Outcome of proximally based medial hemisoleus muscle flap for coverage of soft tissue defects in leg

Objective: To review the use of proximally based medial hemisoleus muscle flap for exposed soft tissue defects in middle third leg. Methodology: The descriptive (retrospective) study was conducted in PakItalian Modern Burn Center, Multan from January 2014 to December 2018. Retrospective data was collected among patients where medial hemisoleus muscle flap was done. This series depicts the use of medial hemisoleus muscle flap in Patients having small to medium sized defects (ranged from 4-12 cm length and 2-8 cm width). The flap was done in most of the cases after 3 weeks. Patients having small to medium sized defects in middle third of tibia (Defect size ranged from 4-12 cm length and 2-8 cm width) were included in the study Variables of study were recipient-site issues, donor-site management, complications, and outcomes. Descriptive analysis was done. Results: Among 96 patients, 84 were males and 12 were females and their age ranged between 15-57 years. Out of 96 flaps 90 flaps survived completely, four had major flap loss and two flaps completely lost. Major complication was infections in flap followed by graft loss and haematoma. Conclusion: Proximally based medial hemisoleus muscle flap is a reliable flap easy to do and easy to follow.  &nbsp

Assessing the validity of admission test into the internship programme at a private university in Pakistan

Objective: To report the development and validity assessment of a comprehensive model of assessment method comprising written test and multiple mini interviews for selection in a medical internship programme. Method: The psychometric validation study was conducted at the Aga Khan University, Karachi, and comprised anonymised scores of written admission test, multiple mini interviews and exit written exams for all the interns who completed their internships in 2018 and 2019. Correlation between admission and exit tests, and predictions were assessed. Data was analysed using SPSS 20. Results: There were 160 interns; 80(50%) each in 2018 and 2019. Mean scores were 68.8±4.40% for written tests and 76.7±4.66% for multiple mini interviews. The mean score for exit examination was 68.1±6.84%. The Cronbach\u27s alpha of scores on the written admission test was 0.82 and 0.88 for the two years, respectively, while for the multiple mini interviews, the corresponding values were 0.81 and 0.94. The written admission and exit tests were moderately correlated (0.44) while the correlations of multiple mini interviews scores with written admissions and exit tests were -0.28 and 0.04, respectively. Conclusion: The selection process should comprise multiple measures of assessment to ensure the selection of the best candidate

Diagnostic Accuracy of Peroperative Color Doppler Ultrasonography for Determining the Nature of Anterolateral Thigh Flap Perforators

Objective: To determine the diagnostic accuracy of color Doppler ultrasonography for diagnosing septocutaneous nature of anterolateral thigh flap perforators taking peroperative findings as gold standard among patients undergoing soft tissue reconstruction. Methodology: A total number of 100 patients undergoing soft tissue reconstruction using antero-lateral thigh flap perforators at plastic surgery unit, Pak Italian Modern Burn Center, Multan and fulfilling the selection criteria were approached. An informed consent were taken from them before enrolling in the study. Information regarding their demographic data were noted in the proforma. A high frequency color Doppler ultrasound was done by the consultant radiologist to determine the nature of the perforator (as per operational defination) and the results were noted in the proforma. The anterolateral thigh thin flap was undermined, but kept in situ. The elevation was performed either on superficial or sub-facial plane depending upon situation and surgical plan, and the points of emergence through the deep fascia and nature of its perforators, as they appeared during surgery, was noted in the proforma. Results: Age distribution of the patients was done, it showed that out of 100 patients, 17 %( n=17) were in age group of 15-27 years and 83%( n=83) were in age group of 28-40 years and  mean age was calculated as 33.96±5.72 years. Gender distribution of the patients was done, it showed that 88 %( n=88) were male whereas 12 %( n=12) were females. In this study, Sensitivity and specifity of septocutaneous nature of perforator was 78.41% and 83.33% respectively and PPV was 97.18% and NPV was 34.48% and  accuracy was 79%. Conclusion: Color doppler ultrasonography is the reliable test for the prediction of nature of anterolateral thigh flap perforator

Outcome of proximally based medial hemisoleus muscle flap for coverage of soft tissue defects in leg

Objective: To review the use of proximally based medial hemisoleus muscle flap for exposed soft tissue defects in middle third leg. Methodology: The descriptive (retrospective) study was conducted in PakItalian Modern Burn Center, Multan from January 2014 to December 2018. Retrospective data was collected among patients where medial hemisoleus muscle flap was done. This series depicts the use of medial hemisoleus muscle flap in Patients having small to medium sized defects (ranged from 4-12 cm length and 2-8 cm width). The flap was done in most of the cases after 3 weeks. Patients having small to medium sized defects in middle third of tibia (Defect size ranged from 4-12 cm length and 2-8 cm width) were included in the study Variables of study were recipient-site issues, donor-site management, complications, and outcomes. Descriptive analysis was done. Results: Among 96 patients, 84 were males and 12 were females and their age ranged between 15-57 years. Out of 96 flaps 90 flaps survived completely, four had major flap loss and two flaps completely lost. Major complication was infections in flap followed by graft loss and haematoma. Conclusion: Proximally based medial hemisoleus muscle flap is a reliable flap easy to do and easy to follow.  &nbsp

