Combined Military Hospital Research Articles

Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

Objective: To compare the mean time for analgesic requirement of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Combined Military Hospital, Kharian. Period: 1st July 2022 to 1st January 2023. Methods: A total of 60 patients with 30 patients in each group undergoing elective c section were included in the study. Patients were counselled about VAS scoring system before procedure. Time (in minutes) for first rescue analgesia and requirement in 24 hours was noted. Results: Mean time required for first analgesia was 143.966±8.15 minutes in group A as compare to 86.400±7.08 minutes in group B (p=0.000). Conclusion: Our study has concluded that TAP block is a promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries.

Role of L5 Nerve Root Morphology in Identification of Lumbosacral Transitional Vertebra. Is it a Reliable Indicator?

Objective: To determine whether L5 nerve root morphology can assist in identification Lumbosacral Transitional vertebra. Study Design: Cross sectional study. Place and Duration of Study: Radiology Department, Combined Military Hospital, Multan Pakistan, Apr 2019 to Apr 2020. Methodology: Patients of both genders, 15 to 50 years age who underwent whole spine MRI were included in the study. Patients were referred from Combined Military Hospital Multan, from neighboring Combined Military Hospitals and Civil. Sagittal and axial T1WS and T2WS were performed along with coronal T2WS/FS sequences. Axial images were assessed for identification of L5 nerve root arising from LV5-SV1 level and hence vertebra was identified as LV5. Correlation was done with sagittal images for presence of Transitional vertebra, further confirmed by counting vertebral bodies from C2 vertebra upto sacrum using cross referencing tool. Results: A total of 135 patients were included in the study. Out of these, transitional vertebra was confidently labeled in 23 patients by nerve identification method which was confirmed on vertebral counting method. However, in four patients, L5 nerve root morphology was not clear and we had to rely on vertebral counting method for identification of transitional vertebra. Conclusion: Neuroanatomy and morphology of exiting L5 nerve roots can act as a reliable method for numbering of lumbosacral vertebra and identification of transitional vertebra.

T-Tube Drainage Versus Primary Duct Closure After Open Common Bile Duct Exploration In Management of Choledocholithiasis

Objective: To determine the outcomes of T-Tube drainage versus Primary Duct Closure after open common bile duct exploration in management of choledocholithiasis. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Kharian Pakistan, from Aug 2019 to Jul 2022. Methodology: All patients aged 26-64 years of either gender and undergoing open Common Bile Duct exploration for choledocholithiasis, were recruited in the study. Group-A consisted of 30 patients who underwent T-tube drainage, while Group-B consisted of 30 patients who underwent primary ductal closure. Results: Total 60 patients were included in the study ranging from 26–64 years. There were 49(81.6%) females and 11(18.3%) males. Operative time in Group-A was 118.2±5.06 minutes, whereas, in Group-B it was 100.37±2.93 minutes. The duration of sub hepatic drain in Group-A was 16.37±1.75 days, and in Group-B was 7.47±2.71 days. In Group-A, hospital stay was 17.07±1.92 days, and in Group-B, the average hospital stay was 9.61±2.63 days. The total number of complications in Group-A was 05(16.7%). Total complications in Group-B were 02(6.67 %). Conclusion: Primary closure of CBD is a safe and effective alternative to T-tube drainage in selective patients. Our study recommends the use of the primary closure technique strongly except for cases where the distal patency of CBD is doubtful.

Iron Deficiency Anemia Among Women in Skardu, Gilgit-Baltistan

ABSTRACT Objective: To determine the frequency of iron deficiency anemia among women in Skardu, Gligit-Baltistan. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Skardu, Pakistan, from Dec 2021 to May 2022. Methodology: A total of 202 women were selected through consecutive sampling from General Medical OPD of Combined Military Hospital, Skardu, Pakistan. Hemoglobin globin levels (Hb gram/deciliter), mean corpuscular volume (MCV fL) and red cell distribution width (RDW%) were determined for all enrolled patients. Results: Mean age of participants in this study was 34.46±10.93 years. Reduced Hb was observed in 62(30.69%) women with a mean hemoglobin level of 9.48±1.59 gl/deciliter and mean corpuscular volume of 79.97±10.7d fL. Among these women, 5(2.47%) were severely anemic (6.56±0.39 gl/deciliter), 28(13.86%) moderately anemic (8.51±0.83 gl/deciliter) while 29(14.35%) were mildly anemic (10.92±0.48 gl/deciliter). Women of younger age group, between18-35 years, were found to suffer more from iron deficiency anemia (39.14%) with mean hemoglobin levels of 11.31±1.80 and mean corpuscular volume of 79.34±10.86 fL. Conclusion: Iron Deficiency Anemia is present in female population of Gilgit-Baltistan in general and woman of childbearing age in particular. Emergency measures for awareness and fortification of basic food items with iron should be undertaken at large scale.

