Journal of Bahria University Medical and Dental College

Emotional Intelligence: A Valued Workplace Competency

2022-10-06T01:09:50-06:00

Some employees may exhibit emotional symptoms such as
work pressure, agitation, anxiety, depression and irritability
.
1These symptoms are related to the various dimensions of
the emotional intelligence (EI)

Dilemma of Dantrolene: A life-saving drug unavailable in Pakistan

2022-10-06T06:20:24-06:00

Malignant hyperthermia (MH) is brought on by a number
of anaesthetic drugs, primarily succinylcholine and inhalation
anesthetics.1 It is a hypermetabolic reaction in those who
are genetically predisposed

Drug Resistance due to Elaboration of Beta Lactamases and the Role of CTX-M in Enterobacteriaceae

2022-10-06T05:30:53-06:00

The Enterobacteriaceae family are the most common pathogens associated with hospital and community acquired infections
worldwide. These bacteria are treated with broad spectrum antibiotics especially 3rd generation cephalosporins. Over the
period of time due widespread and rigorous use of these medications, Enterobacteriaceae has developed antibiotic resistance
(AMR). Among all, the most compelling antibiotic resistance mechanism is production of -lactamases enzymes by this
microorganism. Over the course of time -lactamase has evolved more than 1300 distinct enzymes. Amongst these most
deleterious is extended spectrum beta lactamases (ESBL). ESBL producing Enterbacteriacaeae are responsible for a
high number of deaths worldwide. These enzymes are considered challenging as they are difficult to be identified in the
laboratory wShich cause delay in diagnosis and administration of appropriate antimicrobial therapy. The coexistence of
ESBL with other antibiotic resistance gene is another therapeutic challenge rendering empirical antibiotic treatment
ineffective.

Determining the Effect of Intrathecal Dexmedetomidine on Postoperative Pain Relief after Cesarean Section

2022-10-06T01:15:17-06:00

Objective: To analyze efficacy of intrathecal Dexmedetomidine as adjunct to hyperbaric Bupivacaine in terms of postoperative analgesia after caesarean section.
Study Design & Setting: This randomized controlled trial was conducted at Department of Anesthesia, Rawal Institute
of Health Sciences, Islamabad from20th, October 2018 to 20thApril 2019 after taking Ethical board approval from the
Institute. (letter no RIHS-REC/030/18, dated, 18th October 2018).
Methodology: Total n=120 patients having ASA status I, II undergoing elective cesarean section were randomly divided
into 2groups (60 each) by lottery method. Group-A, was given hyperbaricBupivacaine (0.5%) 12mg alone and group-B,
was given hyperbaricBupivacaine (0.5%) 12mg along with injection Dexmedetomidine 4ug in intrathecal space respectively.
Patients were followed in postoperative period for onset of pain and requirement for rescue analgesia in first 6 hours.
Results: There was statistically significant difference in mean onset of postoperative pain among both the groups-A and
B (178.18 ± 12.51 versus 364.07± 35.58min respectively with p value 0.000), as well as, postoperative analgesic requirement,
in first 6 hours, 39 (65.0 %) versus 31 (51.7 %) with p-value 0.000 respectively. However, on stratification, considering
effect modifiers, like age (20-30 years and 30-40 year and previous history of cesarean section), there was statistically
significant difference in mean onset of pain in both groups, but no significant difference was found regarding rescue
analgesic requirement in both groups.
Conclusion: Intrathecal Dexmedetomidine along with hyperbaric Bupivacaine was better than hyperbaric Bupivacaine
alone in controlling postoperative pain in caesarean section.

