Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

OBJECTIVES This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form. METHODS: This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at <0.05. RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury. CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales

Propofol Versus Dexmedetomidine Sedation Reduces Delirium

OBJECTIVES Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine infusion to prevent delirium is controversial. We hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD.METHODOLOGY After the approval from institutional ethics review board and informed consent, a comparative cross sectional study was conducted in 100 patients scheduled for cardiac surgery. Patients suffering from consequential psychological issues, delirium, and grievous dementia were excluded. Delirium was evaluated by confusion assessment method for ICU (CAM-ICU). Normality and homogenity of data were analyzed using Kolmogorov-Sminorv and saphiro wilk. The factors related to delirum status were analyzed using Logistic Regression.RESULTSThe mean age among propofol group was 55.14+9.6 while among Dexmedetomidine was 55.96+12.1. POD was present in 24 of 50 (48%) and 4 of 50 (8.%) patients in propofol and dexmedetomidine groups, respectively. variables which had significance values <0.05 were patient age (0.000), associated disease (p<-0.003). In regards to other variables like patient gender (p value: 0.660), pre-operative medication (p value: -0.090), different type of surgery (p value: -0.239), had no correlation with POD.CONCLUSIONIn comparison with propofol, dexmedetomidine postoperative sedation minimized the occurrence and abbreviated the time span of POD in patients who had to undergo cardiac surgery

Positivity of Lumbar Puncture for Acute Bacterial Meningitis among Children Presenting with First Febrile Seizure

OBJECTIVES: To determine the frequency of lumber puncture-proven acute bacterial meningitis among children with fever and seizures of first onset.METHODOLOGY From March 2020 to March 2021, a hospital-based descriptive cross-sectional study was conducted at the paediatrics department of Hayatabad Medical Complex Peshawar. The sample size for a total of 342 people was estimated using WHO software. The study included all children who had first-onset febrile seizures through OPD and the emergency department. All children underwent lumber punctures using a stringent aseptic procedure, and the hospital laboratory received the samples to look for bacterial meningitis. On a pre-made Proforma, details including name, age, and gender were entered. The gathered data were input into the computer for additional SPSS analysis (version 23).RESULTS Most individuals were male and were lies in the 21-40 months of age group. Mean weight and length/height were evaluated, respectively. The majority had a history of 6-10 days of disease duration. Bacterial meningitis was found significantly (p<0.05) associated with age, gender and neurological deficit, while non-significantly (p>0.05) associated with the duration of diseases.CONCLUSION All children between the ages of 6 months and 60 months who presented with episodes of fever and seizures were found to have a statistically significant (p<0.05) association found among bacterial meningitis and age groups

Impact of Personality Trait of Emotional Stability on Oral Parafunctional Habits

OBJECTIVES To find the impact of emotional stability on oral parafunctional habits. METHODOLOGY A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over five months, from July to November 2021. Data was collected using a medical questionnaire and a ten-item personality inventory scale (TIPI). The medical questionnaire comprised two sections with 11 items. The first section had six demographic statements, including age, gender, marital status, occupation, educational level and medical condition. The second section consisted of a pre-validated parafunctional habits questionnaire. RESULTSThere was a non-significant difference in the scores of the personality trait of emotional stability across categories of oral parafunctional habits of nail-biting (p=0.093), tooth grinding (p=0.192), tooth clenching (p=0.055), biting on hard objects (p=0.17) and chewing gum (p=0.116). CONCLUSION Emotional stability was most prevalent in individuals who denied having the habit of nail-biting, teeth grinding, tooth clenching and biting hard objects but neither agreed nor disagreed with having the habit of chewing gum

Effect of Gender on the Outcome of Acute Coronary Syndrome in Type 2 Diabetes Mellitus