Influence of Age, Gender and BMI on Normal Abdominal Aorta Diameter taken on Abdominal Sonography in Healthy Asymptomatic Pakistani Population

Objective: To evaluate the abdominal aorta diameter in asymptomatic Pakistani population to determine the associations between age, gender and BMI and abdominal aortic diameter measured by ultrasonography. Study Design: Case series. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Lahore, Pakistan, from Jun to Dec 2021. Methodology: A total of ninety-four healthy asymptomatic subjects of both genders, between 18-80 years of age, were enrolled for the study. Aortic diameters were measured (inner to inner method) using electronic calipers on static images. The Anteroposterior and Transverse (TR) diameters were measured at three levels: the first at the aortic hiatus, which was directly below the abdominal aortic commencement, the second at the suprarenal (mid-point), and the third at the aortic bifurcation (lower level). Results: Males had significantly larger (p-value<0.001) anteroposterior and transverse abdominal aorta diameters than females, with abdominal aorta diameter values found to be significantly higher (p-value 0.001) in age group of greater than 40 years except anteroposterior distal abdominal aorta diameter. Similarly, a significant difference (p-value <0.001) was noted in abdominal aorta diameter among patients with different BMI groups other than distal abdominal aorta diameter. Conclusion: Abdominal aorta diameters vary greatly depending on age, gender and BMI. Clinicians must know the usual diameter of the abdominal aorta in order to recognize an aneurysm at an early stage.

Parents Perception on use of Antibiotics in Children

Objective: To determine parents’ perception on use of antibiotics in children. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Kharian Pakistan, from Jul 2022 to Mar 2023. Methodology: Fifty parents aged 18-50 years were included in the study. Their parity, education levels, knowledge and attitudes on antibiotic use, including basic concepts of antibiotics, indications of antibiotic, administration of antibiotics, Antimicrobial Resistance and other side effects; parental experiences and practices around buying antibiotics without a prescription and parental experiences regarding using antibiotics to treat their children themselves were noted. Result: Sixteen respondents (32%) were male and 34(68%) were female. It was found that most parents used Cefixime 28(56%), followed by Amoxicillin, and Azithromycin. Twenty-three (46%) participants stated that antibiotics could cure infections caused by viruses. Eighty-eight percent participants knew that antibiotics should only be taken according to doctor’s prescription. Almost half of parents believed that antibiotics should be withdrawn as soon as the symptoms disappear. About 26% of parents believed that antibiotics could prevent the common cold. Thirty-six (72%) parents agreed that overuse of antibiotics exists in Pakistan. Conclusion: Poor knowledge or understanding of antibiotic usage persists among parents in Pakistan. A doctor's prescription for antibiotics may have an impact on how parents use those medicines on their children.

10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score Calculation in Out-Patient Department

Objective: To calculate 10-year Atherosclerotic Cardiovascular Disease risk score in outdoor department of a tertiary care hospital and identify individuals at high risk of cardiovascular disease. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Malir, Pakistan, from Oct 2020 to Mar 2021. Methodology: 116 patients presenting to Out-Patient Department of General Medicine of CMH, Malir, Pakistan, without previous evidence of cardiovascular disease were included. Previous history of diabetes, smoking, use of anti-hypertensives, Aspirin and statins was recorded. Systolic and diastolic blood pressures, waist circumference, HbA1c, fasting blood sugar, fasting LDL, HDL and total cholesterol were tested for each patient. 10-year ASCVD risk score was calculated using online ASCVD Risk Estimator calculator. Results: Mean age of the patients was 58.6±9.92 years with 62.1% being males and 37.9% being females. Mean 10-year ASCVD risk score was 13.37±7.1, of which 21 patients (18.1%) had Very High, 66(56.9%) had Intermediate and 29(25%) had Low 10-year ASCVD risk score. Among Very High cases, 80.9% were males, all were in age group 50-79 years, 61.9% were diabetic, 33.3% were smokers and 66.7% were obese. Conclusion: A very high percentage of study group had Intermediate or Very High 10-year ASCVD risk score. Identifying those individuals at high risk early and controlling the modifiable risk factors can help lessen the morbidity and mortality associated with cardiovascular diseases.

