Ghurki Trust Research Articles

Efficacy of Platelet-Rich Plasma (PRP) in Treating Plantar Fasciitis.

Platelet-rich plasma (PRP) is an autologous blood derivative with an enhanced platelet concentrationand can enhance the tissue-healing process naturally. Plasma witha higher concentration of platelets on activation leads to the release of various growth factors that in turn augment tissue repair and jump-start the healing process.The aim of this study was to determine the efficacy of PRPin reducing pain and improving functional outcomes in patients with plantar fasciitis who had failed to respond to conservative treatment. A retrospective study was performed at the Orthopedics Department of the Ghurki Trust Teaching Hospital, Lahore, during March 2020 to January 2021. A total of 140 patients, 25 to 65 years of age, with plantar fasciitis were included. Patients who had undergone foot surgery in the past, those with a generalized inflammatory disorder, pregnant female patients, those taking anticoagulants and those with tumours of the lower extremity were excluded. Following aseptic measures, 2.5 ml of PRP containing 5.5% calcium chloridewas administered at the most tender point on the medial aspect of the heel. All injections were administered by the principalresearcher himself. All patients were followed at regular intervals post-therapy and efficacy was measured at the end of three months post-therapy. The average age of participants was 41.56 ± 10.37 years, with most patients (94 out of 140, 67.14%) falling in the 25-45 age range. The study population consisted of 89 male(63.57%) and 51 female(36.43%) patients, with a male-to-female ratio of 1.7:1. PRP therapy was effective in 131 patients (93.57%), and age was found to be a significant factor influencing treatment success (p < 0.05). PRP is a highly effective treatment option for plantar fasciitis, providing substantial symptomatic relief and improving patient outcomes, specially in patients unresponsive to conservative treatment. Further researchis necessary to confirm these results and establish standardized guidelines for its use.

Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow.

Background Local depot steroid injections can consistently and predictably relieve tennis elbow pain in the short term. Prolotherapy, extracorporeal shockwave therapy, autologous blood, and local injections of platelet-rich plasma (PRP) are examples of novel treatment approaches. Objective The objective of this study is to compare the effectiveness of autologous blood injection and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow)using the visual analog scale (VAS) over 12 weeks. Methods A descriptive case series was conducted from July 10, 2019, to July 9, 2021, at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital. A total of 396 patients with tennis elbow, aged 20 to 50 years, were included (198 in each group). Patients managed with non-operative methods and those with other associated injuries in the same elbow were excluded. Group I received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution. Group II received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks. Results In Group I, the average age of the patients was 36.04 ± 8.26 years, while in Group II, it was 37.23 ± 7.32 years. The male-to-female ratio was2.3:1; 276 (69.81%) of the 396 patients were male, while 120 (30.19%) were female. Group I's mean baseline VASscore was 6.99 ± 0.99, while Group II's mean baseline VAS score was 6.99 ± 1.06 (p = 1.000). Group I had a mean post-therapy VAS score of 3.11 ± 1.62, while Group II had a mean score of 2.48 ± 1.26 (p = 0.0001). About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis (p = 0.0001). Conclusion This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection, with a statistically significant p-value of 0.0001. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effectivetreatment, reducing the need for repeat procedures and improving patient outcomes.

COMPARING THE CLINICAL OUTCOMES OF LUMBAR TRANSFORAMINAL VS INTERLAMINAR EPIDURAL STEROID INJECTIONS IN A REGISTRY COHORT

