Chandka Medical College Hospital Research Articles

Role of Multiple Serial Casting beyond Standard Casting Technique in Managing Club Feet

Aim: To find the role of multiple serial casting beyond standard casting technique in managing club feet. Methodology: Cohort prospective study. Department of Orthopaedic, Chandka Medical College Hospital Larkana from July 1, 2021 to June 30, 2022. One hundred cases were enrolled. The Pirani scoring system was applied for detailed monitoring of the severity and treatment of clubfoot, and the Ponseti method technique was performed. Foot or feet were cast and fastened in an abduction brace at 95% of the correction rate being achieved. All children below two years of age who had one or both feet clubbed were included in this study. Results: The majority of the children visiting the hospital setting for treatment of clubfoot were within the age group of 0–5 months, followed by 6–12 months in 55% and 31% of the children, respectively. About 70% of the children with club feet were boys, with only 30% being girls. The baseline Pirani score was 3.47±0.523, while it decreased significantly to 0.0321±0.135 as the final Pirani score. The outcomes of the study showed that 68% of the children had excellent treatment, 10% had really good treatment, and 18% had fair treatment. Conclusion: Serial casting is a favourable technique for the treatment of clubfoot, wherein it assists in the maintenance of foot balance and proper development. Keywords: Multiple serial casting, Standard casting, Club feet

Indications and Complication of Laparoscopic Cholecystectomy at a Tertiary Care Setting in Sindh Province: A Cross Sectional Survey

Objective: The study was aimed to-evaluate the indications and-complications-of the laparoscopic cholecystectomy at a tertiary care setting in sindh province. Background: The-hepato-biliary-system is affected by a wide range of illnesses known as gall bladder diseases, each of which has a unique clinical presentation and degree of morbidity. The majority of adult populations in Western nations are affected by cholelithiasis, which affects 5% to 25% of the adult population. Initially, people from developing nations had little access to the advantages of laparoscopic cholecystectomy. Materials and Methods: A cross sectional study was carried out at the surgical dept Chandka Medical College Hospital Larkana for a period of 6 months in 2020 which included patients who went through laparoscopic cholecystectomy were included in the study, however, the patients having a history of previous abdominal surgery, hepatobiliary carcinoma , challenges ejection fraction, patients with coagulopathies and those reactive for HbsAg or HCV antibodies were excluded from the study. Results: The mean age of the subjects was 43.8± 9.67 years. There were 93.7% of study participants were females, 18.6% were diabetic and 26.5%) were hypertensive. 41.81% patients were aged between 30 to 40 years. The indications for the cholecystectomy included Symptomatic cholelithiasis for 148 (83.62%) cases, acute cholecystitis for 24(13.56%) cases and gall bladder polyp for 5 (2.82%) cases. There were 11 (6.21%) cases which needed to be converted to open cholecystectomy. Bile leaking was reported in 8 (4.52%) cases and injury to liver/intestine were reported for 3 (1.69%) cases. Conclusion: In a setting of a developing country, -laparoscopic-cholecystectomy-looks to be a safe and-effective treatment with few complications. Keywords: Laparoscopic cholecystectomy, Indications, Complications, cholelithiasis.

Foot Care Awareness among Diabetic Patients

Objective: To assess the awareness of the patient regarding foot care. Methodology: This retrospective study was conducted at Diabetes & Endocrinology Ward, Chandka Medical College Hospital, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1st January 2022 to 30th June 2022. There were 200 patients enrolled in this study suffering from type-2 diabetic patients with an age more than 30 years were included. A well-structured questionnaire was designed for documenting the awareness related questions about foot care from each diabetic patient. Patients were classified as those who have visited physician for foot care or not, ulceration presence, and risk status. Results: The mean age of the cases were 50.7±10.4 years with more males having no foot ulceration while higher females suffering from foot ulcerations. The educational status presented higher level of primary education in both groups while this was followed by no education in foot ulceration diabetic patients. The knowledge scores presented higher number of patients above age 45 having the knowledge of foot care with 127 females presented. The awareness of self-foot care was observed in on 45 cases with highest in those having at least secondary education. There were 45.5% those diabetic patients having long time history of diabetes. There were 9% cases with previous history of foot ulceration. The awareness of foot care practice was observed in 37.5% of the total cases with only 4 those having foot ulceration. There was very poor hygiene awareness about feet in cases with foot ulceration. Awareness about not soaking the feet was only present in 24% of ulceration foot diabetic patients while 34% were not aware of risks with walking barefoot outside. Those patients whose feet were examined by physicians had significantly higher trend of walking barefoot. They also were less aware of drying toes web spaces as compared to the other groups. Practical implication Conclusion: Diabetic foot ulceration was observed significantly low in those patients who had knowledge regarding self-care. Keywords: Foot ulcers, Diabetes, Neuropathy, Guidelines, Amputation

