeding in cirrhosis. Study Design: Retrospective longitudinal Study. Place and Duration of Study: Department of Medicine, Fauji Foundation Hospital, Rawalpindi Pakistan, from Feb to Jul 2021. Methodology: Esophageal variceal band ligation (EVBL) was done in 123 patients. The study cohort was divided into two groups: Group-1 without re-bleed and Group-2 with re-bleed. Blood chemistry, Child-Pugh and MELD score, including the indications of EVBL and risk factors, were also analysed. Regression analysis was performed. Results: Re-bleed occurred in 10.6% (n=13) of patients. The mean duration between ligation and re-bleed was 8.75±2.8 days. Oesophageal ulcers were the most common cause of re-bleeding (38.5%). Mortality rates among the two groups were 21.8 %( n=24) and 30.8 %( n=4), respectively. The model for end-stage liver disease score (OR 2.177, CI 1.069-4.43, p .03), APTT (OR 0.593, CI 0.397-0.887, p .01) and Sodium (OR 1.345, CI 1.07-1.69, p<0.01) were detected as the predictors of re-bleed. Conclusion: Although re-bleeding after banding occurs in a trivial number of patients, it contributes to mortality. Coagulopathy, high sodium and MELD score are major predictors.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139140443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariam Sarwar, Fuad Ahmad Siddiqi, Salman Riaz, Ammad Hasan Chaudhry, Muhammad Hassan, Ashfaq Hussain
{"title":"Multidrug-Resistant Organisms and Their Association with Risk Factors; A Study at the Intensive Care Unit of Tertiary Care Hospital, Peshawar","authors":"Mariam Sarwar, Fuad Ahmad Siddiqi, Salman Riaz, Ammad Hasan Chaudhry, Muhammad Hassan, Ashfaq Hussain","doi":"10.51253/pafmj.v73i6.10323","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.10323","url":null,"abstract":"Objective: To investigate rates of multidrug-resistant organisms (MDRO) infection, their antimicrobial resistance (AMR) patterns, and risk factors for acquisition of such infections at a Tertiary-Care Hospital ICU. Study Design: Cross sectional study. Place and Duration of Study: Adult Intensive Care Unit of Tertiary Care Hospital, Peshawar Pakistan, from Jan to Dec 2022. Methodology: All patients admitted to adult ICU who developed signs/symptoms of infection after 48 hours of admission were investigated. Microbiological diagnosis was done via standard microbiological practices, and if the patient had acquired an MDRO infection, it was included in the study. Results: During the study, 92 patients acquired MDRO infection in total. The most common source was blood (43.5%). The most common organisms isolated were Klebsiella pneumoniae (21.7%), Acinetobacter baumannii (20.7%) and Pseudomonasaeruginosa (17.4%). The highest percentage of resistance among Gram-positive organisms was exhibited to Penicillin and Co-amoxiclav (91%). Gram-negative isolates exhibited high overall resistance to all used antibiotic classes. The least frequency of resistance was recorded for Tigecycline (1%) against Klebsiella pneumoniae and 33% against Escherichia coli, while 32% Acinetobacter baumannii and 25% Pseudomonas aeruginosa were Colistin/Polymyxin resistant; none of the Klebsiella pneumoniae showed Colistin resistance. Conclusion: Antimicrobial resistance in our setup was high among Gram-negative and Gram-positive organisms. The most common risk factor was central line placement among the patients, highlighting the importance of infection control measures and the need to implement infection control bundles to circumvent infections due to invasive devices.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139140064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdul Waheed Khan, Hassan Jaffar, Tarique Ahmad Maka
{"title":"Post-Burn Sceptic Limb in Epileptic Sudani Young Man","authors":"Abdul Waheed Khan, Hassan Jaffar, Tarique Ahmad Maka","doi":"10.51253/pafmj.v73i6.6064","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.6064","url":null,"abstract":"Burns in epileptic patients are not uncommon, but it is difficult to manage in remote areas of third-world countries. Despite the reduction in burn injuries secondary to a seizure, such injuries still lead to significant morbidity and mortality. In Darfur, Sudan, we managed such an epileptic patient having a full-thickness burn endangering the limb and life. Since these patients should adhere to a specific medication, controlling it remains to be difficult. The patient was managed with serial debridement, dressings, antibiotics, anti-epileptics and a protein diet. Therefore, preparation for preventive strategies consists of lifestyle modification and patient education that is further warranted.