Clinical Outcome of Preterm Neonates with Respiratory Distress Syndorme on Continuous Positive Airway Pressure

2022-10-06T01:21:17-06:00

Objectives: To evaluate the clinical course in preterm neonates with Respiratory Distress Syndrome on bubble Continuous
Positive Airway Pressure along with their outcome during stay in hospital.
Study Design and Setting: A descriptive case study at the NICU was carried out at Bacha-Khan Medical Complex Swabi
from December 2020 to December 2021.
Methodology: Respiratory Distress Syndrome was diagnosed by following the criteria: tachypnea (> 60 breaths/min),
subcostal retraction and saturation <92%. Clinical course was assessed by mean length of hospital stay from the day of
admission to the day of discharge. Outcome was assessed by means of switching the baby to mechanical ventilation by
failing CPAP therapy by not maintaining O2 saturation > 92% and tachypnea > 60 breaths/min on 10cm maximum pressure
of H2O. CPAP response were noted.
Results: Total of 100 patients enrolled in our study, 56 patients were male and 44 patients were female. Mean age was
1.24+0.04days. Mean gestational age of babies was 31.18+0.170weeks. Mean weight of babies was 2.035+0.023kg. Mean
hospital stay was 15.05+0.237days. Out of 100 patients included in study 76% babies needed ventilatory support during
hospital stay and 24% babies recovered from respiratory distress syndrome without need of ventilator support.
Conclusion: Respiratory Distress Syndrome is a fatal complication in Preterm neonates in Neonatal Intensive Care Unit.
Respiratory assistance done through continuous positive airway pressure has shown encouraging results in management
by preventing complications, mechanical ventilation need, less hospital stay and preventing mortality

Correlation of Uroflowmetry with Prostate Volume and International Prostatic Symptom Score (IPSS)

2022-10-06T01:33:23-06:00

Objective: To correlate Uroflowmetry with Prostate volume and International Prostatic Symptom Score in BPH patients
and healthy adults in a subset of Karachi Population.
Study Design and Setting: This is a crossectional study carried out at Ziauddin Hospital, Karachi over a period of 6
months.
Methodology: In this study 100 Samples were taken through non probability convenience sampling. Inclusion criteria
includes 40years and above. Sample initially was taken on the basis of International Prostatic Symptom Score i.e., less
than 8 and greater than 8 score. Ultrasonography was performed. 65 Individuals with International Prostatic Symptom
Score > 8 and Prostate volume <25 and individuals having symptom index < 8 and Prostate volume > 25ml went for
Uroflowmetry. Mean and standard deviation was taken out for quantitative variables. Univariate analysis and Multiple
Linear Regression applied to assess relationship between Uroflowmetry with Prostate volume and International Prostatic
Symptom Score.
Result: Mean age of patients was found to be 58±6 years. Mean International Prostatic Symptom Score was 11±4. Mean
Prostate Volume was 28ml±5, mean Qmax was 14ml/s ±4. The correlation between Qmax and International Prostatic
symptom score was found to be negative (-0.78) and statistically significant. No correlation was found between Prostate
volume and Qmax.
Conclusion: Qmax and International Prostatic Symptom Score are reliable tool for assessing Benign Prostatic Hyperplasia
patients concluding that as Symptom Score increases Qmax decreases. Qmax showed no correlation with Prostate volume.
Prostate volume assessed on Ultrasonography is not an authentic parameter for diagnosing BPH patients.

The Effectiveness of Submucosal Dexamethasone after Third Molar Extraction. A Single Blind Randomized Clinical Trial

2022-10-06T01:38:22-06:00

Objective: To evaluate the efficacy of dexamethasone in alleviating pain and trismus of the patients who underwent
extraction of the third molars.
Methodology: A total of 120 patients took part in this randomized, controlled trial. The wisdom teeth of patients were
surgically extracted under local anesthesia. The patients were randomly assigned to one of two group and study control
with 60 patients in each group. Preoperative and Postoperative measurements of edema, trismus and pain were analyzed.
In study group, dexamethasone was immediately given after extraction. However, in control group, no dexamethasone was
given to the patients. The paired t-test was carried out to compare the means scores of pains and trismus and. A p value
of = 0.05 was judged significant.
Results: The pain scores of patients in group 1 were mostly pain-free on the third post-operative day after dexamethasone
administration, with complete pain resolution in all patients on the seventh post-operative day. About trismus in post
operative phase almost all of the patients belonging to group 1 did not report to suffer from trismus with just two patients
complaining of mild trismus. Whereas, on the 7th post-operative day, all of the group 1 patients free from trismus. About
the comparison of trismus, pain and Edema in study groups, a significant difference p<0.05 was found.
Conclusion: Inflammatory complications are frequently associated in the post operative phase of extraction of third molars.
Dexamethasone has been proven to be useful in reduction of pain, trismus and edema experienced by the patients when