Epidural steroid injections are a safe and effective treatment for acute low back pain associated with radicular pain. Objective: The main objective of the study is to find the clinical outcomes of lumbar transforaminal vs interlaminar epidural steroid injections in a registry cohort. Methods: This prospective cohort study was carried out at Ghurki Trust Teaching Hospital, Lahore, over one year, from June 2023 to June 2024. A total of 185 patients were included in the study. Patients aged &gt;18 years and presented with symptoms of lumbar radiculopathy due to lumbar disc herniation, spinal stenosis, or degenerative disc disease were included in the study. Results: The mean age of the TFESI group was 45.6 ± 10.3 years, while the ILESI group had a mean age of 46.2 ± 9.8 years (p = 0.67). The gender distribution was also comparable, with 55 males and 37 females in the TFESI group, and 58 males and 35 females in the ILESI group (p = 0.78). Baseline pain intensity (VAS score) and disability (ODI score) were similar between the two groups, with no significant differences in VAS (7.6 ± 1.1 vs. 7.5 ± 1.2, p = 0.58) or ODI (52.4 ± 10.2 vs. 51.9 ± 9.9, p = 0.71). In the TFESI group, 52.2% of patients had lumbar disc herniation, compared to 49.5% in the ILESI group (p = 0.69). Lumbar spinal stenosis was diagnosed in 32.6% of patients in the TFESI group and 34.4% in the ILESI group (p = 0.81). Conclusion: It is concluded that both lumbar transforaminal epidural steroid injections (TFESI) and interlaminar epidural steroid injections (ILESI) are effective in the management of lumbar radiculopathy, leading to significant reductions in pain and improvements in functional outcomes.

Association of Raised C-Reactive Proteins With Prolonged ICU Stay in Children with Bronchopneumonia: A Cross Sectional Study

Objective To study the association of raised CRP with prolonged ICU stay in children with bronchopneumonia at Ghurki Trust Teaching Hospital, Lahore, Pakistan. Methodology This cross-sectional study was conducted in Paediatric Intensive Care Unit of Ghurki Trust Teaching Hospital, Lahore, Pakistan, for a duration of six months (June 2023 to December 2023). Out of 127 children admitted into ICU, 82 met the inclusion criteria, aged 2-60 months, diagnosed with bronchopneumonia. Upon admission, blood sample was taken for CRP levels and these levels were correlated with ICU stay, TLC count, O2 dependency, and antibiotics duration of the patients. Patients were divided into five groups based on CRP counts. CRP counts less than 0.3 mg/dL were taken as normal. CRP counts from 0.4-0.9 mg/dL were taken as mild, 1-10 mg/dL were considered moderate, 11-49 mg/dL were considered marked, and ≥50 mg/dL were considered severe. Results Out of 82 patients, 45 (54.88%) were males and 37 (45.12%) were females. This study found that raised CRP was present in 73 (89.02%) out of 82 children (p&lt;0.04). Amongst 73 (89.02%), 08 (10.96%) patients had mild elevation of CRP, 36 (49.32%) had moderate elevation, 22 (30.14%) had marked, 07 (9.59%) had severe elevation. Moreover, a direct relation was observed among CRP and ICU stay (3.82±3.12), O2 requirements (3.72±3.07), TLC (13.36±5.18), antibiotic treatment duration (9.52±3.94) of broncho pneumonic patients. Conclusion Higher CRP levels significantly result in longer ICU stays and higher oxygen requirements in children with bronchopneumonia.

Comparison of the functional outcome of Philos Plate Vs. external fixator in the management of proximal humerus fracture

Background: Proximal humerus fractures, are a major medical issue that are relatively prevalent. 4-5% of all fractures are proximal humeral fractures, most of which involve older and osteoporotic individuals. Objectives: To compare the functional outcome of philos plate vs. external fixator in the management of proximal humerus fracture. Material and Methods: A retrospective comparative study was conducted at the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore. From November 23, 2022, to May 23, 2023. After approval from the hospital's ethical board, 112(56 per group) patients were included in the study through an emergency. Informed consent was taken from parents. We stratified patients into two groups. Group A received the treatment of Philos, while Group B received the external fixator treatment. Functional outcome was assessed at the end of 3 months postoperatively using constant shoulder score. The collected data were entered and analyzed accordingly using SPSS version 27. Results: In the current study, a total of 112 patients included underwent two surgical interventions, among these, 56 patients underwent Philos plating while an equal number of patients underwent external fixation. In Group A and B, the majority were males (37:47) out of 112. The mean age of patients was equal in both groups (Group A=44.36±11.71), and the mean age of patients was (Group A=44.88±10.05), ranging from 20 to 80 years. In Group A, the average BMI was less than 24.29±4.23, ranging from 18-35 kg/m2, compared to Group B, 28.89±3.77, ranging from 22-35 kg/m2. 38(67.9%) were effected from right side as in Group A while 41(73.2%) were effected from right side in Group B. Majoruty 28(50.0%) had history of RTA in Group A while patients 24(42.9%) were observed with history of RTA in Group B25(44.6%) cases reported excellent outcome, 6(10.7%) reported very good outcome, 16(21.4%) good, 7(12.5%) fair and 2(3.6%) poor outcome in Group A. In Group B, 36(64.3%) excellent, 7(12.5%) very good, 12(21.4%) cases reported Good and 1(1%) reported fair outcome. So it is concluded that 25(44.6%) cases reported excellent outcome in Group A, comparatively low as compared to Group B 36(64.3%). Only age was significantly associated with excellent outcomes as p&lt;.05. Conclusion: It is concluded that External fixation demonstrated a better outcome as compared to Philos Plating, so in Orthopaedic practice, External fixation should be preferred for patients diagnosed with proximal humerus fracture to get better results and reduce the complications.

