Effects of Oral Retinoids on Ocular Surface, Assessment through Ocular Surface Disease Index (OSDI) Questionnaire

Objective: Oral retinoids commonly prescribed for acne vulgaris have many side effects. The objective of this study was to determine effect of oral retinoids on ocular surface. Methodology:  This quasi-experimental study, conducted at department of ophthalmology and dermatology HBS Medical & Dental College from August 2023 to July 2024, a total of 109 acne patients who were prescribed oral retinoids were included. Tear film break up time (TBUT) and ocular surface disease index (OSDI) scores were calculated at baseline and three months after therapy to determine effect of oral retinoids on ocular surface and presence of dry eyes. Data were analyzed using SPSS 22. Results: Mean age of patients was 28.40 ± 9.81 years. There were 23 (21.10%) males and 86 (78.90%) females. Mean baseline and three months follow up TBUT were 24.13 ± 6.31 and 10.33 ± 6.04 seconds, respectively (p < 0.001). Mean baseline and three months follow up OSDI scores were 3.03 ± 2.13 and 22.80 ± 10.32, respectively (p < 0.001). Frequency of dry eyes in acne patients treated with oral retinoids after three months of therapy was 82 (75.23%). The most common ocular complaint of the patients was gritty sensation in the eyes 33 (30.28%) followed by itching in the eyes 22 (20.18%) and burning sensation in the eyes 17 (15.61%). Conclusion: Dry eyes occurred in 75.23% users of oral retinoids showing a major effect of these agents on ocular surface. Key words: Acne vulgaris, Dry eye, Retinoids. &nbsp

The Effectiveness of Progestogens in Reducing Preterm Birth Risk

Objective: The study aims to evaluate the effectiveness of prophylactic vaginal progesterone in preventing preterm birth among women with a history of spontaneous preterm birth. Methodology: The study was conducted at the department of gynae & Obs, Ayub teaching hospital Abbottabad, from February 2022 to August 2022. IRB approved the study. This study investigated 125 women who had previously given birth prematurely. Demographic, medical, and obstetric data were collected before treatment initiation. Participants self-administered the study drug daily and returned to the study center every 2 weeks for monitoring. The study drug was continued until 36 weeks of delivery. Standard preterm labor treatment was provided as needed. All information was recorded on a standardized form. Results: The mean age of participants was 29 years (SD±8.631), 38% were first-time mothers, and 62% had prior births. The study of 125 women with a history of spontaneous preterm birth found that prophylactic vaginal progesterone was associated with a successful pregnancy outcome in 88% of participants. The average gestational period at delivery in the study was 34 weeks (SD±3.455). While the study demonstrates a positive trend, it's important to note that without a comparison group (e.g., a placebo or no treatment group), it's impossible to calculate a precise p-value demonstrating the statistical significance of the progesterone's effect. The 88% success rate suggests a potential benefit, but further research with a control group is necessary to confirm efficacy and determine statistical significance. These findings support the existing practice of using prophylactic vaginal progesterone in women with a history of spontaneous preterm birth. The high percentage of successful pregnancies (88%) reinforces its potential benefit. Conclusion: Prophylactic vaginal progesterone significantly reduced the risk of preterm birth by 88% in women with a prior history, demonstrating its potential to improve pregnancy outcomes for this high-risk population. However, the specific efficacy of vaginal progesterone can vary, and it is important to discuss individual risk factors and treatment options with a healthcare provider. Keywords:  Cervical Length, Drug Therapy, Progesterone, Preterm Birth, Pregnancy Complications

Spontaneous Hepatic Hemorrhage Following Whipple’s Procedure: A Report of Two Cases.

Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation performed for various pancreatic and periampullary pathologies. While the procedure has undergone significant refinements, it remains associated with significant morbidity and mortality.Spontaneous hepatic hemorrhage/ rupture is a rare but potentially life-threatening complication that has been reported in the literature. We present two rare cases of spontaneous hepatic rupture following Whipple procedure. A 79-year-old male underwent Whipple procedure for periampullary carcinoma. On postoperative day 19, he suddenly developed epigastric pain, nausea and vomiting. Imaging revealed a spontaneous hepatic rupture. Similarly a 67 years old female for suspected periampullary underwent Whipple’s procedure. On postoperative day 14, she presented to emergency department with complaint of right hypochondrial pain, continuous in nature and severe in intensity and was also diagnosed with spontaneous hepatic rupture. Surprisingly, the early postoperative CT of both patients did not reveal any evidence of hepatic injury or hematoma and there was no history of trauma. Both the patients were managed conservatively and were vitally stable on discharge and follow up. Keywords: Preiampullary Carcinoma, Spontaneous Hepatic Rupture, Subcapsular Hematoma, Whipple’s Procedure

Vitamin D Supplements as a Valuable Adjunctive Treatment Option for Irritable Bowel Syndrome