Frequency and Determinants of Postpartum Depression among Mothers Living in Karachi

2022-10-06T01:43:53-06:00

Objective: To determine the frequency of Postpartum Depression (PPD) among mothers living in Karachi and to find out
the determinants of predispose mothers to Postpartum Depression.
Study Design and Setting: The study was cross sectional analytical and was carried by online survey of mothers living
in Karachi
Methodology: Total duration was six months from 1st January, 2020 to 31st July, 2020. The calculated sample size of
study was 369. The study was approved by the Ethical Review Committee of Bahria University Health Sciences Campus,
Karachi. Random sampling technique was used to recruit subjects. 294 participants were part of the research. Mothers with
previous history of depression and those who had given birth to healthy babies were included in the study. Mothers who
have had miscarriage or pre-mature babies were excluded. Questionnaires in both English and Urdu languages were used
for the research. PPD was assessed by the help of Edinburgh Post Natal Depression Scale (EPDS). The score of greater
than 12 was considered to be indicative of PPD.
Results: A total of 294 mothers were enrolled in the study, 187 mothers had an EPDS score >12 giving prevalence of PPD
as 63.6%. This study showed that mothers with PPD were more likely not to breastfeed their child (p=0.01), had lack of
family support (p=0.00) and had previous history of depression as well (p=0.00).

Magnetic Resonance Imaging of Lumbar Spine in Lower Backache: A Comparative Study on Gender Basis

2022-10-06T02:23:01-06:00

Objective: To compare the clinical features of lower backache with Magnetic Resonance Imaging (MRI) findings on
gender basis.
Study design & Setting: A cross-sectional descriptive study was carried out among male & female patients with a backache
at Sir Syed Hospital, Karachi. This study conducted from 1st Jan 2020 to 1st June 2020. We studied 90 patients by using
the non-probability convenient sampling technique.
Methodology: Lower backache is a common problem that creates disability. MRI lumbar spine without contrast were
reviewed with clinical complaints. Performa was used after the ethical approval from Institutional Research and Ethical
committee. Components focused during the study in MRI findings at different spinal levels were disc bulging, neural
foraminal compromise, nerve root compression, ligamentum flavum and facet joint hypertrophy.
Results: The results showed that the mean age of 90 patients was 44.64 years. On MRI imaging 46(86.8%) males and
26(70.3%) females had disc desiccation but multi-level disc osteophyte complexes were demonstrated more in females
11(29.7%). Diffuse disc bulge is more in males at L4-5 and L5-S1 level 49(92.5%) than in females 34(91.9%) at L4-5
and 33(89.2%) at L5-S1 level with mild to moderate spinal canal stenosis. The narrowing of Neural foramen is almost
similar at L4-5 level in both gender but more at L5-S1 in females 35(94.6%) as compared to males 49(92.5%) with nerve
root compression. Overall male patients tended to have slightly more disc degenerative changes than females.

Outcome of Indoor Covid Cases with Moderate to Severe Disease; Convalescent Plasma Transfusion vs Conventional Therapy

2022-10-06T02:27:49-06:00

Objectives: Global COVID-19 epidemic has been therapeutic challenge. Convalescent plasma is observed to improve
clinical outcomes. This research aims to study whether convalescent plasma therapy reduces the mortality and duration
of hospitalization in moderate to severe Covid.
Study Design and Setting: This interventional study was conducted after ethical approval at RIUT COVID-19 center
from1stJune-30th Nov 2020.
Methodology: Hundred Covid patients included; Total 100 hospitalized adult SARS Cov-2 PCR positive with moderate
to severe disease who agreed for convalescent plasma transfusion were included. Fifty in plasma transfusion group and
fifty in conventional therapy group. Those with contraindications for plasma transfusion, delayed presentation, indoor stay
<5 days were excluded. Convalescent plasma was obtained from donors with prior documented SARS CoV-2 infection
meeting donor eligibility criteria. 50 cases received convalescent plasma and50 received conventional therapy. Hospital
stay and outcome documented.
Results: Amongst 100 Covid cases; 44 females and 56 males; mean age 57.88+11.95 years, 74% had moderate covid and
26% severe. Fifty cases received conventional therapy for Covid and 50 received plasma transfusion. Both groups comparable
for gender, age, smoking, obesity, and disease severity. Invasive ventilation administered in 25% and was associated with
mortality (p=0.004). Mortality observed in 29 cases; 20(69%) in plasma transfusion group Vs. 09(31%) in conventional
therapy group (p=0.015). The hospital stay was comparable between two groups The relative risk ratio was 2.22 with 95%
CI (1.12-4.39).
Conclusions: There was no therapeutic benefit in Covid patients treated with convalescent plasma as compared to
conventional treatment.