Comparative Effectiveness and Complications of Surgical and Conservative Management in Breast Abscess Patients: A Prospective Analytical Study

Background: Mammary abscesses are infections that are enclosed without involving the surrounding tissues they are common with breast cancer patients through uncontrolled or poorly controlled mastitis. Hence, this work seeks to assess the management of surgical and conservative approaches for treating breast abscesses. Objective: The objective of the study was to ascertain the treatment methods used in management of breast abscesses and to determine the results and adverse outcomes of those that are applied. Methodology: A prospective analytical study was conducted in the Department of Surgery at Ghurki Trust &amp; Teaching Hospital, Lahore, Pakistan, from February 2023 to March 2024. A total of 270 patients were initially enrolled, with 200 completing the 3-month follow-up. Patients were divided into two groups based on the treatment modality. Group I (Surgical Treatment) and Group II (Conservative/Minimally Invasive Treatment). SPSS version-20 was used to analyse results Patient groups were compared using the chi-squared test for categorical variables, for continuous variables, such as age, an independent samples t-test was utilized to compare the means between the two groups (p≤0.05) was considered. Results: Surgical treatment (Group I) demonstrated a significant reduction in reoperations and respiration compared to conservative treatments (Group II), where a notable percentage of patients (41.7%) needed further intervention. Notably, the rate of deformity due to scarring and contracture was higher in the conservative/minimally invasive group, affecting 30% of these patients, compared to 14.3% in the surgical group. Moreover, there was no carcinoma reported in group II in contrast with group I of the surgically operated patients 5% of them were found to have carcinoma. Conclusion: Surgical treatment for breast abscesses, particularly larger ones, offers more definitive resolution with fewer long-term complications compared to conservative management. Personalized treatment planning is essential to optimize patient outcomes and reduce morbidity.

An Evaluation of Phantom Pain among Traumatic Lower Limb Amputees in Lahore

Background: Amputation is the surgical removal of all or part of an irreparably damaged limb due to injury or disease. Trauma is the leading cause of lower limb amputation in Pakistan. Phantom limb pain (PLP) is a common and distressing complication following amputation, affecting the quality of life and functional outcomes. Objective: The primary objective of this study was to assess the occurrence and intensity of phantom limb pain in patients who had undergone lower limb amputation due to traumatic causes in Pakistan. Methods: A descriptive cross-sectional study was conducted over six months, involving 73 patients who had undergone lower limb amputation due to trauma. The study was carried out in Ghurki Trust Teaching Hospital, Sheikh Zayed Hospital, and Mayo Hospital. Patients aged 20-45 years, with amputations performed within one year, were included. Exclusion criteria were non-traumatic amputations and amputations older than one year. Non-probability convenience sampling was used. Participants were divided into three groups based on the level of amputation: hip disarticulation (n=12), transfemoral (n=28), and transtibial (n=33). Phantom limb pain was assessed using the Numeric Pain Rating Scale (NRPS), an 11-item scale ranging from 0 (no pain) to 10 (severe pain). Data were analyzed using SPSS version 25, and descriptive statistics were presented in tables and graphs. Ethical approval was obtained from the Ethics Committee of Lahore College of Physical Therapy (ERC-LCPT/298/2019). Written informed consent was obtained from all participants. Results: The study found that 83.6% of the participants experienced phantom limb pain. Among the hip disarticulation group, 91.7% reported PLP, with a mean NRPS score of 7.3. In the transfemoral group, 89.3% experienced PLP, with a mean NRPS score of 6.8. In the transtibial group, 75.8% reported PLP, with a mean NRPS score of 5.4. The association between the level of amputation and the presence of PLP was significant, with p-values of 0.003 for hip disarticulation, 0.000 for transfemoral, and 0.001 for transtibial amputations. Conclusion: Phantom limb pain is a prevalent and significant issue among patients with traumatic lower limb amputations in Pakistan, with varying intensity across different levels of amputation. These findings underscore the need for targeted pain management strategies and comprehensive rehabilitation programs to address PLP and improve the quality of life for amputees.

