Group Mean Age Research Articles

Hearing Loss in Diabetic Patients Linked with Glycolyzed Hemoglobin A1C

Objective: Glycolyzed haemoglobin A1c (HbA1c) and hearing loss in diabetic individuals are the primary goals of the present research. Study Design: Randomized Case Control Place and Duration: THQ Hospital Kamalia. Aug 2021 to Feb 2022. Methods: There were 80 patients of both genders with ages 16-75 years were presented. Detailed demographics of enrolled cases included age, sex, body mass index and comorbidities were recorded after taking informed written consent. Patients were divided in two groups. Group I had 40 diabetic patients and group II had 40 non-diabetic patients. Hearing loss among both groups was compared by different glycolized hemoglobin levels. SPSS 25.0 was used to analyze complete data. Results: There were 32 (80%) males and 8 (20%) female in group I and in group II 24 (60%) males and 16 (40%) females. Mean age in group I was 41.31±5.81 years and had men BMI 24.13±7.15 kg/m2 while in group II mean age was 39.11±4.28 years with mean BMI 22.17±11.32 kg/m2. In group I 18 (45%) patients were smokers and in group II 15 (27.5%) were smokers. Frequency of hearing loss in group I was higher found in 23 (57.5%) patients as compared to non-diabetic patients in only 2 (5%). Frequency of tinnitus, vertigo and dizziness were also significantly higher in diabetic patients with p value <0.05. Conclusion: Patients with diabetes mellitus may suffer from impaired hearing and balance even if they do not show any symptoms. As a result, early rehabilitative care should be established to prevent future difficulties. Keywords: Diabetes Mellitus, Hearing Loss, Hemoglobin A1c

The Relationship Between Rheumatoid Arthritis and Serum Vitamin D Concentrations

Objective: The aim of this study is to determine the association between rheumatoid arthritis and serum vitamin D levels. Study Design: Case-control study Place and Duration: THQ Hospital Kamalia. Aug 2021-Jan 2022 Methods: There were one hundred and sixty patients were presented in this study. After obtaining informed written permission, we took detailed demographic information on all patients who had signed up for treatment. Clinical signs and symptoms, X-ray findings, and anti-citrullinated protein levels more than 20 u/mL were all used to diagnose RA in this patient's instance. They all pointed to the disease. Group I featured 80 people with verified rheumatoid arthritis, whereas group II had 80 individuals who did not have rheumatoid arthritis. The levels of vitamin D in both groups' blood were compared. Data was analysed using SPSS 2.0. Results: There were 45 (56.3%) males and 35 (43.7%) females in group I and in group II 42 (52.5%) males and 38 (47.5%) females. Mean age in group I was 44.7±8.35 years and had mean BMI 27.8±9.45 kg/m2 while in group II mean age was 46.5±6.51 years with mean BMI 28.6±6.51 kg/m2. Hypertension and diabetes were the most common comorbidities. Vitamin D level in group I was significantly lower 29.41±5.59 as compared to group II 40.41±8.81(ng/mL). Among 80 cases of rheumatoid arhthritis, positive patients for rheumatoid factor were 72 (90%) in which frequency of hypovitaminos was found among 65 (90.3%) cases. Conclusion: People with RA are far more likely to be vitamin D deficient, and the severity of the disease is directly correlated with this insufficiency. Since vitamin D deficiency affects women more than males, they should be tested with a high degree of suspicion. Taking vitamin D supplements may be necessary to prevent or reverse the progression of the disease. Keywords: Vitamin D Deficiency, Rheumatoid Arthritis, Rheumatoid Factor, Hypovitaminosis

