Journal of Shalamar Medical & Dental College - JSHMDC

A Rare Case of Dengue Myocarditis: Challenges in Diagnosis and Management

Hafiz Muhammad Mubeen Nawaz — 2024-06-29

Dengue fever is a viral infection prevalent worldwide in tropical and subtropical regions and affects millions of people annually. It is associated with several complications, including rare yet significant cardiac complications, such as myocarditis. Myocarditis caused by dengue fever is challenging to diagnose and can be initially mistaken for acute coronary syndrome. This case report describes the diagnostic and management difficulties encountered by examining a young male patient who developed myocarditis as a complication of severe dengue fever. A 30-year-old male, a known smoker, presented to the emergency department with chest pain, diaphoresis, and hypotension. ECG indicated inferior wall ST-T changes. A physical examination revealed no abnormalities. The patient had a five-day history of fever and myalgia. The patient was initially diagnosed with acute coronary syndrome and cardiogenic shock. Primary coronary angiography revealed no abnormal findings. Echocardiography revealed a decreased LV ejection fraction of 40% and global wall hypokinesia with normal chamber dimensions, necessitating further investigation of the etiology. Subsequently, he was diagnosed with dengue virus-induced myocarditis based on laboratory investigations. This case underscores the rarity of dengue-associated myocarditis and emphasizes the pivotal role of maintaining a high clinical suspicion index for early diagnosis and management. Additionally, it emphasizes the significance of continuous case reporting to enhance our understanding and shape the evidence-based practices to address this uncommon complication.

Artificial Intelligence in Health Professions Education

Ahsen Sethi — 2024-06-29

Artificial Intelligence (AI) is revolutionizing various fields, including Health Professions Education (HPE), with its ability to mimic human problem-solving and decision-making capabilities. Unlike the self-aware AI depicted in movies, current AI systems, like ChatGPT, follow human commands and have shown remarkable growth, reaching one million users within five days. AI’s strengths include processing large data sets rapidly, personalizing learning, automating tasks, enhancing presentations, generating clinical cases, and providing real-time feedback.

Addressing the Brain Drain Crisis among Healthcare Professionals

Kashif Khan — 2024-06-29

Many of our healthcare professionals are growing increasingly frustrated and experiencing various psychological conditions, leading to feelings of depression and stress within our society. This editorial will explore the reasons behind the brain draining of healthcare professionals in Pakistan.

Functional Visual Outcomes of Wearing Colored Filters in Patients with Dry Age-Related Macular Degeneration

Syeda Baneen Jannat — 2024-06-29

Background: Age-related macular degeneration (AMD) leads to a permanent decrease in vision, thus affecting the quality of life. Any intervention or modality that enhances the quality of vision and, in turn, quality of life is vital.

Objective: To evaluate the functional benefits of wearing colored filters in patients with dry age-related macular degeneration.

Methods: The study was conducted from March to October 2023 after approval by the Ethical Review Board. Thirty-one patients above 50 years of age diagnosed with dry AMD at Mayo Hospital, Lahore, Pakistan, were selected using a non-probability convenient sampling technique. After informed consent, different color filters were placed in the patient’s glasses according to their compliance. Each eye was tested separately for contrast sensitivity (CS) and best-corrected visual acuity (BCVA) before and two weeks after the filter placement. Contrast sensitivity was assessed using the Lea contrast Flip chart, and BCVA was assessed using the LogMar chart. A paired sample t-test was applied for data analysis. A p value of less than 0.05 was considered as statistically significant.

Results: Best corrected visual acuity in the right and left eye improved significantly from 1.00±0.41 to 0.72±0.25 (p=0.000) and from 0.96±0.43 to 0.72±0.30 (p=0.000), respectively after applying filters. However, changes in contrast sensitivity were not significant in the right eye (p=0.59) and left eye (p=0.39).

Conclusion: Using colored filters significantly improves the best corrected visual acuity, with no contrast sensitivity improvement. This shows that filters selectively impact functional vision in patients with dry age-related macular degeneration.

Comparative analysis of Desarda and Lichtenstein Inguinal Hernia Repair Techniques

Muhammad Hamza Rana — 2024-06-29

Background: Inguinal hernia repair is the most commonly done procedure on the surgical floor these days.