Comparison of Intraocular Pressure Measurement by iCare Tonometer and Goldman Applanation Tonometer

Objective: To compare the Intraocular Pressure measured by the Goldmann Applanation tonometer with by iCare ic100 tonometer in normal human eye to determine the accuracy and reliability of both methods. Study Design: Comparative cross-sectional study. Place and Duration of Study: Ophthalmology Department, Combined Military Hospital, Quetta Pakistan, from Oct 2022 to Apr 2023. Methodology: Approval was secured prior to enrolling every individual, protecting their privacy throughout the process. All instruments adhered to the manufacturer's guidelines for calibration. A single ophthalmologist assessed the intraocular pressure of all participants. In our study we included 400 eyes (200 right and 200 left) among 200 patients. Initially, study eyes were inspected using a slit lamp. Subsequently, iCare tonometer and Goldman applanation tonometer were employed to gauge the intraocular pressure. Results: Out of 200, 87 patients (43.5%) were male and 113(56.5%) were females. Median age of the patients was 51.00(45-58) years range from 22-77 years. Mean IOP measured by iCare was 19.01±7.86 mmHg and by Goldman applanation tonomter was 20.14±8.15 mmHg. The correlation coefficient value between the readings of two instruments was r=0.866 with significant p value (p< 0.001). Conclusion: The iCare ic100 consistently provides high intraocular pressure measurements (2-3mmHg) compared to the Goldmann Applanation tonometer across various sub Groups.

Comparison of Awake Craniotomy with Craniotomy Under General Anesthesia for Resection of Tumors in Eloquent Areas of Brain

Objective: To compare awake craniotomy with craniotomy under general anesthesia for early post-operative parameters in patients undergoing resection of tumors in eloquent areas of brain. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan Apr 2021 to May 2022. Methodology: All the patients who underwent resection surgeries for brain tumors in eloquent areas of brain were included in the study. They were divided into two Groups via lottery method. Group A underwent awake craniotomy while Group B underwent craniotomy under general anesthesia. Relevant intraoperative and early post-operative parameters were compared in both the Groups. Results: A total of 60 patients who underwent resection of eloquent area brain tumors in our hospital during the study period were included in the final analysis. Out of these 40(66.7%) underwent craniotomy under general anesthesia while 20(33.3%) underwent awake craniotomies. Mean age of the study participants was 45.61±7.889 years. Frontal lobe tumors were the most encountered brain tumors in our study participants. Patients who underwent awake craniotomy had statistically significantly lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits (p-value <0.005) as compared to those who underwent craniotomy under general anesthesia. Conclusion: Awake craniotomy emerged as superior option as compared to craniotomy under general anesthesia in terms of early post-operative parameters. Lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits were seen in patients undergoing awake craniotomy.

Comparison of The Postoperative Outcomes of Surgical Lateral Internal Sphincterotomy and Botulinum Toxin Injection in Patients Presenting With Chronic Anal Fissure At CMH, Rawalpindi

Objective: To compare the postoperative outcomes in Lateral Internal Sphincterotomy Group and in Botulinum toxin injection Group in patients managed for chronic anal fissure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2021 to Feb 2022. Methodology: All patients of either gender, aged 30 to 70 years, who had presented to CMH, were included in this study. Block randomization was done to allocate half of them to Lateral Internal Sphincterotomy and half to Botulinum toxin injection. Patients in both Groups were followed for four weeks to assess and compare various short and long term post-surgical outcomes. Results: There were 82 patients in total with 41 in each treatment arm. In the Lateral Internal Sphincterotomy Group, 35 85(37%) of the patients reported postoperative pain relief at 24 hours, 39(95.12%) patients healed, only 2(4.88%) patients had a recurrence. In the Botulinum toxin Group, 29(70.73%) reported postoperative pain relief at 24 hours, 35(85.37%) patients healed, whereas 6(4.63%) had a recurrence. There was no statistical difference in any parameter between either Group. Conclusion: Both methods did not show any statistically significant difference in post-operative outcomes thus other parameters like patient’s choice, cost and expertise may be considered in treatment of chronic anal fissure.

