Frequency of hyperuricemia in thyroid dysfunction

Objective: To determine the frequency of hyperuricemia in patients with thyroid dysfunction. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Department of Chemical Pathology, Army Medical College Rawalpindi, National University of Sciences and Technology [NUST] Islamabad and Military Hospital [MH] Rawalpindi, from Apr 2013 to Jun 2014

Results: Among the fifty five participants, 16 [29.1%] were male while 39 [70.9%] were females. Mean age of the subjects was 45.49 +/- 16.7 years in this study. Hyperuricemia was observed in seventeen [30.9%] individuals with thyroid dysfunction. Mean serum uric acid level was found to be 418.3 +/- 147 micromol/l in participants

Material and Methods: Fifty five individuals with thyroid dysfunction were included in this study. Detailed history was recorded on a questionnaire, blood samples were collected and serum total tri-iodothyronine [T3], free thyroxine [T4], thyroid stimulating hormone [TSH] and uric acid levels were measured

Conclusion: High frequency of hyperuricemia occurs in patients with thyroid dysfunction. Therefore in patients presenting with thyroid dysfunction, evaluation of underlying hyperuricemia should be considered by the clinicians

Immunohistochemical expression of epidermal growth factor receptor in head and neck squamous cell carcinoma

Objective: To determine the frequency of expression of epidermal growth factor receptor [EGFR] by immunohistochemistry in head and neck squamous cell carcinoma [HNSCC]

Study Design: Cross-sectional study

Place and Duration of Study: Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2015 to March 2016

Methodology: Fifty-two cases of head and neck squamous cell carcinoma diagnosed on H and E stain were included in the study. Patients' gender and age were noted. Immunohistochemistry for EGFR was applied and the results were recorded. The data were analyzed by using computer software program SPSS version 19. Descriptive statistics, frequencies and percentages were calculated

Results: Out of the 52 patients of HNSCC, 37 patients were males and 15 females. The age of the patients was between 21 and 80 years with an average age of 58.58 +/- 12.63. Out of 52 cases, 45 cases [86.53%] were positive for EGFR while 7 cases [13.46%] were negative for EGFR. Significant statistical association was not seen between the tumour grade and EGFR expression [p=0.162]

Conclusion: The high expression of EGFR in head and neck cancers among Pakistani patients suggests its value as a therapeutic target. EGFR inhibitors have become well-known part of HNSCC treatment; therefore, patients with EGFR positive HNSCC can be benefitted from the therapy

Malakoplakia of appendix: a case report

We report a case of an extremely rare inflammatory condition of appendix, malakoplakia, in a 22 years old female, who presented with chronic abdominal pain. The clinicopathological features of this condition will be discussed, along with a review of the literature

Assessment of status of thyroid functions in patients of beta thalassemia major, reporting to OPD of military hospital, Rawalpindi

Objective: To determine the status of thyroid functions in patients of beta Thalassemia Major, reporting to OPD of Military Hospital, Rawalpindi

Study Design: Descriptive cross sectional study

Place and Duration of Study: Paediatric Outpatients Department of Military Hospital, Rawalpindi from 1st Jan to 30th Jun 2012

Material and Methods: After taking informed consent from the parents of all the children fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn by strict aseptic means. Samples taken from these patients included complete blood and thyroid profile [serum thyroxine T4, triiodothyronine T3 and thyroid stimulating hormone TSH]. These blood samples were labeled and sent to Armed Forces Institute of Pathology [AFIP], Rawalpindi for analysis by enzyme-linked immunosorbent assay [ELISA]. Primary hypothyroidism was defined by TSH levels >4IU/ml. Statistical analysis was done at the end of study using SPSS version 10. Significance for association was calculated using student t-test

Results: Sixty patients fulfilled the inclusion criteria out of these sixty four patients lost the follow up while 56 patients completed the study. Out of 56 patients, 21 [37.5%] had biochemical evidence of hypothyroidism. Mean Ferritin level was 3924 +/- 1247ng/ml in hypothyroid and 3136 +/- 1387ng/ml in euthyroid patients indicating a significant difference in mean serum ferritin levels between hypothyroid patients and others