OBJECTIVES To determine the frequency of acute coronary syndrome presentations among diabetic patients and in-hospital outcomes based on gender variance. METHODOLOGY This observational cross-sectional study was conducted at the cardiology department of the Pakistan Institute of Medical Sciences, Islamabad. 106 consecutive diabetic patients with acute coronary syndrome were enrolled. Patients were assessed for in-hospital outcomes like congestive heart failure, recurrent angina, and mortality. The outcomes were evaluated based on gender. The Chi-Square test was used for significant differences keeping the P value < 0.05.  RESULTSThe mean age of the patients was 57.75±8.16 years. Males were 57 (53.8%), and females were 49 (46.2%). Congestive heart failure, re-angina, and mortality were significant in both genders yielding a P value of <0.05. CONCLUSION Diabetes is an important predictor of acute coronary syndrome. The complications related to congestive heart failure and mortality are more prevalent in males than females

Vertical Versus Transverse Incision for the Release of the First Dorsal Compartment of the Wrist for De Quervain’s Tenosynovitis

OBJECTIVES The study aimed to compare the clinical outcome of transverse versus longitudinal incision for surgical release of the first dorsal compartment of the wrist to treat de Quervain’s disease. METHODOLOGY In this quasi-experimental study, all the patients with resistant de Quervain’s tenosynovitis who had the surgical release of the first dorsal compartment between January 2008 and  December 2020 were included. The surgeries were performed under local anaesthesia. The first dorsal compartment of the wrist was approached through either a longitudinal or transverse incision, and the tendons of the abductor pollicis longus and extensor pollicis brevis were released. Patients were followed for a minimum of three months, and the primary outcome measure was the Visual analogue score (VAS) for relief of pain and secondary outcome measures were any immediate or delayed complications. RESULTS98 patients were included in the study with a female-to-male ratio of 7:1. The cohort’s mean age was 44 years (Range 25-75). Most patients were housewives exposed to manual work with the involvement of the dominant hand. There were no major complications besides wound issues and transient paresthesia in few patients. The longitudinal incision was associated with less transient nerve palsies, less duration of surgery and easier identification of structure and anomalies. The only advantage of transverse incision was less scar formation. The clinical outcome was similar in both groups: 94% of patients had complete pain relief (VAS 0). CONCLUSION There was no difference in the outcome of de Quervain tenosynovitis when released with a transverse or longitudinal incision. The longitudinal incision had fewer complications as compared to the transverse incision

Treatment of Neurological Diseases in Pakistan and Medicinal Plants - Letter to Editor

In developing and developed countries, neurological diseases contribute to the major reason for morbidity and mortality. The overall burden is 6.5% globally, of which advanced countries contribute 10 to 11%, whereas progressive countries constitute 4 to 5%. The higher ratio in technologically advanced countries might be due to their advanced system providing complete patient data. Some neurological diseases are common and wellestablished, whereas others occur rarely or are poorly ordered. Schizophrenia affects 45 million people, whereas depression affects 340 million globally. The people living with Alzheimer’s constitute 11 to 45 million people, accounting for 1% of the total disease load. 10% Pakistani community suffer from mental disorders, with 1% Alzheimer’s, 5% depression, 2% epilepsy and 1.5% schizophrenia. Medicinal plants play a vital role in treating several neurological disorders. Due to the upsurge in the cost of the available drugs, the local population is dependent on the use of medicinal plants to treat these neurological disorders. Medicinal plants possess a great therapeutic potential and fewer side effects than synthetic drugs. In Pakistan, research on medicinal plants is increasing day by day. The Pakistani population traditionally depends on herbal medications to treat several neurological disorders. The use is more in rural areas due to easy access and costeffectiveness. In Pakistan, there is a stern gap between the availability of neurological care and a trained neurologist. In this scenario, the use of traditional medicinal plants for aiming to treat neurological disorders is obvious

Systemic Comorbidities in Patients with Primary Fascial Space Infections of Odontogenic Orogin: Experience of a Tertiary Care Center