Identification and Predictive Analysis of Colorectal Polyps Using Flexible Sigmoidoscopy: A Retrospective Cohort Study

Background: Colorectal polyps are mucosal growths in the colon and rectum that may progress to cancer if not removed early. Flexible sigmoidoscopy is a common diagnostic tool for detecting these polyps, particularly in symptomatic patients, though predictive factors in younger populations remain unclear. Objective: This study aims to analyze the characteristics of colorectal polyps diagnosed via flexible sigmoidoscopy and identify predictive factors for their presence. Materials and Methods: We conducted a retrospective study on 1004 patients who underwent sigmoidoscopy from August 2023 to February 2024 at Ghurki Trust &amp; Teaching Hospital, Lahore, Pakistan. The study included data from 84 patients diagnosed with colorectal polyps. Analyzed variables were age, gender, polyp count, type (pedunculated or sessile), distribution, and indications for sigmoidoscopy (bleeding vs. other). Statistical analysis using SPSS version 15 included chi-square tests and odds ratios to identify significant associations. Results: Colorectal polyps were detected in 8.4% of patients, with a gender distribution of 7.9% in males and 8.4% in females. Sessile polyps predominated at 64.3%, and the majority of polyps were solitary (75%). Polyps primarily affected the rectum (53.6%) and were less frequently found in the sigmoid colon (21.4%), rectosigmoid junction (17.9%), and descending colon (7.1%). Significant predictors of polyp detection included age (45% in children vs. 6.5% in adults, p &lt; 0.001) and indication for sigmoidoscopy (14% in cases of rectal bleeding vs. 3.3% for other reasons, p &lt; 0.001). Gender was not a significant factor (p=0.467). Conclusion: Sigmoidoscopy effectively detects colorectal polyps, particularly in symptomatic children and those with rectal bleeding. This highlights the need for targeted screening to improve early detection and management. Further research is required to validate these findings and refine screening guidelines.

Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study

Background: The complication intensity of short- and long-term anesthesia during different surgeries depends upon the age, medical history and general lifestyle of a patient. Aims and objectives: The aims and objectives of present study were to evaluate the risks associated with general anesthesia during various surgical procedures. Methodology: Current comparative cross-sectional study was conducted in ICU, general surgery and gynecology units of Ghurki Trust and Teaching Hospital from July 2023 to February 2024. Total 100 patients of appendectomy and hysterectomy were selected as study subjects and divided into two groups. In Group-A (short surgery group) 65patients with appendectomy and in Group-B (Long surgery group) 35 women patients with hysterectomy were included. All of the clinical and demographic data were recorded on MS Excel and SPSS version 2024 were used to process, analyze, and distribute the data as needed and graph pad prism was used to plot graphical data representation. Results: The study identified a significant association between anesthesia duration and increased postoperative complications, notably in patients aged 51-55 years. Enhanced risks included postoperative pain, nausea, and respiratory distress, emphasizing the need for tailored anesthesia strategies based on surgical length and patient demographics. Conclusion: General anesthesia is largely safe but linked to some complications, necessitating innovative improvements and further research with larger sample sizes for enhanced safety.