Objective: To assess the efficacy of vitamin D supplementation on IBS severity.Methodology: This study was conducted at the Department of Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from August 2022 to August 2024. A total of 152 participants aged 18–65 years diagnosed with irritable bowel syndrome (Rome IV criteria) and vitamin D deficiency (<20 ng/ml) were enrolled. Participants were allocated into two groups: Group A (cases, n= 76) received vitamin D supplementation for 1 month alongside standard care, while Group B (controls, n = 76) received standard care alone. The Irritable Bowel Symptom Severity Score (IBS) and serum vitamin D levels were measured at baseline, 4 weeks, and 12 weeks. Statistical analysis was performed using SPSS v23, with a p-value ≤0.05 considered significant.Results: Total 152 patients were included in the study with mean age of 32.7 ± 5.8 years; gender distribution indicated 61(40.1%) male participants and 91(59.8%) female participants. Comparative analysis of pre and post treatment was reported for IBSSSS mean value and Vitamin D values, the pre-treatment IBSSS in group A was 245.8 ± 21.8 while post treatment was 152.1 ± 16.2 with p-value of 0.015, Vitamin D was reported as 15.9 ± 1.23 in pre-treatment while 38.2 ± 1.24 as post treatment in group A, with p-value of 0.007. The elevated vitamin D after Treatment and declined IBSSSS was reported in group A. Conclusion: Vitamin D supplementation is a valuable adjunctive treatment option for IBS patients, especially with vitamin D deficiency.Keywords: GI disorders, Irritable bowel syndrome, Supplementation, Vitamin D deficienc

Association between Hemoglobin Levels and Severity of Coronary Artery Disease among Patients Presenting with ST- Segment Elevation Myocardial Infarction

Objective: This study aimed to elucidate the association between hemoglobin levels (anemia) and the severity of coronary artery disease (CAD) among patients experiencing ST-segment elevation myocardial infarction (STEMI). Methods: This prospective cohort study included patients aged 20 to 80 years presenting with STEMI to Liaquat National Hospital and Medicare General and Cardiac Hospitals between September 2023 and February 2024. Anemia was categorized as per the criteria defined by the World Health Organization based on hemoglobin levels. The severity of CAD was assessed based on the number of vessels affected and the Syntax Score system derived from coronary angiography. Results: Results: Of the 228 patients, 122 were anemic based on hemoglobin levels. The Syntax Score was significantly higher in the anemic group compared to the non-anemic group (27.97±7.15 vs. 24.62±7.04, p<0.01). One-way ANOVA showed significant differences in mean Syntax Scores across anemia severity levels, with the severely anemic group having the highest scores (F(3, 224) = 4.310, p = 0.006). Logistic regression indicated that lower hemoglobin levels were significantly associated with higher CAD severity (β = -0.556, t = -2.284, p = 0.023), and male gender also correlated with higher Syntax Scores (β = 2.294, t = 2.165, p = 0.031). The ROC curve analysis revealed an area under the curve (AUC) of 0.537, indicating that hemoglobin alone is not a strong predictor of multivessel disease in this population. Conclusion: Lower hemoglobin levels are significantly associated with increased severity of CAD in patients with STEMI, emphasizing the need for careful anemia management in CAD patients

From Free Flaps to Pectoralis Major Flaps: A Workhorse in Limited Resources

Objective: To assess the functional and aesthetic outcomes of using pectoralis major flaps in patients with head and neck region soft tissue defects after oral squamous cell carcinoma tumors in a resource-limited setting. Methodology: This prospective study was conducted on patients who received repair of post-ablative defects at the plastic surgery unit of Liaquat University of Medical and Health Sciences and Bilawal Medical College, Jamshoro, between October 2022 and March 2023. All patients admitted to the plastic surgery unit during the study period for reconstruction of post-ablative defects using subsequent PMC flap repair for head and neck region soft tissue defects after oral squamous cell carcinoma that were surgically treated and aged between 20 and 70 years. All major and minor PMC flap-related and flap-unrelated complications were assessed. Results: Among 78 patients, 63 (80.7%) were male and 15 (19.3%) were female, with a mean age of 34.10 ±12.10 years (range: 24-70 years). The Buccal mucosa was the most common location for oral cavity cancer, whereas the base of the tongue and floor of the mouth were used for reconstruction. Infections and wound dehiscence were the most common consequences, and the reconstruction site was statistically significant (p<0.05). Conclusion: Despite encountering a few minor complications both associated and isolated to the PMMC flap, the survival rate of the flap remains high, while the occurrence of complete flap necrosis is extremely rare

Paediatric Risk of Mortality III Score (Modified PRISM) – To Predict Mortality and Hospital Stay in Paediatric Intensive Care Unit