Fetal out comes in Pre-Eclampsia with raised Maternal Serum Uric Acid

Aim: To compare adverse fetal outcome of hyperuricemic pre-eclamptic pregnancy with normouricemic pre-eclamptic pregnancy. Study design: A Cohort Study Methodology: In this study patients with serum uric acid level(SUA) >5.5mg/dl were included in group A and patients with SUA level <5.5mg/dl were included in group B. Patients with medical disorders like renal disease, hypertension, diabetes and currently using drugs affecting uric acid levels like thiazide diuretics were excluded. Both groups were followed until delivery. Intrauterine growth restriction, low birth weight was recorded. Results: A total of sixty patients were studied with age range from 18 to less than 40 years. The mean age in group A was 33.566± 4.19 years while 34.100± 3.46 years in group B. Mean Gestational age was 33.500±4.22 weeks in group A and 34.200±4.71 weeks in group B, while mean serum uric acid level was 7.416±1.04 in group A and 4.202±0.61 in group B. Intrauterine growth restriction was seen 93.3% in group A as compare to 60% in group B (P=0.002)(RRR=55.5%) while Low birth weight was 70% in group A and 10% in group B (P=0.000). Conclusion: The pregnancies with pre-eclampsia and raised serum uric acid levels result in adverse fetal outcome. Significant increased number of IUGR and LBW fetuses were observed in babies born to pre-eclamptic mothers with raised serum uric acid levels in comparison with babies born to normo-uricemic pre eclamptic mothers. Keywords: Pre-eclampsia, serum uric acid, fetal outcome

Dental Anomalies in Children with Cleft Lip and Palate at a Tertiary Care Hospital

Objective: To determine the dental anomalies in children with cleft lip and palate at a tertiary care hospital. Design of the Study: descriptive cross-sectional. Study Settings: Study was conducted at conducted in the OPD of Dentistry at Abbottabad International Medical Institute between the months of January 2021to June 2021. Material and Methods: The convenience sampling strategy was used to obtain the 208 radiographs of patients with cleft lip and/or palate for Data A. In order to conduct the study, the Institutional Review Board granted its approval. Radiographs were examined for suspected dental defects and demographic information was gathered. Results of the Study: A total of 76 (38 in group A and B) patients were included. Mean age in groups A and B was 39.25±3.91 and 38.71±4.01. Out of 38 patients in group A and B, effectiveness of large antecubital vein versus small vein on dorsum of hand in prevention of propofol injection was 81.6% vs. 36.87%. Conclusion: A high rate of dental abnormalities has been found in patients who have had a cleft lip or palate. The most common aberration in the study was tooth agenesis, with the lateral incisor having the highest rate of agenesis. Keywords: Dental Anomalies, Panoramic Radiograph, Cleft Lip and Palate

Efficacy and Safety of Low Dose, Short Course Eltrombopag in Management of DF and DHF

Background: Dengue is the most widespread aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life-threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production.Material & Methods:This study was a cross-sectional observational study which was conducted at Tairunnesa Memorial Medical College and Hospital (TMMCH), Gazipur and Shin Shin Japan Hospital, Uttara, Dhaka. The study was conducted in between July 2021- December 2021. The sample size for this study was 100.Results:The mean age in group 1 was 25±7, in group 2 29±8 and in control group 29±7. The mean Baseline PLT * 109 /L for group 1 was 57±23, for group 2, 51±28 and for control group 54±29. Mean of systolic baseline BP (mmHg) for group 1 was 103.55± 5.04 for group 2 was 105.38±18.34 and for control group was 101.97±8.28 and followed by the mean of diastolic baseline BP (mmHg) was 72.83±6.56, 72.84±12.93 and 71.97±4.75. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%) and in control group was 3(9.1%). In day 7, the recovery rate of group 1 was 93.9% and in group 2 the recovery rate was 94.1%.Conclusions:Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia.

The safety of continued low dose aspirin therapy during Complete Supine Percutaneous Nephrolithotomy (csPCNL)

Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P<0.001). Thirty-nine (97.5%) of patients in group A and 548 (90.9%) of group B were stone free by the end of the study which was not statistically significant (P=0.118). The mean operative time between groups A and B (43.20±21.37 and 44.83±16.83, respectively) was not considered significant (P=0.561). There was also no significant difference between 2 groups in any types of complications. Multivariate analysis showed that, perioperative aspirin use was not a significant predictor of transfusion, Hb drop, operative time and other complications. Remaining on aspirin does not increase the risk of bleeding, transfusionand other complications. Consequently, continuing aspirin prioperatively in csPCNL appears safe. There is no fear for continuing aspirin in csPCNL.

Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients

Introduction and Aim: Enhanced External Counterpulsation (EECP) is an outpatient treatment to improve myocardial perfusion in chronic stable angina patients. We studied the clinical response of heart failure patients' improvement in the functional class and exercise tolerance with EECP. Materials and Methods: We prospectively evaluated twenty-six patients, who had completed a course of EECP with pre and post six minutes’ walk test, functional ability assessed by the New York heart association (NYHA) classification, renal parameters, lipid profile, and diastole to systole(d/s) ratio in terms of Peak amplitude (P) and Area (A) under the curve value. Results: The study group's mean age is of 56 years. The mean left ventricular ejection fraction (LVEF) is 31.44± 5.5%. Patients' demography includes 81% were male, 30% with hypertension (HT),50% with diabetes mellitus (DM), 30%chronic smokers, 61% of them had triple vessel disease (TVD). All the patients improved by a minimum of one NYHA class improvement, Serum urea reduced from 34.37 ± 20.28 to 27.24 ± 18.73 mg/dL (P = 0.002), C-Reactive protein (CRP) reduced from 4.6± 8.0 to 3.76 ± 5.1 mg/dL (P = 0.62). In the measured lipid panel test, only low-density lipoprotein (LDL) reduction from 94.41 ± 38.66 to 80.51 ± 35.09 mg/dL was statistically significant (P =0.03). The six-minute walk test, post-EECP, improved significantly from 340.14 ± 68.5 to 385.5 ± 73.9 meters (P =0.0004). The LVEF increased from 31.44 ± 5.5 to 38.38 ± 8.69 % (P=0.001). Conclusion: EECP treatment significantly improves shortness of breath, six minutes walking distance, and ejection fraction in heart failure patients. The treatment significantly reduces serum urea and LDL level. These positive changes may be due to a sudden increase in cardiac output and hyperdynamic circulation during the treatment.

Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study

Abstract Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern. Purpose To address the influence of dorsal capsulodesis in postoperative results. Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC). Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%). Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate. Level of Evidence Level III (Retrospective Comparative Study).

Comparison Of Scapular Proprioceptive Neuromuscular Facilitation and Myofascial Release Techniques on Pain and Function in Scapular Dyskinesia Associated with Adhesive Capsulitis

Adhesive capsulitis is frequently recognized as ‘Frozen Shoulder’, which is characterized by primarily painful joint range of motions and later progressively restricted range of motion of the glenohumeral joint. Other common names used for adhesive capsulitis includes ‘Periarthritis and Painful stiff shoulder’ and ‘Shoulder arthrofibrosis’. Objective: To compare the effects of scapular proprioceptive neuromuscular facilitation and Myofascial release techniques on pain and function in scapular dyskinesia associated with adhesive capsulitis. Methods: Quasi Experimental study was conducted on 34 patients of Scapular dyskinesia associated with Adhesive Capsulitis. Subjects were allocated to either to PNF technique group and Myofascial release technique groups. Both were treated for 12 sessions in 6 weeks. NPRS and SPADI scale were used to evaluate the treatment effects at baseline, 2 weeks, 4 weeks and 6 weeks. Results: The mean age of Group A was 43.12± 5.25. The mean age of Group B was 43.0±5.95. There was a significant difference between the mean value of baseline, 2 weeks, 4 week and 6-week NPRS score and baseline, 2-week, 4 week and 6-week SPADI score with P value &lt;0.05 in both study groups. There was more significant mean difference of 6.23 between baseline and week 6 NPRS in Group A but there was less significant mean difference of 4.00 between baseline and week 6 NPRS in Group B. There was more significant mean difference of 70.70 between baseline and week 6 SPADI in Group A but there was less significant mean difference of 46.17 between baseline and week 6 SPADI in Group B. Conclusions: The study concluded that PNF technique and Myofascial release techniques were led to significant difference in NPRS and SPADI score, but PNF technique had shown more significant results than myofascial release technique to improve pain and function in scapular dyskinesia associated with Adhesive capsulitis.

