Diagnostic Accuracy of Fetal Anterior Abdominal Wall Thickness as an Early Sonographic Sign for Diagnosing Gestational Diabetes.

Introduction  Traditionally, different fetal variable measurements are used in ultrasound to assess fetal growth. Ultrasound can detect abnormal fetal growth. Gestational diabetes mellitus (GDM) is linked to higher fetal obesity as early as 20 weeks of pregnancy. The amount of fetal adipose tissue may be measured by measuring the thickness of the anterior abdominal wall. Measuring the thickness of the fetus's anterior abdominal wall (AAWT) is a straightforward procedure that may be performed alongside standard abdominal circumference measurements. Objectives  To check the diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, keeping oral glucose tolerance test as the gold standard. Study design  This research was conducted using a cross-sectional analysis. Study place and duration The study was conducted in the Radiology Department at Rawalpindi Medical University and Allied Hospitals from July 10, 2019 to January 9, 2020. Materials and methods  Women between the ages of 18 and 45 who had a family history of type 2 diabetes and were at risk for developing GDM were recruited. Exclusions were made for diabetic women, those carrying multiples, and those with autoimmune diseases. The AAWT measurement of the fetus, which included the skin and subcutaneous tissue, was acquired using the traditional anterior cranial view, 2-3 cm lateral to cord insertion. Pregnant patients at risk for GDM underwent screening using an oral glucose tolerance test. Those exhibiting any two abnormal values were diagnosed with GDM. Results  The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, with the oral glucose tolerance test as the gold standard, were 93.14%, 82.65%, 84.82%, 92.05%, and 88.0%, respectively. Conclusion  The study concludes that the diagnostic accuracy of fetal AAWT as an early sonographic indicator for identifying gestational diabetes is notably high.

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study.

INTRODUCTION: Among various extra-articular manifestations of rheumatoid arthritis (RA), interstitial lung disease (ILD) is the most frequent and concerning manifestation. The reported frequency of RA-associated ILD (RA-ILD) varies in the literature. The objective of the present study was to determine the frequency of ILD in RA patients at a teaching hospital in Rawalpindi. METHODS: 175 male and female patients between 18-70 years were enrolled in the study from January 21, 2022, till July 24, 2022. Patients diagnosed with RA were screened for the concomitant presence of ILD (increased pulmonary markings on chest X-rays and total lung capacity ≤ 80%, predicted on pulmonary function tests). In addition, the frequency of RA-ILD was noted and compared across various subgroups of patients based on age, gender, and disease duration. RESULTS: The mean age of the patients was 45.3 ± 11.5 years. The male-to-female ratio was 1:3.1. The mean disease duration was 6.2 ± 3.5 years at the time of presentation. A total of 118 (67.4%) patients were diagnosed with RA-ILD. The frequency of RA-ILD was significantly higher among patients with a prolonged duration of disease, < 5 years vs. ≥ 5 years (59.1% vs. 75.9%; p-value=0.018). Among 118 patients with RA-ILD, usual interstitial pneumonia (UIP) was the most frequent pattern and was noted in 74 (62.7%) patients, followed by nonspecific interstitial pneumonitis (NSIP), which was noted in 44 (37.3%) patients. When compared, there was no statistically significant difference in the frequency of high-resolution CT (HRCT) pattern of RA-ILD across various subgroups of patients based on age (p-value=0.969), gender (p-value=0.934), and duration of disease (p-value=0.881). CONCLUSION: In the present study, a substantial proportion of RA patients suffered RA-ILD, which warrants routine screening of these patients for undiagnosed pulmonary involvement so that timely identification and anticipated management may improve the outcome of such cases in future clinical practice.

Congenital Dyserythropoietic Anemia Type II: A Case Report.