Post-traumatic Stress Disorder in Women in Post-Natal Period

Objective: To assess and evaluate the presence of post-traumatic stress disorder and its associated factors affecting the women in post-natal period. Material and Methods: Data was collected through a cross-sectional survey from February 2023-July, 2023 at the Department of obstetrics and gynaecology, Ghurki Trust Teaching Hospital Lahore and 101 women fulfilling various diagnostic criteria for post-traumatic stress disorder in post-natal period were included in the study. PTSD symptoms were assessed using the “City Birth Trauma Scale” (CBTS) questionnaire including various stratification of events. SPSS 27.0 software was used for data analysis. Results: The results showed the possible outcome of several factors such as mode of delivery, family system, support and terms with partner or any previous psychiatric illness/PTSD or PTSD following child birth. Women with partner support had a significantly lower incidence of distress &amp; impairment symptoms (33.3%) compared to those without support (81.8%) as p&lt;.05. Conclusion: Our study depicted statistically significant link between PTSD criteria for distress and impairment and partner support and good terms with partner. Given that, partner support ought to be more than what is provided to lower the incidence of PTSD in women following child birth.

Association of Hypomagnesemia With Diabetic Complications.

The study aimed to study the association of hypomagnesemia with diabetic complications in type 2 diabetics. This cross-sectional study, conducted at a Ghurki Trust Teaching Hospital, spanned from January to June 2023 and included 100 randomly selected diabetic patients aged 30-70. With institutional board approval and informed consent, the study focused on assessing hypomagnesemia, using a standard level of below 1.6 mg/dL, ensuring participant confidentiality and privacy. Data collected through physical assessments were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States), including descriptive statistics, analysis of variance (ANOVA), and paired t-test. A total of 100 diabetic admitted patients were randomly selected for the study ages from30 to 70 years irrespective of their gender. The mean age of the participants was 53.86±9.74 years. The mean HbA1c of the participants was 8.7±2.32. Forty-eight percent of them had HbA1c less than 8, while 52% had greater than 8 HbA1c. The mean HbA1c in the hypomagnesemia group was 10.8±1.98, while in the normomagnesemia group, it was 8.9±2.2. There were 58.97% of foot ulcers in Group 1, while in Group 2, there were 31.14%.Around 38.46% and 14.75% had neuropathy in Groups 1 and 2, respectively. Nephropathy in Group 1 was 28.20%, while in Group 2, it was 11.47%. Around 69.23% of Group 1 had retinopathy and 37.70% had retinopathy in Group 2. Hypertension was 23.07% in Group 1 and 37.70% in Group 2; moreover, 7.69% and 8.19% had coronary diseases in Groups 1 and 2 accordingly. The current study concluded that hypomagnesemia was found to have an association with diabetic complications like neuropathy, nephropathy, foot ulcers, and poor glycemic control as evidenced by HbA1c.

Translation and Validation of Edinburgh Handedness Inventory in Urdu Language for Cerebral Palsy

Aim: To translate and validate EHI in Urdu language. Methods: Non-probability convenient sampling approaches used in a descriptive cross-cultural validation research design. The study also included twenty parents of children with cerebral palsy and specialists in pediatric rehabilitation. An English professor or physician completed the back translation, while two separate multilingual translators translated EHI forward into Urdu. These translators were proficient in both Urdu and English. An expert panel committee created and approved the final version of EHI in Urdu. The consent of the guardian acquired beforehand, and confidentiality ensured. The SPSS version 21 used to input and analyzes the data, and a pretest sample of 150 people used1. Result: For reliability statistics, the mean age of participants was 40.4 with standard deviation of 15.994 and Cronbach alpha of EHI questionnaire after translation was 0.943 or after testing on parents of cerebral palsy patients was 0.964 andcontent validity also showed good content validity ratio which was 0.72. Pearson correlation showed an excellent test-retest reliability and internal consistency 0.946 and after testing intraclass correlation varied from 0.523 to 0.956-show high reliability respectively. Conclusion: The Urdu version of EHI is a valid and reliable tool for Urdu speaking population of Pakistan. Keywords: Cerebral palsy, Edinburgh handedness inventory, Ghurki trust teaching hospital, Lahore College of physical therapy

FUNCTIONAL OUTCOME AMONG PATIENTS WITH ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ENDO-BUTTON AT GHURKI TRUST TEACHING HOSPITAL POST 6 MONTHS-A SINGLE CENTERED SURVEY