Objective: The study aims to evaluate and compare two different inguinal hernia repair techniques in terms of preoperative and postoperative measures.

Methods: A comparative cross-sectional study was conducted in the department of Surgery, Aziz Fatimah Hospital from June 27, 2021, to March 02, 2022, using a consecutive sampling non-probability sampling technique. The demographic profile and characteristics of the hernia along with per operative and post-operative variables were collected and analyzed in SPSS 25 using the independent t-test.

Results: The patients admitted for the elective inguinal hernia procedure in the ward underwent two routinely done surgical procedures. The mean age of the study population was 37±11 years. The mean age and standard deviation of patients in Group A (Desarda repair) were 36.43±11.01 years and 37.43±11.05 years of patients in Group B (Lichtenstein repair). Less mean operative time and days to return to daily life activities were seen in Group A (Desarda repair) patients compared to Group B (Lichtenstein repair) patients. Moreover, the estimated cost of the Desarda operative procedure was also much less compared to the Lichtenstein repair.

Conclusion: The inguinal hernia repair technique Desarda is considered to be more effective and economical than the Lichtenstein repair in terms of per-operative and post-operative measures with less mean operative time, early return to normal activities, and cost-effectiveness.

Role of Trans Cerebellar Diameter for Gestational Age Estimation in Intrauterine Growth Restriction Fetuses

Rukhsana Babar — 2024-06-29

Background: Determining gestational age is crucial for quality maternal and fetal care. Ultrasonographic measurements of femur length (FL), crown-rump length (CRL), head circumference (HC), and biparietal diameter (BPD) are used for gestational dating. However, these don't correlate well in Intrauterine growth restriction (IUGR) cases. Studies report that trans cerebellar diameter could be used for gestational age estimation in IUGR cases.

Objective: To find the correlation between trans cerebellar diameter and gestational age based on the last menstrual period (LMP) in intrauterine growth restriction fetuses.

Methods: It was a cross-sectional study. The data was collected from the Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital Lahore from 20 February 2022 to August 2022. After informed consent 60 women aged 18-40 years and parity <5 with suspected Intrauterine growth restriction (IUGR) were included in the study. Gestational age was determined from the LMP while trans cerebellar diameter was by Ultrasonography. The correlation between gestational age and trans cerebellar diameter was determined and compared across subgroups of the study population based on age, parity, and BMI.

Results: The mean age of the study participants was 25.6±6.3 years. The majority of the women were primiparous. The mean BMI was 27.8±3.4 Kg/m2. The mean gestational age was 33.35±2.25 weeks. Trans cerebellar diameter range was 36.3 mm to 49.6 mm. A significant correlation was found between gestation age and trans cerebellar diameter (r=0.979, p-value<0.001) in subgroups based on age, parity, and BMI.

Conclusion: A significant positive correlation was observed between Trans cerebellar diameter and gestational age among women with IUGR suggesting its routine use in estimating gestational age among high-risk obstetric care patients

Physical Activity and Academic-Achievement of Medical Students: An Analytic Cross-sectional Study in Karachi

Naila Baig — 2024-06-29

Background: Physical inactivity is prevalent among medical students, with inconsistent academic scores. Physical activity enhances cognition and performance and improves academic achievement.

Objective: To determine how medical students’ physical activity and associated factors influence academic achievement.

Methods: Using convenience sampling, this analytic cross-sectional study involved Dow International Medical College MBBS students of 1^st year and 2^nd year, to fill the International-Physical-Activity-Questionnaire-S7S. This estimated day-to-day physical activity/week, metabolic equivalent task (MET)-minutes/week, as physical-activity-scores. Annual examination percentage scores were used as academic achievement scores. Statistical significance was determined at p<0.05.

Results: The response rate was 229/307 (74.6%). Median physical activity scores and academic achievement scores were 1188.00 MET-minutes/week and 59.28%. Males were more physically active (p=0.001) despite the female predominance of 54.15%, and 2^nd-year students (n=113), had significantly higher academic achievement scores (p=0.001). Ethnicity, physical limitation, and smoking status had insignificant effects on academic achievement. There was no statistically-significant difference in physical-activity-scores and academic-achievement-scores as per different age-groups (p=0.933, ηp²=0.003 and, p=0.276, ηp²=0.011), and BMI-groups (p=0.218, ηp²=0.021 and (p=0.044, ηp²=0.039). There was a tendency for between-the-group variance (p=0.04) in the “normal-weight” and “obese” BMI groups.