Frequency and Clinical Characteristics of Young Onset Parkinson’s Disease at Chandka Medical College Hospital Larkana

Background: One of the most prevalent forms of neurodegenerative illness, Parkinson's is characterised by a loss of postural response, stiffness, and tremor at rest. Young-onset Parkinson's disease occurs between the ages of 21 and 50 on average, however it begins much younger in 3 to 5 percent of people. Objective: To determine frequency of Young onset Parkinson’s disease in Parkinson’s patients. Methodology: This research was conducted from May 2022 and October 2022 at the Chandka Medical College Hospital in Larkana. The World Health Organization's online calculator determined that 73 people would be used for the study. Permission and ethical review forms were filled out. The data was analysed using SPSS. The significance level of 0.05 was considered crucial. Results: The total number of female patients were 31(42.5%) while male were 42(57.5%) The duration of disease was from 6 months to 22 years. Majority of the patients were in stage 2 and 3 according to Hoehn and Yahr rating scale. The frequency of Young Onset Parkinson’s disease in Parkinson’s patients is 24.7%. Overall prevalence of Parkinson’s disease was seen more in male patients, this even increases in YOPD, (38% VS 62%).Almost all patients in both age categories have bradykinesia and rigidity while 6 patients out of 73 have absent tremors. Loss of postural reflex was seen in 33 patients, every second (51%) patient in idiopathic Parkinson’s disease and every third (38%) in YOPD. Dystonia was seen more in YOPD, total 8 patients have dystonia, 4(28%) in YOPD and 4(8%) in Idiopathic Parkinson’s disease. Dyskinesia was not seen in YOPD while it was frequent in Idiopathic Parkinson’s disease. Family history was positive in total 9 patients, 50% of cases YOPD, while it was positive 5.8% in idiopathic Parkinson’s disease. Conclusion: YOPD is unique subgroup among patients of Parkinson’s disease, it burden is much more than ever reported, this calls for shared decision making , the possibility of genetic counseling and appropriate multidisciplinary treatment options. Keywords: Parkinson’s disease, YOPD (Young onset Parkinson’s disease, bradykinesia, rigidity, tremor, dystonia, postural reflex. Dyskinesia.

The Impact of Covid-19 Vaccines on Sperm Quality

Objective: To determine the impact of Covid-19 vaccines on sperm quality. Study Design: Case control study Place and Duration of Study: Department of Diabetes & Endocrinology, Chandka Medical College Hospital Larkana from 1st July 2022 to 31st December 2022. Methodology: Patients were enrolled as 50 those who had PCR confirmed Covid 19 history and 50 those who never got Covid-19. On this basis those cases who had a Covid-19 history were placed in group A while those who did not had Covid-19 history were placed in Group B. Patients clinical history including anamnesis, marital status, cryptorchidism, operative varicocele, or any chronic ailment were documented. A counting chamber was used for sperm count in a 100 square area. Spermatozoa was measured as either rapid-progressively motile (Type a), or as slow-progressively-motile (Type b), or as situ motile (Type c), and finally as immobile (Type d). The total semen sperm count was gained by multiplication of concentration of sperm with its volume. Results: Volume and concentration was significantly different in both study groups. Difference in tail anomaly was also observed. In group A, it was 29.20 ± 10.26 while 27.59 ± 12.31 was the value of group B. Almost equal number of participants were married. Azoospermia was only found among Covid patients. Conclusion: Azoospermia was only found in Covid patients and no such results were obtained from Covid negative patients. Keywords: Spermatogenesis, Impairment, Corona virus, Congestion, Angiotensin

Calcium and Bone Disorders in Pregnancy and Post-Partum Assessed through Radiological Imaging