Congenital dyserythropoietic anemia (CDA) type 2 is a rare genetic disease that presents with mild to severe anemia. The rare occurrence may be a reason why CDAs are often misdiagnosed since the morphological abnormalities and the clinical features are commonly found in other clinically-related anemias. We report a case of a 17-year-old male who presented in a tertiary care government hospital, with a history of lethargy, abdominal pain, abdominal fullness, and failure to thrive. Bone marrow biopsy reported the uncommon diagnosis of CDA type 2, the Ham test was also positive. The management included a multi-disciplinary approach alongside counseling of the family.

Efficacy of Single Dose of Fosfomycin Versus a Five-Day Course of Ciprofloxacin in Patients With Uncomplicated Urinary Tract Infection.

INTRODUCTION AND OBJECTIVE: Treatment has become more challenging due to an aging population, polypharmacy and high prevalence of comorbid illness, antimicrobial antibiotic allergy or sensitivity, an increase in the number of individuals with underlying immunological or structural abnormalities, as well as the frequency of multidrug-resistant infections. Many multidrug-resistant bacteria are still susceptible to nitrofurantoin and fosfomycin, two ancient medicines. Their high urine concentrations and low toxicity give them an advantage over newer medications. This study aimed to compare the efficacy of a single dose of fosfomycin versus a five-day course of ciprofloxacin in patients with uncomplicated urinary tract infections. Methodology and data collection procedure: This randomized control trial was conducted in the Department of Medicine, Benazir Bhutto Hospital, Rawalpindi. A total of 46 patients were enrolled. Patients were divided randomly into two groups by using the lottery method. In group A, patients were given a single 3 g dose of oral fosfomycin. In group B, patients were given oral ciprofloxacin (500 mg) daily for five days. Then patients were followed-up in the Outpatient Department (OPD) for 28 days. After 28 days, patients were evaluated for resolution of symptoms (as per operational definition). Patients in whom symptoms would not be resolved were managed as per standard protocol. All this information was recorded on proforma. RESULTS: The average age of the patients in group A was 39.41±9.80 years while in group B that was 41.32±17.76 years. In both groups, 23 females were equally divided. The mean duration of symptoms in group A was 4.78±1.98 days while in group B was 4.95±1.29 days. The minimum duration of symptoms was three days and the maximum was 10 days. In group A, there were 15 (65.21%) patients with efficacy achieved, and among eight (34.78%) patients, efficacy was not achieved while in group B, there were 15 (65.21%) patients in which efficacy was achieved, and among eight (34.78%) patients, efficacy was not achieved. There was no significant association between efficacy and study groups as the p-value was not significant (p=0.87).  Conclusion: The conclusion of the study was that in the treatment of simple urinary infections, a single dose of fosfomycin had equal efficacy and tolerability as a five-day course of ciprofloxacin.

Use and Perceptions of Shared Decision-Making by General Surgery Faculty and Trainees.

INTRODUCTION: The purpose of this study was to assess the practice and perceptions of shared decision-making (SDM) by both faculty and residents at Boston Medical Center and explore barriers and facilitators to implementing SDM at our institution. METHODS: We created and distributed an online survey assessing provider demographic and training characteristics, experiences with the informed consent process, practices in SDM, and perceptions about SDM. We used descriptive statistics to summarize provider characteristics and survey responses and univariate analysis to determine associations between them. RESULTS: Fifteen surgeons and 19 surgical residents completed the survey (49% response rate). Most respondents were aware of and had a positive attitude toward SDM (91% and 76%, respectively); 35% reported having SDM training. Providers had varying levels of engagement with different SDM practices, and there were inconsistent associations between provider characteristics and the use of SDM. Often providers thought the patient's health literacy, foreign primary language, clinical condition, and socioeconomic factors were barriers to the SDM process. CONCLUSIONS: Although most general surgery faculty and residents at our institution had a positive view of SDM, they engaged in SDM behaviors inconsistently, with no clear association between clinician characteristics and specific behaviors. We identified several barriers to SDM consistent with those identified by providers in other specialties. This highlights the need for further research to study live general surgery provider-patient interactions, as well as structured SDM education to train general surgery providers to reliably engage their patients in effective SDM.