Conclusion: The study demonstrates hypothyroidism in a significant number of hyper transfused beta- thalassemic patients, emphasizing the importance of monitoring thyroid functions in thalassemic patients, particularly in those receiving suboptimal chelation

Internet use: Disruptive or enhancing towards learning? Views and perceptions of undergraduate medical students

Objective: To describe the perceptions and behaviors of undergraduate medical students regarding the use of internet

Study design: Cross-sectional descriptive study

Place and Duration of Study: Army Medical College, National University of Medical Sciences [NUMS] Rawalpindi, from January 2014 to June 2014

Methodology: Data had been obtained from volunteer undergraduate medical students who were computer literate and were using the internet facility in their daily routine. Students, who did not have the computer and internet using skills and were not using the internet services, were excluded from this study. A structured questionnaire was used which included following items: duration and frequency of internet use, impact of internet use on academic grades, influence of internet usage on relationships with friends and family, effect of overuse on sleep cycle and having the self-knowledge of being internet addicted

Results: Two hundred and twelve students gave consent to participate in this study. Different perceptions of undergraduate medical students regarding the internet use were observed: 64 [30.2%] students spent about two hours daily in internet surfing and 79 [37.3%] participants in our study utilized internet facility for social networking while 67 [31.6%] used it for educational and learning purposes. A total of 147 [69.3%] participants reported that internet use enhanced their learning and had a positive effect on their academic grades

Conclusion: Our study concludes that internet-using skill is a very powerful tool in today's world with regards to academic learning. With appropriate guidance and support, students can get maximum benefit from this facility and can enhance their learning capabilities. Institutes should play their role by making every student computer literate and also by making on-campus advisory services available to figure out internet abuse related issues of the students

Early diagnosis of Typhoid by PCR for FliC-d gene of Salmonella Typhi in patients taking antibiotics

To compare PCR [Polymerase Chain Reaction] with blood culture, typhi-dot and Widal test for the diagnosis of typhoid in patients taking antibiotics. Cross-sectional, comparative study. National University of Sciences and Technology, Islamabad, Pakistan, from April 2013 to August 2014. One hundred and five patients were included in the study. Blood was collected and inoculated into tryptone soya broth for culture. Any growth obtained was identified by API 20 E and confirmed by Salmonella anti-sera. Typhi-dot and Widal test were also done on all the samples. DNA extraction was done and PCR was carried out. Among the 105 patients, 79 [75.2%] were males and 26 [24.8%] were females, with mean age of 20.64 +/- 14 years. Typhi-dot was positive in 58 [55.2%] and negative in 47 [44.8%] patients. Blood widal test was positive in 27 [25.7%] and negative in 78 [74.3%] patients. Salmonella Typhi was positive on blood culture in only one [1%] patient. PCR for Salmonella Typhi was positive in 102 [97.1%] and negative in 3 [2.9%] patients. Positive cases detected by PCR were significantly higher as compared to Typhi-dot [p < 0.001], blood Widal test [p < 0.001] and blood culture [p < 0.001]. Positivity rate of PCR was significantly higher as compared to blood culture, Typhi-dot or Widal test for diagnosing typhoid in patients who were already taking antibiotics

Effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Objective: To determine the effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Study Design: A descriptive study

Place and Duration of Study: Military Hospital [MH], Rawalpindi from October 2011 to March 2012

Patients and Method: One thousand two hundred and ninety three neonates of either gender under the age of 28 days admitted to NICU either as indoor or outdoor were entered in the study. Data included high risk obstetric factors, gestational age, birth weight, APGAR score, gender, need for resuscitation, diagnosis, complications, place of delivery, mode of delivery and outcome. The associations between the place of delivery, mode of delivery and medical skills of the accompanying person with the neonatal mortality were associated using the Pearson Chi-Square method