Aim: To determine the calcium and bone disorders in pregnancy assessed through radiological imaging. Study design: Prospective study. Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st July 2022 to 31st December 2022 Methodology: One hundred pregnant women were enrolled. The blood calcium levels were assessed through serum calcium at these stages through 3 cc blood withdrawal. Dietary intake of calcium was also assessed through food frequency charts. Urinary-excretion of calcium was analyzed through cross-linked N-telopeptides (NTx) type I collagen. Each participant was assessed at 3 points including baseline assessment at 1st trimester, then at 2nd trimester and finally at post-partum 4 weeks. At the 2nd trimester ultrasound bone measurement was conducted at distal radius. Quantitative ultrasound was used for this purpose. In the post-partum women, a radiological imaging including DEXA (Dual-energy X-ray absorptiometry) bone scan was performed. Results: The mean age was 26.9±5.5 years. The mean pregnancy was 2.0±1.1 while the mean number of children was 0.9±0.7. The previous months of breast feeding as mean were 6.8±7.9. The calcium intake from food as well as serum calcium levels was below recommended levels in women during their pregnancy and post-delivery. Through the quantitative ultasound and bone density DEXA scan images presented obvious osteoporotic changes in bone density. There were 24% had 2.5 or less meant osteoporosis formation. Conclusion: Women often lead to calcium deficiency during gestation and lactation and thus chances of musculoskeletal disorders escalate manifolds. Radiological imaging can facilitate in detecting these calcium deficiencies. Keywords: Hemostasis, Regulation, Pregnancy, Mineral absorption

Identification and Incidence of Spina Bifida during Gestation and its Pregnancy Outcomes

Aim: To identify the incidence of spina bifida during gestation and its pregnancy outcomes. Study design: Cohort study Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30th September 2022 Methodology: One thousand pregnant women who were screened for the identification of spina bifida. Doppler based ultrasonography was performed in each patient. The fetus body was examined during sonography Doppler between 18-24 weeks. The body of the fetus was focused and visualized longitudinally in midsagittal section. Spinal cord was traced from neck to sacral, cervical vertebra and thorax. A tram track appearance was observed. Spinal nerve positioning was also observed. In spina bifida nerve tethering was seen. The primary outcomes in reference to baby weight and maturity were recorded while secondary outcomes of the fetuses in terms of any disability were followed up to 12 months of age. Results: The mean age of the women was 25.6±5.6 years. The incidence of spina bifida was 1.1%. Within the primary outcomes observed birth weight ranged within 3.1-3.5kg. Around 81.81% cases were born full term while 18.18 were premature. On 06 months’ follow-up of the spina bifida cases it was observed that 45.45% of new born suffered from skin problems as sores, calluses or and blisters while 36.36% had hydrocephalus with excessive CSF which needed monitoring. Mobility issue and disability was observed in 27.27% cases. Conclusion: Spina bifida cases are identified successfully within gestational period. Prematurity can be significantly noticed in spina bifida cases. The lumbosacral and lumbar lesions are most common as well as skin conditions and hydrocephalus. Key words: Incidence, Spina bifida, Gestation, Outcome

Risk of Congenital Anomalies in Pregnant Women with Type 2 Diabetes

Aim: To assess the risk of congenital anomalies in pregnant women with type II diabetes. Study design: Prospective study Place and duration of study: Department of Diabetes & Endocrinology, Chandka Medical College Hospital, Larkana from 1st October 2021 to 31st March 2022. Methodology: Two hundred pregnant women ≥20 weeks of gestation already suffering from type 2 diabetes were enrolled. Information in relation to their anomaly scan was gained through ultrasonography at the 20th to 21st week. The anomalies were identified as inconsequential (minor) and chief and correlated with the HbA1c percentage category. Results: There were 98 (49%) women who were nulliparous. The poor control as well as worst control HbA1C groups had highest value of body mass index. Within the congenital anomalies observed the overall rate of any anomaly was seen in patients with worst control while least number was observed in good control. Cardiovascular events followed by Genitourinary or renal issues were highest reported as congenital anomalies in fetus. Conclusion: There is a high risk of congenital anomalies in pregnant women with type 2 diabetes with cardiovascular anomalies to be the highest in category. HbA1C ≥11.5% and above is at highest risk of congenital anomalies. Keywords: Risk, Congenital anomalies, Pregnant woman, Type 2 diabetes