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Violence behind the Closed Door: Depression, Suicidal Ideation and Future Concerns Among its Spectators","authors":"S. Khurshid, Hafsa Khalil Toor, Farrah Pervaiz","doi":"10.51253/pafmj.v73i6.9633","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.9633","url":null,"abstract":"Objective: To determine the depression, suicidal ideation, and future concerns among domestic violence spectators. Study Design: Exploratory study design. Place and Duration of Study: Shelter Homes and Community Centres, in Rawalpindi/Islamabad Pakistan, from Aug to Nov2022. Methodology: In-depth interviews with 30 participants aged 12 to 17 years were conducted to assess the future apprehensions and worries of domestic violence spectators. Interviews were recorded and transcribed for thematic analysis. Transcribed data were critically reviewed, and themes were identified. Inter-rater reliability was calculated with the help of Cohen Kappa and was found to be in substantial agreement. Results: The study findings identified major themes related to psychological issues and future apprehensions among participants who witnessed domestic violence. Maladaptive relationships with parents and intensification of social problems such as isolation, self-harm, social withdrawal, suicidal ideation, difficulty in making friends, and apprehensions about the future relationship with a partner were also perceived as serious future concerns among domestic violence spectators. Conclusion: Domestic violence takes a toll on the mental and physical well-being of not only its victims but also its spectators. Early detection and prevention of violent exposure are essential to mitigate its long-term psychological impact.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 49","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relationship of Body Composition with Height and Weight in Attendants of Cancer Patients","authors":"Muhammad Sohaib Nadeem, Ujala Ali, Bushra Riaz, Tallat Noreen, Mansoor Wahid, Lubna Gohar","doi":"10.51253/pafmj.v73i6.9597","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.9597","url":null,"abstract":"Objective: To discern the relationship of height and weight with body composition in healthy attendants of cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct to Dec 2022. Methodology: A total of 226 healthy adults aged 19-47 years having similar daily physical activity levels were included. The body composition of study participants was evaluated using a bioelectric impedance analysis (BIA) machine. The weight of all participants was recorded with the help of a weighing machine. The participants' height was measured using a Harpenden Stadiometer and recorded. Results: Our study showed that weight had a significant positive correlation with body fat mass (rs value=0.83), skeletal muscle mass (rs value=0.763), total body water (rs value=0.704), fat-free mass (rs value=0.75) and per cent body fat (rs value 0.716). On the other hand, height had a negative but non-significant association with fat mass (rs value= 0.025) and a negative significant association with per cent body fat (rs value=-0.16). Height had a positive and significant association with fat-free mass (rs value=0.553), total body water (rs value=0.501) and skeletal muscle mass (rs value=0.505). Conclusion: Weight, if used alone, is not a good indicator of obesity or emaciation, and height has a negative association with fat mass.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saba Riaz, T. Mazhar, Sumbal Riaz, A. Batool, Awishbah Khan, Sadia Khan
{"title":"Correlation of Handgrip Strength with Thumb Flexibility, Strength and Pain in Manual Therapists","authors":"Saba Riaz, T. Mazhar, Sumbal Riaz, A. Batool, Awishbah Khan, Sadia Khan","doi":"10.51253/pafmj.v73i6.9142","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.9142","url":null,"abstract":"Objective: To find the correlation bwteen hand grip strength with thumb muscle strength, flexibility and thumb pain in manual therapists and to find out the variation of these variables in healthy manual therapists. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Pakistan Society of Rehabilitation and Disability, Jinnah Hospital, Ittefaq Hospital, and Riphah University Pakistan, from Nov 2021 to Jan 2022. Methodology: One hundred thirty-five manual therapists were enrolled. Informed consent was taken from participants meeting inclusion and exclusion criteria. The questionnaire was filled out using a Dynamometer for Handgrip strength check, a Manual Muscle testing technique for Thumb muscle strength check, a Numeric pain rating scale for Pain intensity, and Goniometry for Flexibility of the Thumb muscles. Results: Results showed that most manual therapists had no wrist pain (99,73.3%) or thumb pain (104,77%). The majority of therapists (116 ,85.9%), had less than normal grip strength of hand, and 58(43%) had maximum thumb strength. There was a positive correlation between grip strength and thumb strength (r=0.234). There was a negative correlation between grip strength and thumb pain (r=-0.077). Conclusion: The study concluded that most manual therapists did not suffer from wrist and thumb pain. The majority had good thumb muscle strength but poor hand grip strength. Thumb strength positively correlates with grip strength, while thumb pain negatively correlates with handgrip strength.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sikandar Hayat Khan, N. Kureshi, Muhammad Sohail Aslam, Sibtain Rafique