Background of the Study: To assess the functional outcome among patients with arthroscopic ACL reconstruction with endo-button at Ghurki Trust Teaching Hospital post 6 months. Methodology: A single centered survey was conducted on 67 patients with arthroscopic AC Ligament reconstruction using Hamstring auto-graft (Semitendinosus-Gracilis tendons) after 6 months and evaluated for functional outcome. The data was collected from Ghurki Trust Teaching Hospital. The sampling procedure utilized was non-probability sampling. Functional outcome was assessed using subjective form of IKDC score. Data was analyzed using SPSS version 23. Results: Out of 67 patients, all were male. The pre-operative subjective IKDC scoring was less than 30 and post-operative mean IKDC scoring is 73.92. On the basis of findings of study, significant improvement was observed after ACL reconstruction post 6 months. Conclusion: ACL reconstruction shows significant improvement in knee function and significant recovery of preoperative functional status. Keywords: Anterior cruciate ligament reconstruction, international knee documentation score, functional outcome, arthroscopy, endobutton, hamstring tendon, ligament injury

Quality of life among first ray amputated diabetic foot ulcer patients

Background: The quality of life among first-ray amputations due to diabetic foot ulcers is of paramount importance in understanding the holistic impact of this surgical intervention. Objective: To explore the Quality of life among first-ray amputated diabetic foot ulcer patients. Methods: A descriptive cross-sectional study was done using non-probability convenient sampling. The data was collected from Ghurki Trust Teaching Hospital and Shalamar Hospital. A total of n=68 Patients with type II diabetes with first-ray amputation six months ago who aged between 40-65 years were included in this study. The quality of life was accessed through the SF-36 questionnaire. Data analysis was done by using SPSS version 23. Informed consent was taken from every participant and told all the risks and benefits of the study. Results: In this study of diabetic foot ulcer patients aged 45-64 with a mean age of 52±4.33 years, there were 30 females (44.12%) and 38 males (55.88%). Of the participants, 44 (64.7%) reported a good quality of life, while 24 (35.29%) reported a poor quality of life. The overall quality of life was poor, with a score of 39.92±12.89. Specifically, physical functioning (46.32±24.41), emotional well-being (44.71±16.61), social functioning (36.88±17.46), and general health (46.62±21.03) were poor, while physical (82.35±29.63), emotional (82.35±29.63), role limitations, and pain (62.17±17.77) were good. Conclusion: The current study concluded that the overall quality of life among first-ray amputated diabetic foot ulcer patients is low. Keywords: Amputation; diabetic foot ulcer; Diabetes mellitus, first ray; quality of life; SF-36 questionnaire.

ROLE OF DIACERIN IN DIFFERENT GRADES OF OSTEOARTHRITIS

Osteoarthritis (OA) is a joint disease that causes pain and degeneration in the affected area. There are no standard guidelines for agents that can slow down or modify the disease's progress. Diacerin is one such agent used to improve symptoms of OA. The objective was to analyze its efficacy in different grades of OA. A quasi-experimental study was conducted at Ghurki Trust Teaching Hospital in Lahore over six months from Jan 2023 to July 2023. After obtaining informed consent and meeting inclusion and exclusion criteria, we included 78 patients with grade II and III OA (39 each). All patients were given Diacerin (100mg twice daily). The baseline Western Ontario and McMaster Universities Arthritis Index (WOMAC) and pain on the Visual Analogue Scale (VAS) were used to measure the treatment's efficacy in improving symptoms after six months. The data was analyzed using SPSS 23.0. The mean age of the participants was 53.98+6.17 years. The mean WOMAC score was 49.62+7.81 before treatment, which decreased significantly to 38.34+8.79 after six months of treatment (p-value &lt;0.05). The mean VAS score before and after treatment was 7.41+0.98 and 4.82+1.07, respectively. These findings suggest that Diacerein significantly reduces pain and improves functional ability in patients with OA of the knee joint. This treatment was safe and well-tolerated. Its use is recommended in early grades of OA.