Results: A total of 1293 neonates were included in the study and their data regarding place of delivery and mode of transport was evaluated. Four hundred and two [402/1293] cases died in our NICU and the mortality rate of the neonates admitted in our setup was 31.1%. The breakup of neonatal deaths was further subdivided into the patients born in health care with NICU facility [25%], those born in health care without NICU facility [33.60%] and those born in the community setting [40.54%]. The aforementioned percentages were calculated out of the total live births in that particular setup and do not represent mere breakup of total mortality. A total of 50.32% neonates brought to hospital in an unequipped vehicle expired versus 2.28% mortality of neonates that were brought in a medically equipped vehicle. The neonatal mortality rate in patients accompanied by unskilled personnel was 40% versus skilled personnel which was 1.62%. Statistically significant associations using Pearson Chi-Square method were seen between the place of delivery, mode of transport, the skills of the person accompanying the patient in the transport and neonatal mortality [p value = 0.001 each]

Conclusion: Results of this study prove that the quality of birth services and patient transport mechanisms directly affect the neonatal survival and babies who are born in community setting, transported in unequipped vehicle without a skilled medical attendant are at a higher risk for mortality than the patients born in NICU facility, transported in an equipped vehicle and accompanied by skilled medical attendant

Research design and statistical error of articles submitted in a public sector medical journal - a retrospective survey

Objective: The objective of this study was to identify the quality of statistical procedures used, the accuracy of study design, sampling and relevant statistical analysis

Study Design: Retrospective Survey study

Place and Duration of Study: Army Medical College from June 2014 to Jan 2015

Methodology: Three hundred and forty two original research articles published in Pakistan Armed Forces Medical Journal were reviewed. The selected research articles were all original articles. Case series and case reports were excluded

Results: Among 342 articles, the major error was that the objectives, results and conclusion were not in accordance with each other in 115 [33.6%] articles. In 48 [14%] articles study design was incorrect and does not matched with the objectives. In 26 [7.6%] articles sample size was not appropriate as per the guidelines of journal. In 12 [3.5%] articles sampling technique used for sample selection was not mentioned. In 62 [18.1%] articles type of variables was incorrectly defined. In 6 [1.8%] articles descriptive statistics were not given at all. In 13 [3.8%] articles inferential statistics were not given articles. In 60 [17.5%] articles figures and tables were either not given or if given were incorrect. The pattern of statistical errors was almost similar in different years with a little bit difference but that difference could not attained any statistical significance [p = 0.460]

Conclusion: In order to maintain the standards of the medical writing in research with authentication the teaching of statistical methods should be enhanced

Eleven-year-old-girl with membranous sore throat

Diphtheria is caused by Corynebacterium diphtheriae primarily affecting mucous membrane of upper airways. Global incidence of diphtheria has reduced due to worldwide immunization programs. Yet cases of diphtheria are reported across the world because of poor vaccine coverage, large population and low socio economic status. We report here a case of diphtheria in an 11-year-old girl who presented with fever, sore throat, difficulty in swallowing and hoarseness of voice for 3 days. Hematological analysis showed neutrophit leukocytosis with normal lymphocytes, CRP was raised, cardiac profile, renal function test, hepatic functions and chest x-ray were normal. Microscopy of throat swab revealed rods containing metachromatic granules .on Albert stain. Intramuscular penicillin was started and diphtheria antioxin was administered. The child recovered uneventfully and was kept on follow up

Frequency of co-morbidities associated with spinal cord injury

To determine the frequencies of comorbidities [dyslipidemias, diabetes mellitus, and hypertension] in patients with spinal cord injury [SCI] of duration > 1 year. Spinal Cord Injury Department, Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi and Department of Chemical Pathology, Army Medical College, National University of Sciences and Technology [NUST], from October 2013 to March 2014. Thirty six patients with complete spinal cord injury [SCI], level C5 to T12 were included by non-probability, convenience sampling. Control group consisted of age and sex matched healthy individuals. A detailed medical history was obtained. Anthropometric measurements and blood pressure were recorded. Fasting blood samples were obtained and analyzed for plasma glucose and serum lipid profile. Out of thirty six patients, 31 [86.1%] were male and 5 [13.9%] were females; their mean age was 36.6 +/- 11 years. Mean duration of injury was 6.04 +/- 3.35 years. Among cases, dyslipidemias were detected in 25 [69.4%] patients while 7 [19.4%] patients had diabetes mellitus. Whereas in control group, frequency of dyslipidemias and diabetes mellitus were significantly lower than cases i.e 13.8% and 5.5% respectively. Also no significant difference was found between blood pressures of study group when compared with control group. Individuals with chronic SCI had more frequent associated co-morbid conditions like dyslipidemias and diabetes mellitus than normal individuals. Early screening is recommended in patients having SCI >6 months for better patient care and reduction in long term comorbidities in such patients