{"title":"Balance scorecard (BSC): Incorporating \"Key performance indicators\" (KPI) in the Evaluation of the Healthcare System","authors":"Sikandar Hayat Khan, N. Kureshi, Muhammad Sohail Aslam, Sibtain Rafique","doi":"10.51253/pafmj.v73i6.8649","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.8649","url":null,"abstract":"Using the balanced scorecard approach, Strategic Management Initiative (SMI) driven Key Performance Indicators (KPIs) have allowed measurable data regarding various clinical, medical, patient and logistic outputs for healthcare leadership to managean ongoing improvement system in real-time. We underwent a comprehensive search to have 168 articles with the keywords \"Balanced Scorecard in healthcare\". We applied filters for the last ten years only. We shortlisted 14 studies. The study highlighted various KPIs utilised in different healthcare settings, with most authors favouring BSC methodology as a comprehensive strategy to deal with multi-dimensional hospital processes. The most utilised KPIs included service quality, patient safety, increased healthcare literacy, empowering patients, developing the empathic attitude and social skills in medical staff, professional human resource management and financial management and interests of stakeholders. In short, the BSC strategy is suggested for implementation to improve healthcare-related processes.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139141002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects of Estrogen on Histomorphology Steroid-Induced Avascular Necrosis of Head of Femur in Male Rats","authors":"Sadaf Iqbal, Shabnam Hamid, Faiza Umbreen, Mahwash Azam, Ayesha Ali, Maroosh Mirza","doi":"10.51253/pafmj.v73i6.8769","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.8769","url":null,"abstract":"Objectives: To study the effects of estrogen administration on histomorphology of avascular necrosis of the femoral head in male rats. Study Design: Lab-based experimental study. Place and Duration of Study: Department of Anatomy, Army Medical College, National University of Medical Sciences, Rawalpindi (NUMS), in collaboration with the National Institute of Health Islamabad, (NIH) Pakistan from Aug to Nov 2021. Methodology: Thirty male Sprague Dawley rats, three months of age, weighing 200-300 gm, were selected. Rats were equally divided into three groups. Group-A served as a control group in which no intervention was made, and the rats were fed on a standard lab diet. Groups B and C served as experimental groups. In Groups B and C, avascular necrosis was induced by steroids for the first week of the study. Group C along with steroids also received tab estrogen by oral gavage for eight weeks, starting from the fifth week of the study till the twelfth week of the study. All the rats were sacrificed after the completion of the experimental period. The microscopic parameters like cortical thickness and percentage of the empty lacunae were counted. Results: Histomorphological changes were observed when the comparison was made between Group B, Control Group A, and Experimental Groups B and C with statistically significant results (p-value 0.001). Conclusion: Estrogen helps in fracture healing and shows improvement in cortical and trabecular strength. It has shown improvement in the cortical thickness measurement after avascular necrosis causes a decrease in the thickness.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aamir Hussain, Ihsan Ullah Khan, Muhammad Qammar Saeed
{"title":"Frequency and Antimicrobial Susceptibility Profile of Acinetobacter baumannii Isolated at a Tertiary Care Diagnostic Facility","authors":"Aamir Hussain, Ihsan Ullah Khan, Muhammad Qammar Saeed","doi":"10.51253/pafmj.v73i6.10108","DOIUrl":"https://doi.org/10.51253/pafmj.v73i6.10108","url":null,"abstract":"Objective: To evaluate the frequency and antimicrobial susceptibility pattern of Acinetobacter baumannii isolated at a tertiary care setting. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from July to Dec 2018. Methodology: All the specimens submitted, which yielded the growth of Acinetobacter baumannii, were included in the study. Isolates were confirmed biochemically by using api 20NE. Antimicrobial susceptibility was done using standard procedures and as per CLSI's latest guidelines. Results: Nine thousand nine hundred thirty-one specimens were submitted to the Microbiology Department AFIP for culture and antimicrobial susceptibility testing during the study period. Amongst these, 1633(16.5%) specimens yielded the growth of different pathogens. Of 1633 culture-positive isolates, 101(6.2%) were identified as Acinetobacter baumannii. Among these,34.6% of the isolates were recovered from respiratory specimens, while 29.7% from pus and pus swab specimens. Minocycline was the most sensitive antibiotic with 59.4% sensitivity, followed by Doxycycline, to which 48.5% of isolates were susceptible. Sensitivity to all other antimicrobials was 24% or less. In vitro, sensitivity to Carbapenems is very low.Conclusion: Acinetobacter baumannii was isolated from 6.2% of specimens submitted for culture and susceptibility testing. Minocycline was the most sensitive antibiotic, followed by Doxycycline. Sensitivity to most of the other antimicrobials was 24% or less. An alarming resistant pattern demands strict infection control practices and judicious use of antibiotics.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":" 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139138155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}