Objective: To determine mortality and length of stay (LOS) using PRISM III score in critically ill children. Methodology: This study included a total of 129 patients who met the inclusion criteria. The study was carried out in the Pediatric Intensive Care Unit (PICU) of the UCHS & Children Hospital Lahore, spanning from December 2023 to May 2024. Results: The mean age of patients was 7.55 ± 4.20 years, with a mean hospital stay of 5.18 ± 1.30 days. Male patients had a mean age of 8.18 ± 4.38 years, while females had 6.79 ± 3.88 years. PRISM score analysis showed a significant trend in discharge and mortality rates. In the 0-4 PRISM range, 84.7% were discharged, while 15.3% died. For scores of 5-9, 83.0% were discharged, and 17.0% died. In the 10-14 range, 57.1% survived, while 42.9% died. Among scores of 15-19, 40.0% were discharged, and 60.0% died. In the ≥20 range, 16.7% survived, while 83.3% died. Linear regression showed a significant association between PRISM score and length of stay (LOS), with a baseline LOS of 4.716 days. Each 1-unit PRISM increase extended LOS by approximately 5 hours (B = 0.069 days). Conclusion: It was concluded that the PRISM III score has discriminatory power in distinguishing between survival and mortality outcomes. Additionally, it proves to be predictor of the length of stay among survivors. Key words: Length of stay, Mortality, PRISM III score

The Impact of Syrinx on Clinical Outcomes in Arnold-Chiari Malformation: A Retrospective Study

Objective: Arnold-Chiari malformation is congenital or acquired anomaly of the hindbrain that leads to crowding of the cerebellum and brainstem in the posterior cranial fossa. There is an interplay between syringomyelia and Arnold-Chiari malformation. The objective of this study was to analyse the incidence trends, morphological patterns, and clinical outcomes of Arnold-Chiari malformation with and without syringomyelia, focusing on patients treated at Hayatabad Medical Complex, Peshawar. Methodology: This retrospective study was conducted on 150 patients from January 2023 to December 2023. Patients were divided into two groups: 75 with syringomyelia and 75 without syringomyelia. Key variables included tonsillar herniation, syrinx length, and surgical outcomes. Statistical analyses were done using t-test and chi-square test to assess relationship between variables, with a significance threshold of p<0.05. Results: Patients with syringomyelia exhibited significantly higher tonsillar herniation (mean: 10.8 ± 2.3 mm) compared to those without syringomyelia (mean: 7.4 ± 1.9 mm) with p<0.001. Syrinx presence was significantly associated with surgical outcomes (p<0.05). Among patients with syrinx, those with improved surgical outcomes had a mean syrinx length of 18.6 ± 7.5 mm, while stable or unimproved cases exhibited larger syrinx lengths. A significant difference in surgical outcomes was noted between the groups, emphasizing the clinical impact of syrinx presence. Conclusion: A strong association was found between syrinx presence and clinical outcomes in Arnold-Chiari malformation. Early diagnosis and timely intervention are critical for improved patient outcomes. Keywords: Arnold-Chiari malformation, Surgical outcomes, Syringomyelia, Tonsillar herniatio

Efficacy of Xylocaine and Nitrate Combination in Preventing Radial Artery Spasm and Pain during Transradial Coronary Interventions

Objective: To compare the efficacy of Xylocaine combined with nitrate versus nitrate and placebo in preventing radial artery spasm (RAS) and reducing pain during transradial coronary interventions.Methodology: This study was conducted at Hayatabad Medical Complex, Peshawar, from July to December 2024. A total of 60 patients undergoing transradial coronary procedures were included. Patients were assigned to one of two treatment groups based on clinical considerations: 30 received Xylocaine and nitrate, while 30 received nitrate and placebo. Both patients and interventional cardiologists were blinded to treatment allocation. Radial artery spasm was assessed using a radial spasm score, and pain was measured using the Visual Analog Scale (VAS). Statistical analysis was performed using t-tests and chi-square tests, with significance set at p < 0.05.Results: The Xylocaine and nitrate group had a significantly lower RAS rate (13.3%) compared to the nitrate and placebo group (36.7%) (p = 0.04). Pain scores were also significantly lower in the Xylocaine and nitrate group (2.3 ± 1.2) than in the placebo group (4.1 ± 1.6) (p = 0.01). Procedural duration and nitrate doses were similar between groups.Conclusion: The combination of Xylocaine and nitrate significantly reduces radial artery spasm and procedural pain compared to nitrate and placebo. This double-blind quasi-experimental study supports its clinical utility in improving patient outcomes during transradial coronary interventions.Keywords: Coronary Interventions, Nitrate, Pain Reduction, Radial Artery Spasm, Xylocain

Bilateral Four-Rooted Maxillary Second Molars: A Case Report with Cone-Beam Computed Tomography Analysis

Deeper understanding of root canal anatomy is fundamental for successful endodontic treatment. Two palatal roots in maxillary second molars, although uncommon, can be encountered in clinical practice. Advanced diagnostic tools like cone beam computed tomography (CBCT) plays a pivotal role in identification and management of this type of complex anatomy. This case report presents endodontic management of maxillary second molar with two palatal canals using CBCT and magnification.Keywords: Dental Pulp Cavity, Maxillary Molar, Palatal Canals, Tooth Root, 3D imagin