Neuropathophysiological Mechanisms and Treatment Strategies for Post-Traumatic Epilepsy

Aim: To understand and analyze neuropathophysiological mechanisms and treatment strategies for post traumatic epilepsy. Study design: Cohort clinical trial study Place and duration of study: Department of Neurosurgery, Chandka Medical College Hospital, Larkana 1st January 2021 to 31st March 2022. Methodology: One hundred and twenty cases of traumatic brain injury were enrolled. In 1st sub group there was 20 cases were given either Sodium valproate (SG1a) while 20 were given its placebo (SG1b). Similarly in subgroup 2nd and 3rd, each had 20 cases who were given Levetiracetam (SG2a) or Phenytoin (SG3a) respectively or other given its respective placebo (n=20/SG2b, SG3b). Primary and secondary outcomes were measured. Results: The mean age was 30.1±3.3 years. There was almost equal number of both genders with slightly higher number of males than females with no significant variance. Around 40.83% of the cases were suffering from traumatic brain injury as a result of fall from a higher/raised building or structure. Conclusion: The sodium valproate had a highest efficacy in controlling of the post-traumatic brain injury epileptic seizure not only for a short duration but for longer duration as well. Keywords: Treatment strategies, Post-traumatic epilepsy, Neuropathophysiological mechanisms

Critical Analysis of Etiopathology of Cervical Lymphadenopathy in patients reporting to the Department of Surgery Chandka Medical College Hospital Larkana

Introduction: Nodes that are aberrant in their size, consistency, or number are referred to as lymphadenopathy. Study Duration: Current research was carried out at Surgery Department of Chandka Medical College (CMC) & Teaching Hospital, Larkana starting from March 2019 to September 2020. Subjects & Methods: After taking written informed consent, 162 patients was included in the study after fulfilling of the inclusion criteria. Chi square test was applied and P-value <0.05 was considered significant Results: The results of reactive/benign in our study were as out of 162 patients 54(33.3%) belongs to positive group and 108(66.7%) belongs to negative group. In tuberculous the frequency distribution results showed that 57(35.2%) positive and 105(64.8%) were negative. In causing factors the results of malignant frequency distribution were as out of 162 patients 51(31.5%) were positive and 111(68.5%) were negative. Conclusion: In conclusion, our study reveals a lower prevalence of malignancy, reactivity, and benign causes of cervical lymphadenopathy, and an increased prevalence of Tuberculosis as a cause of cervical lymphadenopathy in patients presenting to the surgery department at CMC Hospital in Larkana. To avoid lengthy delays in identification and treatment of numerous medical diseases, including potentially curable malignancies, we advocate for conducting biopsy early in the workup of cervical lymphadenopathy. Keywords: Cervical lymphadenopathy, lymphoma, Tuberculous. Etiopathology, Chandka Medical College

Clinical Evaluation of Respiratory-triggered 3D Magnetic Resonance Cholangiopancreatography with Navigator Echoes Compared to Breath-hold Acquisition Using Compressed Sensing and/or Parallel Imaging

Aim: To investigate image quality of respiratory triggered 3D MRCP with compressed parallel and sensing imaging in clinical setting. Study design: Cross-sectional study Duration and place of study: Study was conducted in the duration of1st July 2021 to 31st December 2021 at Department of Radiology, Chandka Medical College Hospital, Larkana. Methodology: Ninety patients with age between 40-70 years were enrolled. The patients got three various kinds of MRCP 3 dimensional as a protocol of their diagnosis plan. Four point scoring system was adapted for quality assessment. Results: The mean age of the patients was 66.9±8.6 years. There were almost similar number of males and females. Minimally invasive-intraductal papillarymucinous carcinoma was presented only in 2.22%. Comparison of three magnetic resonance cholangiopancreatography techniques showed that signal quality, was better as longer time involved in 1st magnetic resonance cholangiopancreatography case while blurring was also seen in breath holding magnetic resonance cholangiopancreatography. Conclusion: Better imaging quality of ductal system is obtained through respiratory triggered 3D magnetic resonance cholangiopancreatography against breath hold. Keywords: Magnetic resonance cholangiopancreatography, 3D Imaging, Compressed Sensing, Parallel imaging

Comparison of Efficacy between Open and Close Reduction in Supracondylar Fracture of Humerus in Children Using Flynn’s Criteria