OBJECTIVES To assess systemic immune-compromised comorbidities in patients presenting with odontogenic infections that extend to fascial spaces. This study was designed to investigate the incidence of immune-compromising systemic comorbidities among patient presenting with odontogenic infections.METHODOLOGY This cross-sectional study was performed at the Department of Maxillofacial Surgery, Hayatabad Medical Complex (HMC) Peshawar from October 2018 through April 2019. However, patients older than 10 years of age, presenting with fascial space infections other than odontogenic cause, secondary fascial space infections and patients with multiple organ failure were excluded. The odontogenic infections were categorized according to their anatomical location. The prevalence of comorbidities was also assessed.RESULTSA total of 145 patients were included, where the male to female ratio was 3.8:1, mean age ~ 56 ± 14.74 years (range: 12-80 years) and mean duration of the odontogenic infections was 5± 1.2 days. The submandibular space was the most frequent site involved in odontogenic infections with a frequency of 60 (41.4%), followed by buccal space with 44 (30.3%) patients &    canine space with 31 (21.4%) patients. Of the 79 patients with comorbidities out of total 145 patients, diabetes mellitus was recorded in 60 patients. Other comorbidities included hypertension, renal and hepatic impairment. CONCLUSION Diabetes mellitus was the most common immune compromising comorbidity presented in patients with odontogenic infections extending in fascial spaces. Assessment of diabetes in routine dental practice is emphasized to avoid exacerbation of the odontogenic infections

Proximally Based Medial Hemi-Soleus Muscle Flap Employed For Moderate-Sized Pretibial Defects of the Middle Third of the Leg

OBJECTIVES This study was undertaken to document the clinical indications and outcome of proximally based medial Hemi-soleus muscle flap for coverage of moderate-sized complex pretibial defects of the middle third of the leg. METHODOLOGY This descriptive case series was conducted at the Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Burn & Trauma Center, Hayatabad, Peshawar, over five years. (i.e., from November 01, 2016, to December 31, 2021). It included all adult patients of either gender whose complex pretibial wounds of the middle third leg were managed with proximally based medial Hemi-soleus muscle flaps. RESULTS The mean age was 31.40±9.83 years, ranging between 19-47 years. All the patients had complex post-traumatic defects secondary to road traffic accidents. There were 9(33.3%) patients with minor defects (i.e., measuring ≤2×2 cm2), whereas 18(66.6%) patients had medium-sized defects (i.e., ≥2×2 cm2 and ≤7×5 cm2). Their hospital stay ranged between 9-15 days with a mean stay of 11.92±3.1 days. All the flaps (100%) survived. Partial skin graft loss was encountered among three patients (n=3;11.1%). CONCLUSION The study provides a good evidence base regarding the usefulness of the flap in managing complex defects of the leg. It is recommended to carry out similar studies internationally. These should help improve our findings and come up with further refinements

Burden of Obstetrics and Gynaecological Referrals to Tertiary Health Care System

OBJECTIVES This study aimed to assess the burden of obstetrics and gynaecological cases, causes and pattern of referral to tertiary care hospital. METHODOLOGY This descriptive cross-sectional study was carried out from May 2022-July 2022 using the data of patients who were referred to the Department of Obstetrics and Gynecology Unit 2 at Isra University Hospital from various primary, secondary, tertiary, and private hospitals for any obstetric or gynaecological emergency were the primary source of data. The confidentiality of each patient was carefully respected. This study evaluated the prevalence, reasons and pattern of referral of various obstetric and gynaecological conditions for which patients were referred to Isra University Hospital within the study duration and the management options provided to these patients. RESULTS The gynaecological cases accounted for the majority (71%) of referrals.  Patients between 21-30 yrs of age comprised 51% of the total. Most patients (20%) were multipara in their third trimester (18%). High-risk patients (60%) were this study’s most common reason for referral, whereas financial restrictions (4%) were the least common. Only 5% of patients were referred from other tertiary care facilities, whereas 49% of patients came from the primary sector (49%), secondary (33%), and private (13%). CONCLUSION There is an imperative need to upgrade health system infrastructure, mainly primary and secondary health care systems and especially in the field of maternal and childcare, to enable prompt and appropriate diagnosis and management of various conditions in all nearby hospitals