Urological Injuries in Obstetrical and Gynaecological Surgery at Tertiary Care Hospital

2022-10-06T04:45:45-06:00

Objectives: To determine the frequency of urological injuries in obstetrical and gynaecological surgery.
Study Design and Setting: The Cross Sectional Study was conducted at Department of Obstetrics & Gynaecology, Jinnah
Postgraduate Medical Center, Karachi for duration of 6 months from 31st December 2020 to 30th June 2021.
Methodology: A total of 142 patients selected between the ages of 25 to 55 years of age were included. In this study all
patients were included who fulfilled the inclusion criteria undergoing obstetric(cesarean section) & gynecological surgeries
(laparatomies & hysterectomies). They were enrolled after taking written and informed consent. Risk factors for urological
injuries were assessed in terms of indication (risk for surgery), site of urologic injury, duration of surgery and time interval
after surgery. Patients having urological injury from other than obstetric and gynecologic surgeries and those who did not
give consent were excluded.
Results: Age range in this study was from 25 to 55 years with mean age of 40.20 ± 6.92 years. Majority of the patients
77 (54.23%) were between 41 to 55 years of age. Mean duration of surgery was 62.16 ± 14.52 minutes. Mean time interval
after surgery was 37.51± 13.89 hours. In this study, frequency of ureteral injury, urinary bladder injury and mixed injury
in obstetrical and gynaecological surgery was found in 01 (0.70%), 19 (13.38%) and 01 (0.70%) patients respectively.
Conclusion: This study concluded that knowledge of pelvic anatomy, careful dissection and patience in difficult cases are
the key factors to anticipate and prevent injury

Impact of Clinical Expertise on Inferior Alveolar Nerve Block Anaesthesia Resulting in Transient Facial Nerve Palsy; A Cross-sectional Study Amid Pakistani Dental Graduates

2022-10-06T05:02:43-06:00

Objective: The purpose of the study is to observe the impact of clinical expertise on inferior alveolar nerve block (IANB)
anaesthesia resulting in transient facial nerve palsy (FNP) in dental operators having different levels of clinical experience.
Methodology: This observational cross-sectional study was conducted in the Department of Dentistry, Jinnah Postgraduate
Medical Center. The study was conducted over a period of six months, starting from September 2021 and lasting till
February 2022. The patients who required IANB for any dental treatment in lower posterior teeth were divided into three
groups between dental operators: Undergraduates (Interns), Graduates (House Officers), and Postgraduate trainees, having
100 cases in each group. A structured questionnaire was administered through convenience sampling to dental operators.
Data was analyzed by using SPSS version 24.
Results: A total of 300 cases were part of the study. According to the results, 28% (n=84) of patients suffered from transient
facial nerve palsy following IANB. Out of this 84%, 15% (n=45 of total cases) were by Undergraduates (Interns), 10%
(n=30 of total cases) were caused by Graduates (Interns), and only 3% (n=9 of total) incidences happened following IANB
by Postgraduate trainees.
Conclusions: The incidence of IANB-related facial nerve palsy (FNP) is comparatively more in junior dental operators,
which depicts their lack of clinical experience

An Assessment of Asymptomatic Bacteriuria During Pregnancy and Antimicrobial Resistance to its Common Bacterial Isolates in the Urine