Objective: To compare the efficacy between open and close reduction in supracondylar fracture of humerus in children using Flynn’s criteria. Study Design: Randomized control trial. Place and Duration of Study: Department of Orthopaedic Surgery, Chandka Medical College Hospital, Larkana from 1st April 2019 to 31st March 2022. Methodology: One hundred patients were enrolled and divided into two groups (open reduction and closed reduction groups). Each group had 50 patients. Fracture-fragments which were reduced through open reduction protocol or closed reduction were operated under highly standardized care and fixation was performed through K wiring in cross wise pattern. Results: Most of the children were male in both groups with only 20 and 24% females in open and closed reduction groups respectively. The efficacy analysis presented that open reduction efficacy was only 8-10 percent respectively in 5-10 and 11-15 years children respectively. The Flynn criteria also presented that 31 cases of open reduction were having an excellent grade followed by 14 with good. Conclusion: Open reduction method to be superior over closed reduction with higher number of satisfactory scores and efficacy. Keywords: Efficacy, Supracondylar fracture, Flynn’s criteria, Open reduction, Close reduction

Role of Multislice CT Imaging in Predicting the Visibility of the Round Window during Cochlear Implantation

Aim: To envisage the visibility of round window nichein pediatric cochlear implantation by using computed tomography. Study design: Retrospective study Place and duration of study: Department of Radiology, Chandka Medical College Hospital, Larkana from 1st July 2021 to 31st March 2022. Methodology: Fifty five patients underwent the procedure of unilateral-cochlear implantation. Slices of round window niche and round window membrane were selected for visualization through HRCT imaging. The temporal bone imaging through high resolution computed tomography scans; before and after the operation were examined in detailed and scored. Each round window membrane and round window niche was then visualized for its visibility. The sensitivity as well as specificity of high resolution computed tomography imaging in prediction of round window membrane visuality were calculated. Results: The comparison of predictive values showed that the positive-predictive value of RWM was 73.1% and negative as 91.2%. The sensitivity as well as the specificity of HRCT identification in prediction difficulty in visualizing RWM was 79% and 87% respectively. Conclusion: Pre-operative high resolution computed tomography was proved helpful in visualization of detecting round window niche. Key words: CT scan; Cochlear implantation; Round window niche; Pediatrician

Neurological and Mental Health Responses to Pandemic Covid-19

Aim: To assess the neurological and mental health responses to pandemic Covid-19. Study design: Cohort study Place and duration of study: Department of Medicine, Chandka Medical College Hospital Larkana and Department of Medicine, Khairpur Medical College Hospital Khairpur Mir’s from 1st October 2021 to 31st March 2022. Methodology: Two hundred patients who suffered Covid-19 infection and 200 who had any other life event except Covid-19 were enrolled. All patients who were above 18 years of age and were positive for Covid-19 through reverse transcriptase PCR were included in the study.Global Psych trauma Screening was done by enlisting twenty-two items which assessed trauma related symptoms while five items only assessed the factors increasing risks. Results: There were 112 (56%) females and 88 (44%) males in Covid-19 patients and 150 (75%) females and 50 (25%) males in non-Covid patients. The mean age of the Covid-19 patients was 49.65±15.5 year while of non Covid patients was 39.02±12.01 years. A significant increase in post-traumatic stress disorder (PTSD) cases probability was noted in the Covid-19 cases than non Covid-19 related events. Neurological responses showed that patients who had suffered from Covid 19 infections had a generalized weakness with hyposmia formation. Conclusion: Covid-19 is related with high level of depression, anxiety, hyposmia and other mental and neurological responses. Keywords: Neurological health, Mental health, Response, Covid-19

Managemnet of Fournier’s Gangrene at Department of Urology Chandka Medical College Hospital