Efficacy of therapeutic ultrasound in De-Quervain' s Tenosynovitis

Overuse or repetitive motion can develop De-syndrome, Quervain's which produces pain along the thumb side of the wrist. The thumb tendons get irritated or inflamed as a result of these motions. Activities that involve regular side-to-side extension of the thumb or wrist might trigger De Quervain's tenosynovitis. Objective: To assess the efficacy of therapeutic ultrasound in De-Quervain's Tenosynovitis. Methods: In this study, forty people were separated into two groups: interventional and control groups, each with 20 people. Results: The interventional group's mean age was 37.70 with a standard deviation of 7.921, while the control group's mean age was 36.60 with a standard deviation of 7.816. Out of 20 individuals in the intervention group, 10 were male and 10 were female, whereas in the control group, 11 were male and 9 were female. The interventional group's mean height and weight were 1.642m0.1740 and 75.9515.830, respectively, while the control group's mean height and weight were 1.675m01517 and 75.5013.296. Out of the 20 patients in the interventional group, one was underweight, seven were normal weight, four were overweight, and eight were obese. Eight patients in the control group were of normal weight, seven were overweight, and five were obese. Conclusions: It was determined that ultrasonic therapy is useful in treating De-tenosynovitis quervain's when the tendon is inflamed

Pain after Laparoscopic Cholecystectomy: Effect of IntraperitonealInfiltration of Injection Bupivacaine

Objective: The aim of this study is to determine the effectiveness of intraperitoneal bupivacaine in patients undergoing laparoscopic cholecystectomy. Study Design: Prospective randomized study Place and Duration: Study was conducted at the department of SurgeryDow University Hospital (Ojha), Karachi for duration of six months from May 2021 to October 2021. Methods: There were 70 patients of both genders were presented in this study. Adult patients above 16 years of age, ASA class 1 &amp; 2, undergoing elective cholecystectomy were included in this study. Informed written consent was taken from all the patients for detailed demographics age, sex and body mass index. Patients were categorized into 2 groups. Group A had 36 patients and received 40 ml of intraperitoneal infiltration 0.25% Bupivacaine at Gall Bladder bed and Right Subphrenic space. Group B control group with 34 patients received no intraperitoneal Bupivacaine. Both groups received 20 ml of 0.25% Bupivacaine at ports site incisions. All patients were educated about the standard Visual Analogue Score (VAS) pain score of 0 – 10, during pre anaesthetic evaluation visit. SPSS 23.0 version was used to analyze data. Results: There were 28 (77.8%) females in group A and in group B females were 31 (91.2%). 43.55±13.93 years were the mean age in group A and in group B mean age was 39.94±11.54 years. Mean body mass index of group A was 26.14±13.41 kg/m2 and in group II mean BMI was 25.06±11.53 kg/m2. In group B close technique was used in 26 (72.2%) while in group B 24(70.6%) cases received closed technique. Post-operatively low pain score was observed in study group as compared to group B. Frequency of rescue analgesic was higher in group B as compared to group A. Conclusion: We concluded in this study that the use of intraperitoneal bupivacaine for laparoscopic cholecystectomy was significantly effective in terms of low pain and is an effective method for improving the quality of life within the early recovery period.

Double Blinded Comparative Study of Bupivacaine with and without Dexamethasone in Supraclavicular Brachial Plexus Block