[Structured viva as an assessment tool: Perceptions of undergraduate medical students]

To document the undergraduate medical students' perceptions regarding the structured viva as an assessment tool. Cross sectional. Army Medical College, National University of Sciences and Technology [NUST], Islamabad from April 2013 to April 2014. Data was collected from fourth year students of a public sector medical college. A structured questionnaire was used to evaluate student's perception regarding relevancy of viva questions to syllabus, level of comfort while being assessed and provision of adequate time to answer, bias or harassment by the mentors, freedom to answer in their own learning styles. One hundred seventy one, fourth year students gave consent to participate in this study. Almost all of the students were satisfid after being assessed in oral structed viva room: the results obtaind were: relevancy of questions to course: 169 [98%]; comfortable environment of viva room: 165 [97%]; appropriate time to answer the questions: 162 [94.7%], structured viva: 132 [94.7%]; welcomed upon arrival for viva: 147 [86%]; encouraged by examiner: 144 [84%]; facilitated to answer in their own learning style: 137 [80%]; covered all the topics: 120 [70% 1; demotivated during viva: 11 [6.4%] and bias during viva: 14 [8.1%] There is substantial need of introducing innovations in the conventional exam strategies being practiced in our medical colleges. Introducing structured viva examination, making the exam environment comfortable and adapting an appreciative inquiry approach while assessing students can greatly help them to overcome exam stress

Methylmalonic acidemia

Methylmalonic Acidemia [MMA] is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan

Frequency of helicobacter pylori [HP] infection in children with recurrent abdominal pain [RAP]

To study the frequency of Helicobacter Pylori [HP[infection among children with recurrent abdominal pain [RAP]. Cross-sectional comparative study. Military Hospital [MH], Rawalpindi from December 2011 to February 2012. One hundred children of either gender aged 2 to 12 years presenting with RAP were tested for HP at Paediatric OPD MH, Rawalpindi who consented to participate in the study. Those children who tested positive for Helicobacter Pylori Stool Antigen Test [HPSAT] were labeled as those having Hp infection. The stool assay was performed using the HpSAT kit and the socio-demographic and clinical profiles of children were associated. Out of 100 children included in the study HpSAT was positive in 38% children. Frequency of Hp infection was significantly associated with source of drinking water [p = 0.014], socioeconomic status [p =0.001] and positive family history of dyspepsia [p= 0.023]. While age and gender have no significant association with HP infection. Hp infection is very common in children presenting with RAP in our Paediatric OPD. Children with family history of dyspepsia, from low socioeconomic class and those drinking filtered water are at greater risk for HP infection. It is recommended that children from other populations in our country should also be tested in their medical health facilities in order to have a wider analysis of this problem in our setup

Post graduate students' perception of educational environment at army medical college, rawalpindi: assessment by pheem [post graduate education environment measure]

To assess the post graduate students perception of various aspects of the learning and educational environment at Army Medical College, Rawalpindi. A descriptive study. Army Medical College, Rawalpindi from May 2014-July 2014. The modified Postgraduate Hospital Educational Environment Measure [PHEEM] a scored 34 item questionnaire was administered to evaluate various aspects of the learning environment. Three domains of the learning environment were covered with the help of PHEEM scores: perceptions of autonomy; perceptions of teaching; and perceptions of social support. Total and subscale scores were calculated according to Likert scale. Descriptive statistics were used to calculate mean SD. Analysis of variance [ANOVA] was used to compare scores between different departments. Total 39 postgraduate trainees were included in the study. Average of total score came out to be 107, whereas for perception of teaching it was 45.57 [SD = 5.22, range: 43 - 48], for social support it was 24.76 [SD =3.76, range: 21 - 27] and for perception of autonomy it was 36.84 [SD = 4.09, range: 33 - 39]. The overall and subscale scores were also compared between post graduates of the different departments of the public sector medical colleges. The education climate was rated as more positive than negative determined by overall PHEEM scores. Army Medical College as an institution has a positive education environment