Aims and object: To assess the aetiology and management of Fournier’s gangrene. Methodology: We examined 30 paients retrospectivdely, during the period from 2015 to 2020, the patients from the Urology department of CMC Hospital at SMBB Medical University Larkana. All the related data were taken as well as demographic details, history and risk factor from the patients regarding illness. Routine investigation carried out including Blood CP ESR, Urine Dr, Blood sugar, Renal profile and pus culture sensitivity. 20 patients under gone for surgical debridement, 5 patients require skin grafting and 4 patients requires testes burrial after recovery under aseptic measures. Result: 30 male patients with mean age 20±10.5 year. Majority (80%) of patient presenting with necrotising infection on scrotum,perineum and hypogatric area. Basic laboratory investigations including Blood CBC showed mean WBC 15000/cmm3, mean Hb was 8.5 gms, Urine analysis showed pyuria and haematuria, pus culture and sensitivity positive in 90% cases and most prevalent organism was E.Coli, Mean Blood urea was 35mg and serum creatinine was 1.9mg. Commonest causes of fourneir gangreen was trauma, UTI, urethral stricture, indewelling catheter and perianal abcess and D.M was commonest comorbidity). All patients treated by surgical debridement while 5 patients requires skin grafting and 4 patients requires testes burrial after recovery under aseptic measures with with triple regimen antibiotics. Conclusion: Surgical debridment of necrotic tissues and triple regimen antibiotic are the main stay for primary management of Fournier’s gangrene (FG) to decrease the morbidity and mortality keywords: Fournier’s Gangrene, surgical debriment, and triple regimen antibiotics.

Frequency of Hyponatremia in Patients with Ischemic Stroke Presenting in Neurology Department Chandika Medical College Larkana

Introduction: The World Health Organization describes a stroke as having "rapidly emerging clinical symptoms of localized or generalized impairment of brain function without obvious non-vascular cause1. Hyponatremia is more likely to impede stroke survivors' ability to recover from the condition. Our research evaluated the incidence of hyponatremia in ischemic stroke. Therefore, the precise size of the issue would be evaluated. Objective: To determine the frequency of hyponatremia in patients with ischemic stroke. Material and Methods: The design of this study was a descriptive cross-sectional study. All in patients and out patients coming in Neurology department of Chandka Medical College Hospital Larkana, and the duration of this study was Six months, from 13 October 2020 to 12 April 2021. A total of 107 stroke patients were included in this study. The purpose, risk and benefits of the study were explained to the patient on a prescribed Proforma, Results: A total of 107 Ischemic stroke patients were included in this study. Most of the patients were above 40 years of age. The average age of the patients was 68 years. Out of 107 patients, 70(65%) were male and 37(35%) were female. Frequency of Hyponatremia in patients with ischemic stroke was observed in 24% cases. Rate of developing Hyponatremia was significantly high in age group of 60 to 80 years. Similarly Hyponatremia was significantly high in hypertensives as compared to non-hypertensive Patients (32% vs. 13% p=0.03) . There was no gender predilection seen, Diabetes increased the risk of developing hyponatremia about two folds. (38% versus 20%). Increased BMI, Obesity increased the risk of developing hyponatremia in the setting of ischemic stroke two folds. (36% vs 18%) Conclusion: The prevalence and frequency of post-stroke hyponatremia was found to be considerable. This is especially concerning because hyponatremia has a worse effect than stroke itself on prognosis and death. Keywords: Hyponatremia, Stroke, Ischemic, Hyponatremia, Cerebral Salt Wasting Syndrome, Syndrome of Inappropriate Antidiuretic Hormone Secretion.

Frequency of Seroma Formation after Modified Radical Mastectomy in Patients who receive Neo-adjuvant Chemotherapy

Background: Breast cancer is among the commonest of causes of the death caused due to cancer in the females throughout the world. Objective: To determine the frequency of Seroma formation in patients undergoing Modified Radical Mastectomy after neoadjuvant therapy. Methodology: Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Chandka Medical College Hospital, Larkana from November 2019 to January 2022. A total of 217 diagnosed cases of breast carcinoma patients who underwent a modified radical mastectomy after initially receiving neoadjuvant chemotherapy were selected for this study. Pre-designed proforma was used to collect information related to different variables. Results: The average age of the women was 47.29±8.38 years. The frequency of seroma formation in patients undergoing modified radical mastectomy with neo-adjuvant therapy was found in 41.94% (91/217). The average seroma Volume and number of resected lymph nodes were 56.64±5.64 ml and 7.59±1.08. Conclusion: Prediction of seroma formation following Modified Radical Mastectomy with neo-adjuvant therapy remains challenging. We identified no potential risk factors other than the pathological status of the tumor which was associated with an increased frequency of seroma formation.