Preventive Strategies against Human Papillomaviruses

Human papillomavirus (HPV) infection is among the most common viral infections of the reproductive tract. Out of more than 100 different types of HPV identified so far, only a few (termed as “high-risk” subtypes) are associated with cervical cancer. On the other hand, “low-risk” subtypes are associated with genital warts and other benign changes in cervical and oral mucosa. Majority of the HPV infections usually clear up without any intervention within a few months. However, a fraction of HPV infections, such as those with types 16 and 18, can become persistent which may lead to the development of anogenital or cervical cancers. HPV subtypes 16 and 18 together are responsible for approximately 70% of all cervical cancer cases, the fourth major cause of cancer-related deaths in women. In the absence of any specific treatment options, preventive measures are considered as cornerstone of strategies aimed at curbing the burden of this disease. This chapter presents a comprehensive review of strategies that can be employed to prevent and eradicate HPV infection. Minimizing the exposure to HPV risk factors such as unprotected sex, multiple sex partners, early age sex, and not being circumcised, can reduce the chances of getting HPV infection to a significant level. Mass screening programs have also been effective in HPV eradication. Nevertheless, immunization against HPV has proven to be the most promising strategy in fight against HPV. Virus-like particles based on bivalent, quadrivalent, and nonavalent anti-HPV vaccines have been licensed and are available in market under the trade names of Cervarix®, Gardasil®, and Gardasil9®, respectively. Various clinical trials and population-based studies have demonstrated high levels of efficacy for all the three vaccines in preventing type-specific malignancies

Impact of guillain barre syndrome on psychosocial functionings of patients in islamabad

GuillainBarre Syndrome (GBS) is a rare autoimmune disease of unknown causes that affects peripheral nervous system. Objectives: To review the impacts of the GuillainBarre Syndrome on the psychosocial functioning of the patients and to assess the relationship between GuillainBarre Syndrome and the psychosocial functioning Methodology: Comparative cross sectional survey was conducted on 100 participants (50 GBS patients from Shifa International Hospitals and 50 normal participants from Islamabad in 6 months time from February to July 2013. Data collected through Structured Questionnaire in hospital settings for GBS patients and normal persons from Islamabad through Psychosocial functioning scale and social functioning scale and analyzedby using SPSS version 17

Microbicides for the Prevention of HPV, HIV-1, and HSV-2: Sexually Transmitted Viral Infections

Sexually transmitted diseases (STDs) can be transmitted through genital-genital, orogenital, or anogenital contacts and remain to be a public health concern worldwide. Approximately one million people around the world are believed to be newly infected with sexually transmitted infections (STIs) each day. Numerous causative agents including bacteria, viruses, protozoa, yeast, and fungi are responsible for STIs; however, viruses exhibit more serious risks, probabilities and outcomes of STDs than other organisms. The most lethal viral STIs are human immunodeficiency virus-1 (HIV), herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), and human papillomavirus (HPV), which are responsible for major sexually transmitted viral infections including AIDS, herpes simplex, and genital warts, respectively. Despite the fact that several prevention strategies such as vaccination, abstinence from sex, limiting sex partners, the use of condoms and a range of therapeutic drugs have drastically reduced the risk of contracting STIs, these three infections continue to spread at an alarming rate. The high incidence and lack of effective vaccine, instigated scientists to look for alternate, cheap, and efficient strategies for controlling these deadly viruses. Microbicide are relatively new approach that may be helpful in preventing STIs transmission when applied inside the genitals before intercourse. Like other interventions, microbicides are used as prophylactic measures against STIs. Therefore, an excellent safety and efficacy profile analysis is mandatory before their approval for human use. Although no safe and efficacious microbicide is yet available, many candidates including nonoxynol-9, Savvy, cellulose sulfate, Carraguard, VivaGel, tenofovir gel, and PRO 2000 have shown promising in vitro activity and many more are under development. However, very few of them have moved to large-scale phase III trials. This chapter aims to provide a brief overview of various microbicides along with their mechanism of actions and recent updates on safety and effectiveness trials

Wagner Versus The University Of Texas Classification Of Diabetic Foot Ulcers: A Descriptive Study In Nishter Hospital Multan

Objective: The aim of this study was to compare two widely used classification systems “Wagner and university of Texas Classification” in description of diabetic ulcer.Study design: Descriptive studyPlace and duration of study: The study was conducted in surgical department of Nishtar Medical University and Hospital, Multan from January 2015 to January 2017Material and Methods: All the patients with new foot ulcer because of diabetes either single or multiple on same foot or on both feet coming in OPD of Nishtar Medical University and Hospital were enrolled in this Descriptive study. Demographic data such as gender, age, diabetes duration, smoking, socioeconomic status, education level, hypertension and history of cardiovascular and cerebrovascular disease, and other chronic complications of diabetes were also recorded. Along with wound measurement grading was done using Wagner and university of Texas classification. Statistical analysis was performed by using SPSS version 21. To describe the data frequency tables, graphs and descriptive statistics like mean and standard deviation is used. For the purpose of analysis t test is used at 5% level of significance.Results: One hundred individuals with diabetic foot ulcers were studied in 24-month period. Demographic and clinical data depicts presence of neuropathy in 67 patients (67%). Ischemic limb was diagnosed in 26 patients (26%). 34 patients got amputation (34%) while in 17 patients healing was problematic. There were no major amputations. None were lost to follow-up and none died. A significant number of our patients were lower socioeconomic status and was having no education. When results of both the classification were compared by using student t test (p value indicate no statistical significance >0.05)Conclusion: This study confirmed that both classification systems are equally good in description of diabetic foot ulcer

Noninvasive monitoring intracranial pressure - A review of available modalities

Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date.Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the review.Results: A total of 94 publications were reviewed, and we found that over the past few decades clinicians have attempted to use a number of modalities to monitor ICP noninvasively.Conclusion: Although the intraventricular catheter remains the gold standard for monitoring ICP, several noninvasive modalities that can be used in settings when invasive monitoring is not possible are also available. In our opinion, measurement of optic nerve sheath diameter and pupillometry are the two modalities which may prove to be valid options for centers not performing invasive ICP monitoring