Outcomes of Type-1 Tympanoplasty with and without use of Topical Nasal Steroids; a Comparative Study

Objective: To compare the outcome of Type-1 tympanoplasty procedure in patients given intranasal steroids post-operatively versus those not given intranasal steroids after procedure. Study Design: Quasi-Experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi. Pakistan from May 2021 to May 2023. Methodology: A total of 464 patients, 232 of which were given intranasal steroids (Group-A), and 232 who were not given intranasal steroids (Group-B) were made part of this research. Upon inclusion, all pre-operative demographics were documented. Patients in post-operative follow up period were assessed for condition of tympanic membrane and improvement of hearing ability. Results: In current study, post-operatively, in patients who were given intranasal steroids, graft take-up frequency was 227(97.84%) and residual perforation was 5(2.16%) was better than in patients who were not given intranasal steroids, which came to 224(96.55%) and 8(3.45%), respectively (p=0.399). In terms of post-operative WHO grade of hearing impairment distribution (p<0.001) and post-op hearing status (p=0.005) difference between patients who were given intranasal steroids and those not given intranasal steroids was statistically significant. Conclusion: Addition of intranasal steroid spray to the treatment regimen following tympanoplasty is provides better outcomes in terms of higher graft take-up frequency and an improvement in hearing from preoperative levels.

Omparative Study Between Pulsed and Continuous Itraconazole for the Treatment of Onychomycosis

Objective: To compare efficacy of pulsed versus continuous daily oral Itraconazole in the treatment of onychomycosis. Study Design: Randomized Control Trial (ClinicalTrials.gov: NCT05567484). Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Abbottabad, Pakistan, from May to Dec 2021. Methodology: We enrolled 60 patients whose toenails showed signs of onychomycosis (crumbling nail plates, thicker nail beds, and yellowing). They were randomly divided into Group-A and Group-B, with 30 patients each. Group -A (Pulse Therapy) took two capsules of oral Itraconazole 100 mg twice weekly for one week every month for three months while Group-B (Continuous Therapy) received continuous oral 100 mg of Itraconazole once daily for 12 weeks continuously. Patients were subjected to an Onychomycosis Severity Index-based clinical evaluation. Results: In Group-A (Pulse Therapy), 25(83.3%) patients showed mycological cure whereas in Group-B (Continuous Therapy), 23(76.7%) patients showed mycological cure but difference in the efficacy of both drugs was not statistically significant (p-value=0.519). Conclusion: Pulsed therapy with Itraconazole and continuous Itraconazole therapy have comparable efficacies in treating dermatophyte toenail onychomycosis.

Comparison of Peripheral Neurotoxicity of Weekly Paclitaxel Versus Thrice Weekly Paclitaxel Chemotherapy Among Cancer Patients

Objective: To compare peripheral neurotoxicity of weekly Paclitaxel vs thrice weekly Paclitaxel chemotherapy among cancer patients. Study Design: Quasi-experimental study. Place and Duration of study: Oncology Department, Combined Military Hospital, Rawalpindi, Pakistan from Feb to Nov 2021. Methodology: We enrolled 200 patients with diagnosed malignancies taking Paclitaxel chemotherapy for more than three months and less than one year. They were divided into two groups: Group-A received Paclitaxel weekly while Group-B received this medication thrice weekly. Peripheral neurotoxicity was assessed by consultant oncologist on the basis of Eastern Cooperative Oncology Group score and patients in both groups were categorised into four grades from 0 to 3, on the basis of clinical symptoms described in ECOG score. Results: Out of 200 cancer patients prescribed Paclitaxel, 67(33.5%) were male while 133(66.5%) were female, 107(53.5%) received Paclitaxel weekly while 93(46.5%) received thrice weekly, 65(32.5%) had Grade 0 neuropathy, 90(45%) had Grade-I, 42(21%) had Grade-II while 03(1.5%) had Grade-III neuropathy. Dosage schedule was not associated with presence and severity of neurotoxicity. Conclusion: A significant number of cancer patients using Paclitaxel had presence of neuropathy in our study, regardless of weekly or thrice weekly dosing of Paclitaxel.

