Journal of Ayub Medical College, Abbottabad : JAMC

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Klipple-Trenaunay syndrome (KTS) is an extremely rare congenital vascular disorder with poorly defined incidence and prevalence. We report a case of a patient who presented after road traffic accident with primary complaints of poor wound healing and persistent bleeding from wound site. Discernible presence of arteriovenous malformation and skin hypertrophy since birth lead to the diagnosis of Klipple-Trenaunay syndrome (KTS). There was an incidental finding of acanthocytosis on peripheral film of blood which remained elevated even after clinical improvement of the patient...

We present a 23-year-old white British male that presented to the Accident and Emergency Department, two weeks after the second dose of the BNT162b2 (BioNTech/Pfizer) vaccine. No similar use has been documented previously in literature. We report one potential complication of the Pfizer COVID-19 vaccine: A known case of Stevens-Johnson syndrome (SJS) that occurred after the second dose of the Pfizer COVID-19 vaccine alone without exposure to any other drug. Despite a significantly severe adverse drug reaction, the patient demonstrated completed recovery...

Proteus syndrome is a rare disease manifested by progressive segmental overgrowth involving the skeletal, Cutaneous, subcutaneous, and nervous systems. We report the case of a 24-year-old female who was born with no obvious abnormality at birth. From the age of 1 year, she developed asymmetric enlargement of her left upper limb and bilateral lower limbs leading to enlargement of the right-hand phalanges with radial deviation, enlargement of the right big toe, lateral deviation of left foot, and discrepancy in the length of lower extremities and kyphoscoliosis...

Osteochondroma are the most common benign tumours of the bone presenting in the young age group. Commonly found at the metaphysis of the long bones and mostly pedunculated; atypical locations and sessile appearances have also been described in literature. Due to the risk of conversion to malignant chondrosarcoma, the recommended treatment of these lesions is complete excision. We encountered a similar sessile growth in the pelvic region of a 21-year-old male with complaints of pain and swelling. After thorough investigation, excisional biopsy was performed and abdominal wall repair was reinforced with a polypropylene mesh...

Incarcerated gravid uterus for in ventral hernia is an extremely rare obstetrical and surgical problem which contributes to pregnancy related complications. We searched for literature to identify aetiology, presentation, complications, and management options for incarcerated gravid uterus, and are presenting this case with literature review. This extremely rare case report, first ever from Pakistan, of an incisional hernia containing gravid uterus as its contents and is bulging out of abdominal cavity. She presented at 27 weeks with ulceration of ventral hernia skin...

Intra-vitreal Vancomycin (IV-V) and ceftazidime (IV-C) are commonly in the treatment of acute post operative endophthalmitis. But there are suboptimal responses in some cases due to the emergence of antibiotic resistant micro-organisms. Moxifloxacin is a wide range antibacterial drug that is available as an eye drops for topical use for different types of ocular infections including post-operative endophthalmitis. But it has not been explored extensively as an intra-vitreal drug for post-operative endophthalmitis...

Fractures are an ordinary consequence of trauma. Paediatric fractures are rather uncommon because the bony framework is still in its growth phase and therefore compliant to such traumas. The incidence of vascular injuries is also low lying (<1%) in this age group. Nevertheless, management and recovery continue to be a challenge. In this case report, we discuss a 2-year-old child with a traumatic bilateral femoral fracture, a tibial fracture with added vascular injury. Delayed management may give rise to a variety of complications in such a peculiar case...

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year...

Heamophagocytic Lymphohistiocytosis (HLH) is problematic to diagnose. The conditions that predispose to HLH present in a similar fashion, such as sepsis and haematological cancers. We look at the case of a 66-year-old man with a diagnosis of CLL, who presented with pyrexia and non-specific symptoms which included abdominal discomfort and weight loss. Sepsis, the principal suspicion was thoroughly investigated and excluded. Routine autoimmune pathologies were exhausted with comprehensive panels. The patient was trialled on steroids, presumptively, with a limited response...

Extended trochanteric osteotomy is an invaluable technique for enhancing femoral exposure during revision total hip arthroplasty. Complications are rarely reported but may include non-union. Even rarer is the incidence of extended trochanteric osteotomy resorption. We present our experience using a modular tapered stem in managing a resorbed extended trochanteric osteotomy following revision total hip arthroplasty in a patient with extensive hip surgical history. Good surgical technique is important in the prevention and management of resorption...

BACKGROUND: The objective of the study to assess the workability and cosmetic outcome of endoscopic thyroidectomy vestibular approach (TOETVA) and share results of underdeveloped country with the world about their first clinical experience. METHODS: We performed TOETVA in 3 patients presenting with thyroid nodules in our hospital, between October 2020 and December 2020 at Liaquat National hospital. Three-port technique was used, one 10-mm port for camera and two 5-mm ports for working...

BACKGROUND: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. METHODS: All patients with indication of total laparoscopic hysterectomy during the study period were included...

BACKGROUND: Identification of gene targets and biological pathways involved in colorectal carcinoma (CRC) is essential for better management of patients. Our study aims to highlight common somatic mutations in colorectal carcinoma and to identify dysregulated pathways and gene enrichment based on KRAS and BRAF interaction network analysis. METHODS: By using cancer browser tool in COSMIC database, mutation frequencies of the top 20 mutated genes listed for colorectal adenocarcinoma were identified...

BACKGROUND: Cryotherapy is a common destructive treatment modality for treating plantar warts that results in blistering and scarring. Mitomycin an antitumor drug with antiviral property is a safe, better and a promising option for treating plantar warts. Objective was to compare efficacy of cryotherapy and mitomycin microneedling in the management of plantar warts. It was a randomized controlled trial conducted at the Skin Department CMH Abbottabad from 1st May to 31st December 2021...

BACKGROUND: One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. METHODS: This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022...

BACKGROUND: Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life...

BACKGROUND: Various modalities have been used to treat hypopharyngeal cancer. Non- surgical modalities include radiotherapy alone, sequential chemoradiation and concomitant chemoradiation or bio radiation. This study was conducted to evaluate the primary non-surgical treatment. METHODS: A total number of 67 patients treated from March 2009 to January 2022 were enrolled in this study. The 2-year and 5-year survival rates were estimated using the Kaplan-Meier method...

BACKGROUND: The proper estimation of depth of the orotracheal tube (OTT) in intubated patients is difficult. Several methods have been developed for proper estimation of the depth of OTT. The purpose of this study was to compare two commonly used formulae (21/23 rule and Chula formula) for proper estimation of depth of OTT in our Pakistani population. METHODS: In this randomized interventional study, we included 74 adult patients. The study was conducted in the Intensive care unit of a tertiary care hospital in Karachi, Pakistan, from October 2021 to April 2022...

BACKGROUND: Hepatitis C is a diverse illness that causes significant death and morbidity. The hepatitis C virus infects hundreds of millions of individuals globally (HCV). More than 80% of those infected develop chronic infection; the remaining 10-20% recovers spontaneously through natural immunity. Acute hepatitis is only icteric in 20% of individuals and is seldom severe. METHODS: A pilot study was conducted at INOR hospital Abbottabad. Eleven hepatitis C positive and 10 hepatitis C negative participants were included in the study...