Oxidative Stress: Use of Alternative Therapeutic Agents

Kalonji seeds are a powerhouse of crude fibers, amino acids, iron, sodium, calcium, and potassium. Kalonji is also rich in vitamins that include – Vitamin A, Vitamin B, Vitamin B12, Niacin, and Vitamin C. Kalonji oil is much better than other oil as it contains essential fatty acids, vitamins, and minerals. It comprised approximately 17% protein, 26% carbohydrates, and 57% plant fats and oils. Apart from drugs various substances and life style changes are being advised to correct oxidative stress burden in human body. Analysis of the lipid content in the oxidatively modified LDL from hyper lipidemic patients revealed that the level of lysophosphatidylcholine was greatly elevated, and the high level of the lysolipid was shown to impair the endothelium-dependent relaxation of the blood vessels. In alllopathy blood lipid levels are normalized by statins, fibrates, niacin and bile acid binding resins (BABRs). All of these allopathy related drugs have low compliance ranges from mild compliance due to metalic taste of BABRs to severe side effects like rhabdomyolysis by fibrates and statins. Cardiovascular diseases are leading cause of death in western and eastern countries of the world. Hyperlipidemia is one of the strong risk fractions for heart diseases. To evaluate hypolipidemic drugs efficacy, the study was conducted at Ghurki trust teaching hospital, Lahore Pakistan from January 2020 to August 2020. Ninty hyperlipidemic patients were selected from cardiology and medical wards of the hospital. They were divided in three groups, one at placebo therapy, another on Kalonji and third one on Vitamin B3. After one and half month, significant changes (p value ranging from &lt;0.05 to &lt;0.001) were observed in their LDL and HDL-cholesterol. Conclusion of the study was to recommend use of herbal medicine and vitamin B3 for prevention of any heart diseases with good patient compliance. KEY WORDS: kalonji, LDL cholesterol, HDL cholesterol, blood vessels.

Onion Byproduct Contains Factors with the Ability to Modulate Plasma Lipids and Lipoprotein Levels

Heart diseases due to hyperlipidemia (primary or secondary) can lead to cause chest pain, heart attacks, strokes, cardiac arrhythmias, cardiac failure. Because of these risks, treatment is often recommended for people with hyperlipidemia, because it is well known factor to increase incidence of heart diseases. This may lead to development of atherosclerotic plaques which is major etiological factor for establishing coronary artery disease (CAD). Hypolipidemic drugs used in allopathy include Statins, Fibric acids, Niacin, and Resins but all have their low compliance due to frequent side effects. Medicinal herbs like Onion and Ginger are hypolipidemic agents commonly used as flavoring agents and making foods spicy and tasty. We have compared hypolipidemic potential between these two medicinal herbs. The study was conducted at Ghurki Trust teaching hospital, Lahore from January to June 2023. Eighty secondary hyperlipidemic patients were enrolled after getting written consent which was approved by Ethics committee of the hospital. They were divided in two equal groups comprising 40 patients in each group. Group-I was treated by Ginger 10 grams daily in three divided doses for 2 months. Group-II was advised to take Onion 200 grams daily in divided amount with each meal i.e.; breakfast, lunch, and dinner for two months. After two months therapy it was observed by statistical analysis that 10 grams ginger reduced TC (total cholesterol) of 38 hyperlipidemic patients 12.4 gm/dl and LDL-C (low density lipoprotein cholesterol) 27.3 mg/dl. In group-II, onion reduced TC in 35 patients 17.9 mg/dl and LDL-C 14.8 mg/dl. Changes in tested parameters are significant biostatistically with p-values &lt;0.01 to &lt;0.001. We concluded from this research work that Onion and Ginger reduces risk of CAD by decreasing plasma total

Metabolites of Rusuvastatin Inhibit Oxidation of both Low-Density Lipoproteins and Very Low-Density Lipoproteins