Physical-activity-scores and academic-achievement-scores showed no correlation (rs=0.035, p=0.597), and were independent of sitting hours/day (rs=0.043, p=0.558 and rs=0.039, p=0.603), sleep-hours/day (rs=0.077, p=0.223 and rs=0.001, p=0.984), and study hours/day (rs=0.040, p=0.556 and rs=0.091, p=0.181). Physical activity categories and academic achievement groups appeared independent of each other with no effect. (p=0.363, φc=0.097).

Conclusion: Physical activity has no effect on academic achievement of undergraduate medical students. Male students were physically more active but there was no association of gender with academic achievement.

Development and Validation of Survey Instrument for Measurement of Hospital Functional Service Quality

Iram Fatima — 2024-06-29

Background: Emergency, diagnostics, and surgical services are critical areas of hospitals both in terms of technicalities and resource creation. The literature review reflects that there is a need to develop a survey instrument-based measurement model that can identify areas of functional service quality within hospital facilities based on patients’ perspectives as hospital quality improvement initiatives.

Objective: To design and validate an instrument that helps to evaluate the functional service quality of hospitals using structural equation modeling.

Methods: It was a mixed-method research having a cross-sectional study design. A total of 817 responses were purposively collected from consumers of surgical, emergency, and diagnostic departments of tertiary care hospitals. Simple descriptive, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was performed to identify the factors to formulate the instrument using SPSS Amos 20.0

Results: The study validated seven constructs for the development of Func.Qual (Survey instrument named to measure hospital functional service quality). Amongst these constructs’ assurance, responsiveness communication, and reliability are critical contributing factors reported earlier. Whereas promptness, food and aesthetics are new constructs extracted in local settings. The values of goodness of model fit indices found statistically valid with Comparative Fit Index (CFI=0.96), Root Mean Square Error of Approximation (RMSEA=0.055) and Standardized Root Mean Square Residual (SRMR=0.05).

Conclusion: Func.Qual is a powerful survey instrument to measure hospital functional service quality. The current study is an effort to enrich the literature associated with the body of knowledge for hospital functional service quality.

Correlation of urinary gamma glutamyl transferase to creatinine ratio with albumin creatinine ratio in patients with type 2 diabetes mellitus

Shazia Hameed — 2024-06-29

Background: Diabetic Nephropathy is one of the most serious outcomes of Diabetes Mellitus worldwide. As tubular injury precedes albuminuria, tubular enzyme Gamma Glutamyl Transferase (GGT) may serve as a more sensitive diagnostic biomarker for diabetic nephropathy.

Objective: To determine and correlate urinary Gamma Glutamyl Transferase to creatinine ratio with urinary albumin creatinine ratio (uACR) in Type 2 diabetics based on gender.

Methods: A cross-sectional study was undertaken at Shaikh Zayed Hospital from March 2022 to April 2023. A total of 100 male and female participants were included in this study. The study participants included 75 type 2 diabetics and 25 controls. The diabetic group was subdivided into normoalbuminuric and microalbuminuric based on urinary albumin creatinine ratio. All subjects' fasting blood glucose, urinary albumin, urinary creatinine, and urinary GGT levels were measured on the automated chemistry analyzer. The data was analyzed by SPSS version 24. “t-test” was used to compare the variables between different groups. The Pearson correlation test was used to establish the correlation between Gamma Glutamyl Transferase to creatinine ratio and uACR.

Results: Urinary GGT (uGGT) levels were significantly higher in all type 2 diabetics as compared to controls (p <0.001). Both urinary albumin and uACR were raised in male diabetics (p<0.001) and female diabetics (p<0.005) as compared to controls, in male diabetics more increase was observed (p<0.001). A highly significant positive correlation was observed between uGGT:Creatinine ratio and uACR of all normoalbuminuric patients (‘r’ males=0.837 & females=0.919) and microalbuminuric patients (‘r’ males=0.600 & females=0.636) at p<0.001.

Conclusion: Urinary Gamma Glutamyl Transferase to creatinine ratio is positively correlated with urinary albumin creatinine ratio and may serve as a more sensitive biomarker than urinary albumin creatinine ratio in diabetic patients with renal damage.