Carotid Atherosclerosis in Diabetic Patients and Associated Risk Factors

Objective: To determine the frequency of carotid atherosclerosis in diabetic patients and find out its association with various risk factors. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Nowshera Pakistan, from May to Jul 2022. Methodology: Patients, from both genders, were included in this study. Demographic information was obtained from all patients. Patients fulfilling the inclusion and exclusion criteria underwent carotid Doppler ultrasound after giving informed consent. High-resolution 7.5 MHz probe B mode ultrasonography and atherosclerosis was classified on the basis of grey-scale imaging. Results: A total of 100 patients were included in the study, out of which 74 were males and 26 were females. Among diabetics, 54% occurrence of atherosclerosis was seen, with a major share of 24% involvement of the left carotid artery, followed by 18% bilaterally, and 12% right carotid artery involvement. Carotid intimal media thickness increased with advancing age, with variable severity of mild in 32%, moderate in 14%, and severe stenosis in 3% of positive cases. Conclusion: There was a high association of carotid atherosclerosis with diabetes mellitus, having significant association with older age, hypertension, hyperlipidemia, and smoking.

Comparison of Urine Specimen with Recto-Vaginal Swab to establish carriage of Group B Streptococcus Colonization in Pregnant Females

Objective: To determine maternal vaginal colonization with Group B Streptococcus using both recto-vaginal swab and mid-stream urine in order to determine which specimen type can give better results. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, Department of Gynecology and Obstetrics, Combined Military Hospital and Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2022. Methodology: Recto-vaginal swabs and mid-stream urine were taken from 194 pregnant women between 36th and 37th weeks of pregnancy. Swabs were inoculated on blood and MacConkey agar while urine specimen was inoculated on blood and CLED agar. All plates were incubated at 37°C in either ambient air or CO₂ incubator. Identification of Group B Streptococcus was made on the basis of colony morphology (β-haemolytic colonies on blood agar), Gram stain, catalase test and confirmation were done by means of latex agglutination tests. Results: In comparison to urine, a Group B Streptococcus carriage rate of 8.2% was detected in recto-vaginal swab. Urine specimen of only 3 patients yielded growth of Group B Streptococcus giving a urine carriage rate of 1.5%. Conclusion: Recto-vaginal swab gives a better insight to the presence of Group B Streptococcus as compared to mid-stream urine.

Association Between Helicobacter Pylori Infection and Vitiligo

Objective: To determine the association between Helicobacter pylori infection and vitiligo in patients visiting a tertiary care hospital of Punjab, Pakistan. Study Design: Case control study. Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Lahore Pakistan, from Oct 2021 to Mar 2022. Methodology: A total of 60 adult vitiligo patients and 60 healthy controls, of both genders, were included in the study. Their ages ranged from 18-70 years. All study participants underwent stool antigen test to detect the presence of Helicobacter pylori antigen. Results: The mean age of the cases was 43.47±8.16 years whereas it was 40.08±7.42 years in the controls. The mean duration of disease was 4.133±1.21 months. H. pylori Infection was detected in 36(60%) cases as compared to 11(18.3%) controls (p<0.001, OR=6.68); which was found to be statistically significant. Conclusion: Significant association between H. pylori infection and vitiligo was demonstrated in the current study.

Comparison of Efficacy of Intralesional Triamcinolone and Combination of Triamcinolone With 5-Fluorouracil in The Treatment of Keloid

Objectives: To study the efficacy of intralesional Triamcinolone and combination of Triamcinolone with 5-Fluorouracil in the treatment of keloid in terms or reduction in height of lesion. Study Design: Cross-sectional analytical study. Place and Duration Of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, Jul 2020 to Mar 2021. Methodology: A total of 56 patients suffering from keloid formation were included in our study. Patients who had received previous treatment for keloids were excluded. All patients were assessed for volume of keloid before and after 8 weeks of intervention. Group A patients received therapy with intralesional Triamcinolone 4 mg with 5-Fluorouracil 45 mg once weekly while Group B patients received intralesional Triamcinolone 10 mg alone once weekly. Patients were followed up after 8 weeks to ascertain mean reduction in volume of keloid post-intervention. Data was analyzed by SPSS 26.0. Results: The difference in total volume post-treatment between the two groups was significant, (p=0.001), however the difference in total volume reduction across both groups with treatment was not significant, (p=0.382). Treatment was effective in 23(82.1%) of with the combination of Triamcinolone and 5-Fluorouracil, while this figure was only 16(57.1%) with Triamcinolone alone, (p=0.042). Conclusion: The combination of intralesional Triamcinolone and 5-Fluorouracil is superior to intralesional Triamcinolone alone in the treatment of keloids, and may be considered for therapy in patients who do not respond to treatment with single agents.