Coronary Artery Disease is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body. Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes the inside of the arteries to narrow over time, which could partially or totally block the blood flow. This process is called atherosclerosis. Coronary artery disease (CAD), when get worst, it is known as coronary artery syndrome (CAS). There are many allopathic medications which can stop, even at starting points of the disease (CAD). Hypolipidemic drugs like statins, fibrates, resins and niacin are well known agents used for prevention of CAD. There are ethnic-based medicinal herbs which can be used to treat or prevent CAD with narrow to moderate range of statistical significance. We compared Rosuvastatin 10 mg with Indian dates (Jujubes) as hypolipidemic agents. This research was conducted at Ghurki Trust Teaching Hospital, jalo park, Lahore, Pakistan. Duration of study was two months. Twenty to seventy years old 60 hyperlipidemic patients of both gender were included in research work with written consent. We divided these patients in two equal groups. Group-I was advised to take Tablet Rosuvastatin 10 mg, twice daily for two months. Group-II was advised to take 500 grams Indian dates for two months. Their baseline parameters like LDL-cholesterol, HDL-cholesterol, systolic/diastolic blood pressure was determined in the hospital laboratory. Separate file was maintained for their name, age, sex, occupation, and address. After two months therapy we compiled data related to tested parameters. Paired t-test was applied to compare changes in all parameters. Their mean values with ± SD before and after treatment were compared and analyzed statistically. It was observed that Rosuvastatin significantly decreased systolic/diastolic blood pressure, LDL-cholesterol, and increased HDL-cholesterol in 27 hyperlipidemic/hypertensive patients. Indian dates used in 30 hyperlipidemic patients significantly decreased systolic blood pressure, and LDL-cholesterol, but insignificant changes were seen in diastolic blood pressure, and HDL-cholesterol. We concluded from the research work that Rosuvastatin is potent hypolipidemic and hypotensive medicine as compared to indian dates.

Clinical findings of Tarlov cyst according to its location and level in lumbosacral spine on magnetic resonance imaging

Background: Tarlov cysts are fluid filled cysts that are most found in the lumbosacral spine. Patients often present with a series of distinguished neurological deficits that correlate with the mass effects of cyst provided on the level and location of the lumbosacral spine. Objective: To determine the clinical findings of Tarlov Cyst associated with its level and location magnetic resonance imaging Methods: A total of 60 patients with different sets of neurological deficits were included in this descriptive cross-sectional study conducted in Ghurki Trust and Teaching hospital. Data was collected by using Questionnaire/Performa. An MRI procedure was used to assess the Tarlov cysts. A Convenient sampling technique was used in this study. Data was evaluated and analysed with SPSS v-25 and Microsoft excel. Results: Out of 60 patients, there were 40 females (66.67 %) and around 20 males (33.3%). The most common neurological deficits that was found in patients were numbness seen in 50 patients, loss of reflexes seen in 40 patients, mass effects in the affected region were seen in 20 patients and changes in the bowel function was seen in 10 patients. The most common location of Tarlov cysts found in patients was sacral region 28(46.7%), lumbosacral region 24(40%) and lumbar region 8(13.3%). Conclusion: The study concluded that the frequency of female was more than male. And the most common site of Tarlov cyst was found to be at LV4-LV5 and LV5-level S1 exhibiting different clinical manifestation.

Outcome of split-thickness skin graft (STSG) in complex orthopaedic trauma.

Objective: Complex orthopedics wounds are challenges to surgeon and patient in operative management. Road traffic accidents, the major cause of open fracture, represent a massive global health problem with high mortality and morbidity rates. Study Design: Retrospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: January 2021 to January 2022. Material &amp; Methods: Thirty eight patients with open fractures with skin loss, treated with graft, and wound where a flap was not possible were included in the study. The outcome was assessed in terms of the outcome of STSG in complex orthopaedic trauma. Results: A total of 38 patients were included who underwent STSG graft. Among these, more than half of cases, 33(86.8%), were males, while 5(13.2%) were female cases with a mean age of 25.82±13.09 ranging from (6-63) years. Graft loss was found in 4 cases (10.5%), graft contracture in 7 cases, altered sensation in three cases, skin pigmentation in 4 cases, episode infection in 8 cases, and skin breakdown in only one case observed. Average hospital stay ranged from 2-3 weeks in all cases. Conclusion: It is concluded that Acute complex orthopedics wounds present a unique challenge for surgeons. Good surgical technique, early appropriate surgical intervention, source control, early use of broad-spectrum antibiotic therapy, VAC dressing, and early tissue coverage prevent wound infection and decrease the chances of limb amputation.