Faculty perceptions and objective impact of faculty development workshops

To document the perception of participants and the impact of faculty development and related educational workshops arranged in a public sector medical education setting. The departments of medical education [DME]; army medical college and armed forces Post Graduate Medical Institute, Rawalpindin, Pakistan from 2013 to 2014. A descriptive study. During 2013 to 2014, nine faculty educational workshops were arranged by the faculty members of the departments of medical education [DME], Army Medical College and Armed Forces Post Graduate Medical Institute, Rawalpindin, Pakistan. Both clinical and pre-clinical teaching faculty members attended the workshops. Proper consent was taken from each participant to document their perceptions for this study. Two hundred and forty of the teaching faculty members of the army medical corps participated in different proportion for the workshop arranged during a period of one year. At the end of each workshop a questionnaire was completed by each participant. The study addressed the perceptions of the participants regarding impact of workshop,the facilitator's knowledge about the workshop topic and his/her communication skills.The responses of the participants were documented for each question and the percentages were calculated. The planning efforts of professional development workshops by the departments of medical education at Army Medical College and Armed Forces Postgraduate Medical Institute resulted in a satisfactory implementation of the set objectives for faculty development

Factors related to the use of internet for health care management among university students

To determine the frequency of using internet for diagnosis and treatment of medical conditions; to identify the most frequent [websites] resources used for selfdiagnosis and treatment of medical conditions; to assess the awareness of inaccuracy of information on internet for self-diagnosis of medical conditions A cross-sectional study was done including students in the GMU using validated self-administered questionnaire. The questionnaire includes in addition to socio-demography of participants, information about the use of internet for self health management, most common website searched, history of complication following the use and if they had verified the diagnosis with treating physician. Informed consent was taken from participants and the confidentiality of the participants was maintained. Data was analyzed using SPSS V.20 and Chi-Square test was done. The results showed that 93.6% of the participants were using internet for healthcare management and the main reason was the ease of accessing medical information online. In 75.9% of respondents who had used the internet for self-management, the diagnosis was verified with a doctor, and 49.7% of them found that it was inaccurate. 43% of the participants took medication listed online followed by their internet-based self-diagnosis. Specialized medical websites were the most credible source as 57.10% of the study sample using this successfully verified their diagnosis with a doctor. Most of the participants were using the internet for self-diagnosis and management and 49.7% of respondents found that the diagnosis was inaccurate after it had been verified by a doctor. Specialized medical websites were the most credible source. It was identified that students do realize how inaccurate the internet can be

Histopathological findings of biopsy specimen in children presenting with lower gastrointestinal bleeding

Objective: The aim of this study was to determine the frequency of different histopathological findings of biopsy specimens obtained through colonoscopy in children presenting with lower gastrointestinal bleeding

Methodology: It was a descriptive cross sectional study which was carried out at the department of Pediatrics Military Hospital, Rawalpindi, and Armed Forces Institute of Pathology [AFIP] Rawalpindi from June 2010 to 19 February 2012. 80 biopsy specimen obtained through fibre-optic colonscopy were included in the study and the histopthological findings reported by consultant Pathologist were recorded. Data was analysed using SPSS version 10

Results: A total of 80 biopsy specimens were included in the study. Out of these, 47 [58.75%] patients had polyps in colon. Histopathological examination revealed juvenile polyp to be the most common finding; all 47 patients revealed juvenile polyps.13 patients had chronic non specific colitis.11 cases were found to be normal .Only 03 had evidence of ulcerative colitis while 06 specimens revealed no specific findings

Conclusion: Histopathologically, juvenile polyp is the major cause of LGIB in children in our set up which is also found in other national and international studies

Caudal duplication syndrome

Complete duplication of genitourinary system, colon and vertebral column is a very rare and complex congenital condition termed as "caudal duplication syndrome" with variable presentations. This term is often quoted as a type of incomplete separation of mono-ovular twins or conjoined twinning. It is associated with other congenital malformations of the genitourinary, gastrointestinal and other organ systems. The hereby reported case, a 3-month-old male infant had presented with the classical form of the disease i.e., duplication of the gastrointestinal, genitourinary system and vertebral column with anterior abdominal wall hernia and a large lipomeningocele