2022-10-06T05:07:22-06:00

Objective: The objective of this study is to assess asymptomatic bacteriuria during pregnancy and its antimicrobial resistance
to the common bacterial isolates in the urine.
Study Design and Setting: The cross-sectional study was carried out in the Antenatal Clinic, Obstetrics and Gynaecology
Unit of Avicenna Medical and Dental Hospital, Lahore, Pakistan.
Methodology: This descriptive, cross-sectional study lasted for nine months and information was collected with the help
of a self-designed questionnaire using non-probability random sampling. The frequency distribution of socio-economic
and demographic factors of 167 pregnant women was observed while the cultural examination was performed on urine
samples of diagnosed cases of asymptomatic bacteriuria through microscopy to find out antimicrobial resistance against
bacterial isolates.
Results: The prevalence rate of asymptomatic bacteriuria was 13.2%. The most common pathogen was E. coli followed
by Klebsiella Pneumoniae and Staphylococci. Resistance of urine pathogens was observed against Ampicillin, Amoxiclav,
Norfloxacin, and Piperacillin/Tazobactam.
Conclusion: E. coli was identified as the most predominant pathogen that showed higher resistance to Cefotaxime. History
of renal stone, trimester, parity, education and low-socio-economic status were the significant factors for ASB

Helicobacter Pylori Infection and Frequency of Clarithromycin Resistance by qPCR

2022-10-06T05:25:14-06:00

Objective: Determine the frequency of Helicobacter pylori (H. pylori) infection in our population, the response to triplequadruple regimen and resistance to clarithromycin.
Study Design and Setting: Study design is case-series, Medicare Cardiac & General Hospital, Karachi- 2020-2021. All
patients (N=110) were selected from outpatient department (OPD) of the Jinnah Medical College Hospital (JMCH) and
Medicare Cardiac and General Hospital.
Methodology: Patients with nausea, abdominal pain, diarrhea and IgG positive were included, and ELISA was done for
detection of H. pylori infection.. IgG negative for H. pylori and having other gastrointestinal infections were excluded from
this study. Patients positive with infection were prescribed the initial triple /quadruple regimen (triple regimen therapy
including Proton pump inhibitor (PPI) 20 mg, Metronidazole 400mg, Amoxicillin 250 mg or Quadruple therapy by adding
Bismuth subsalicylate). In ten cases of relapse Sequential / Rescue therapy were continued after a gap of 6 weeks included
PPI 20 mg, metronidazole 400mg ciprofloxacin 200mg BD or Levofloxacin 400 mg OD. The qPCR was performed for
the detecting resistant to clarithromycin in patients with H. pylori IgG positive after therapy.
Result: During the follow-up, 60 (54%) cases were recovered from initial triple regimen, whereas 40(36%) cases recovered
quadruple therapy and remaining 10 (7%) had clarithromycin resistance and were prescribed sequential therapy replacing
clarithromycin by fluoroquinolones.
Conclusion: The study showed that majority of H. pylori infected patient in our population recovered from initial
triple/quadruple regimen. The alternate option with clarithromycin resistant was sequential and rescue therapy with high
eradication rate.

Aesthetic Anxiety in a Child with Cleidocranial Dysplasia

2022-10-06T06:17:43-06:00

Cleidocranial dysplasia (CCD) is a rare syndrome that affects the skeleton and teeth. It is characterized by absent or
hypoplastic clavicles, mobile shoulder girdles, patent fontanelles, supernumerary teeth, retained deciduous and delayed
permanent teeth. A 10 year old boy with CCD is reported with chief complaints of aesthetics and dental pain. The bullying
and social agony at a tender age were alarming as the patient was highly distressed regarding his missing teeth. Juvenile
aesthetic concerns and the psychosocial impact were emphasized in this case. He was treated with manual scaling, pulp
therapy, restoration, and a prosthesis to speedily replace his missing teeth. Long-term orthodontic treatment was suggested.
Due to the early diagnosis, a better prognosis exists for multidisciplinary treatment. Counselling was pivotal for dealing
with his aesthetic anxiety and oral health. Special attention should be given to the aesthetics and psychosocial state of
patients with syndromes in underdeveloped societies