Frequency of Vitamin D Deficiency in Patients of Epilepsy on Valproate Sodium

Aim: To determine the frequency of vitamin D deficiency in patients of epilepsy on valproate sodium. Study design: Case control study Place and duration of study: Department of Neurology, Chandka Medical College Hospital, Larkana and Khairpur Medical College, Khairpur Mir’s from 1st July 2021 to 31st December 2021. Methodology: One hundred adults were enrolled which were further divided into two groups. Those patients suffering from clinically determined epilepsy (n=50) and treated for epilepsy were placed in group A and were treated with sodium valproate while healthy adults within same age group were placed in group B (n=50). Clinical assessments were made through neurological assessment for epilepsy. A blood of 2cc was withdrawn from group A and B participants and tested for 25(OH) vitamin D levels by and serum sodium valproate (in only group A) using enzyme linked immunosorbent assay. Results: The mean of group A patients was 24.2±3.5 years while of group B was 28.3±1.5 years. The dosage of sodium valproate in mg/d was given as a mean value of 869± 350.9. The mean serum levels of sodium valproate as assessed was found as 79.8 mmol/L. Body Mass Index value showed that obesity was significantly highly common in group a than Group B.A comparison of vitamin D levels between group A and Group B showed that the severe deficiency as well as deficiency of vitamin D was significantly prevalent (56%) in epileptic group such as group A while insufficiency was also higher in the similar group A. Conclusion: There was a high frequency of vitamin D deficiency in patients with epileptic condition and getting treated with sodium valproate. Key words: Frequency, Vitamin d deficiency, epilepsy, Valproate sodium

Role of Triple D Score in Eswl: Our Experience at Urology Department Chandka Medical College Hospital Larkana Pakistan

Aim: To detect usefulness of triple D score in ESWL (extracorporeal shock wave lithotripsy) for management of renal stone. Methodology: Retrospective Study was conducted at Urology department, CMCTH) at SMBBMedical University Larkana. 50 patients underwent ESWL from 2018 to 2020. All the related data were taken as well as demographic details, history and risk factor from the patients. Routine investigation carried out including Blood CP ESR, Urine DR, Blood sugar, Renal profile, urine culture sensitivity and CT KUB. The stone density, skin-to-stone distance, and stone size were calculated by a radiologist. Results: ESWL was performed on 50 patients with average age of 30± 8 years and a sex ratio (male female) of 1:0.3. The stone-free percentage after the first treatment session was 40 percent and 90 percent on 2nd sitting, based on the triple D score, which included stone size, skin to stone distance, and stone density (HU). The mean stone size was 15.8 mm, the Skin to Stone Distance was 6.4 cm, and the stone density was 594 HU were established respectively. Conclusion: The Triple D Score is easy to compute and reported by radiologist. The use of the Triple D Score in ESWL patients has been shown to improve overall ESWL success rates. Keywords: Extracorporeal, Shock, Wave, Lithotripsy, Renal stone and Triple D score

Effectiveness of Vitamin C for Iron Supplementation in Patients with Iron Deficiency Anemia

Introduction: Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions, particularly iron deficiency. Objectives: The main objective of the study is to find the effectiveness of vitamin C for iron supplementation in patients with iron deficiency anemia. Material and methods: This cross sectional study was conducted in Chandka Medical College Hospital Larkana during February, 20220 to March 2021 with the permission of ethical committee of hospital. Data were collected from 100 patients suffering from iron deficiency anemia (IDA). Participants were selected through randomly sampling technique. Results: The data was collected from 100 patients and mean age was 45.67±5.81 years. The only factors which emerged as statistically significant from the adjusted logistic regression analysis model were insufficient intakes of iron (OR = 7.39; 95% CI: 1.45-37.57) and vitamin C (OR = 6.14; 95% CI: 1.34-28.27), frequent (≥2 times per week) tea consumption (OR = 0.01; 95% CI: 0.01-0.08), infrequent (≤2 times per week) red meat consumption (OR = 3.71; 95% CI: 1.01-13.61), and the possession of a personal history of IDA (OR = 6.00; 95% CI: 1.45-24.76). Conclusion: It is concluded that main risk factors in relation to contracting anemia were inadequate intakes of iron and vitamin C, frequent tea consumption, infrequent red meat consumption, and a past personal history of IDA. Keywords: Patients, Anemia, Hb, Iron