Effect of Long-term Azithromycin in Reducing Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective: To determine the effect of long-term Azithromycin administration in reducing acute exacerbation of Chronic Obstructive Pulmonary Diseases. Study Design: Quasi-experimental study. Place and Duration of Study: Medicine and Pulmonology Departments of Combined Military Hospital, Peshawar Pakistan, from Jun 2019 to May 2020. Methodology: Patients of Chronic Obstructive Pulmonary Diseases who had more than three hospital admissions in the last one year or required parenteral steroids for management were included in the study. They were randomly divided into two groups where Group-I was administered Azithromycin 500mg, thrice weekly, in addition to routine Chronic Obstructive Pulmonary Diseases medications, and Group-2 received only routine Chronic Obstructive Pulmonary Diseases medications. Both groups were compared for hospital admission due to Chronic Obstructive Pulmonary Diseases, hospital admission due to other causes, parenteral steroid use and Emergency Department visits after six months. Results: Out of 150 patients of Chronic Obstructive Pulmonary Diseases, 78(52%) received Azithromycin for six months while 72(48%) received only usual treatment of Chronic Obstructive Pulmonary Diseases, while 13(16.6%) patients from Azithromycin-Group had more than three Chronic Obstructive Pulmonary Disease related hospital admissions in six months. However, 34(47.2%) patients in non-Azithromycin-Group had more than three such admissions. More than three Chronic Obstructive Pulmonary Disease related hospital admissions and use of parenteral steroids were found significantly more in non-Azithromycin-Group (p-value <0.001). Conclusion: Long-term Azithromycin use was found beneficial for patients suffering from Chronic Obstructive Pulmonary Diseases. Use of parenteral steroids and Chronic Obstructive Pulmonary.....

Comparison of Self-Esteem in Patients Before and after Chemical Skin Peeling: An Interventional Study

Objective: To evaluate the self-esteem of patients undergoing chemical peeling for therapeutic reasons. Study Design: Pre-post Observational study. Place and Duration of Study: Department of Dermatology Combined Military Hospital, Multan Pakistan, from Mar to Aug 2021. Methodology: Forty-four patients were included in the study. After detailed history and clinical examination, self-esteem of all selected patients meeting the inclusion criteria was determined using RSES (Rosenberg Self-Esteem Score) score. Four sessions of chemical peeling were done using 30% salicylic acid with interval of 2 weeks between each session. (At week 0, 2, 4 and 6) All patients were advised the use of similar sun blocks during the treatment period. Post-peel RSES was re-assessed at 6 weeks. Results: The pre-peel RSES score (17.95±2.29) improved significantly after the sessions of chemical peeling. The post-peel RSES score was (19.47±1.95). p-value<0.001 Conclusion: Our study showed chemical peeling with 30% salicylic acid caused a significant enhancement of patients’ self- esteem, as significant difference in Rosenberg Self-Esteem Scores was seen before and after chemoexfoliation.

Comparison of Port-Site Hernia Development With And Without Use of Dilator For Gall Bladder Extraction Site in Elective Laparoscopic Cholecystectomy

ABSTRACT Objective: To compare the incidence of port-site hernia with and without use of dilator for extraction of gall bladder in elective laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Oct 2019 to Oct 2021. Methodology: Sixty patients scheduled to undergo laparoscopic cholecystectomy were included in the study based on the inclusion and exclusion criteria. Patients were divided into two equal groups (n=30). Group-A included patients in whom dilator was used and Group-B had those patients in whom dilator was not used. All patients were followed up by clinical examination for development of hernia at the port-site for extraction of gall bladder for 18-24 months postoperatively. Frequency of clinical development of gall bladder extraction port-site hernia was noted for every group. Result: Mean age of the patients was 42.90±14.12 years with an age range of 22 to 85 years. Of all the patients 9(18%) were male and 51(82%) patients were females. In Group-A, one patient developed port-site hernia clinically whereas in Group-B no patients developed this condition. The p-value was found to be 0.31. These results are statistically insignificant showing that use of dilator in elective laparoscopic cholecystectomy does not increase the incidence of port-site hernia significantly. Conclusion: Use of dilator does not significantly affect the incidence of development of port-site hernia from where gall bladder is extracted.