Background: Through the use of bupivacaine-induced brachial plexus blocking, it is possible to achieve high levels of anaesthesia and analgesia for surgical procedures. When dexamethasone was given to bupivacaine as an additive, the anaesthesia and analgesia lasted significantly longer in the patients who participated in the study. Aim: To study sensory and motor blockade, as well as the duration of postoperative analgesia and the duration of postoperative pain relief. Methods: We were able to enrol 60 patients in the experiment after they were approved by the Institutional Ethical Committee and provided written informed consent to participate. ASA I and II patients, ranging in age from 18 to 60 years old, who had undergone elective surgery on their upper extremities were included in this study. They were separated into two groups of almost equal size.. Results: The mean age in group 1 was 42.6 years with 13.6 SD whereas in group 2 mean age was 37.8 years with 12.5 SD. In group 1 mean weight was 61.7 kgs with 5.9 SD whereas in group 2 the mean weight was 58.2 kgs with 4.8 SD. The descriptive analysis of group 1 and group 2 showed that the mean pulse rate with SD was 83 ± 6.5 and 84 ± 7.2 respectively. While the systolic BP was recorded as 122 and 126 for groups 1 and 2 the standard deviation in this case was 7.8 and 6.4 respectively. Diastolic blood pressure for group 1 was 75 ± 8.2 SD and for group 2 it was recorded as 78 ± 7.9 SD. The analysis of SPO2 for group 1 was 97.3 ± 1.4 SD while group 2 showed 97.5 ± 1.1 SD as mean and SD values. For group 1 the onset of motor block ( minutes) was 3.8 ± 0.8 SD and for group 2 it was 17.5 ± 2.3 SD. Onset of sensory block ( minute) for group 1 was 7.2 ± 1.5 SD and for group it was 15.6 ± 1.6 SD. Conclusion: The addition of 15 millilitres of 0.5% bupivacaine to 15 millilitres of dexamethasone significantly accelerates the onset of sensory and motor blockage in the patient. It has been demonstrated to significantly increase the duration of sensory and motor blockage as well as analgesia. It has been demonstrated that dexamethasone adjuvant is completely safe and has no negative effects when used in the brachial plexus block. Keywords: Double blinded study, upper limb, supraclavicular brachial plexus

Comparison of Angiographic Features of Young and Older Patients Undergoing Primary Percutaneous Coronary Intervention

Aim: To compare angiographic features of young and older patients undergoing primary percutaneous coronary intervention. Study design: Comparative study Place and duration of study: Dept of Cardiology, Loralai Medical College&amp; Hospital, Loralai from 1-10-2020 to 31-3-2021. Methodology: One hundred patients suffering from stenosis and coronary artery diseases were divided into two groups in accordance with their age. Patients with ≤40 years were placed in group I while those &gt; 40 years were in group II. The demographic and clinical variables were entered. Results: The mean age of group I was 34.4±3.9 years while the mean age of group II was 63.2±8 years. There were more males than females in Group I and Group II respectively. The clinical history of both groups showed that obesity, smoking, high cholesterol and low HDL as main comorbidities in group I and group II. Most of the group I had single vessels CAD (SVCAD) 64% while double and triple vessels disease (DVCAD or TVCAD) incidence was similarly high in group II as 36% Conclusion: There are angiographic variance in young and older adults as number of vessels involved and lesion numbers. Key words: Coronary arterial disease, Angiographic features, Myocardial infarction

Challenging the dogma to \u201calways operate\u201d acute hip fractures: a proof-of-concept pilot study for nonoperative management of undisplaced femoral neck fractures

BackgroundThe notion that all acute hip fractures are a surgical entity requiring either surgical fracture fixation or hip replacement represents a historic dogma, particularly within the orthopaedic community of the United States. The present study from a European regional trauma center was designed to challenge the notion that stable and undisplaced femoral neck fractures represent an absolute indication for surgical management.MethodsThe purpose of this study was to investigate the hypothesis that stable and undisplaced femoral neck fractures of the Garden types 1 and 2 can be safely managed nonoperatively. A retrospective observational cohort study was carried out at a regional orthopaedic trauma center in Germany from January 1, 2016 to June 30, 2021. The inclusion criteria specified patients older than 18 years suffering a < 24 h, traumatic, femoral neck fracture Garden types 1 and 2. Exclusion criteria included Garden types 3 and 4 femoral neck fractures, pregnancy, active infection or previous surgery, tumor-associated fractures, medical history of femoral neck necrosis, vascular injury associated with femoral neck fractures, nerve injury associated to a femoral neck fracture and ≥ 24 h femoral neck fracture. The primary intention of this research was to identify deterioration of fracture retention with an ensuing unplanned trip to the operating room in femoral neck fractures Garden types 1 and 2. Secondary were included unplanned readmissions and complications such as surgical site infection.ResultsA total of 41 undisplaced femoral neck fractures (Garden types 1 and 2) were included in this study; n = 20 were in the resulting admission operatively treated (group 1) and n = 21 were treated conservatively. The mean age in group 1 was 76 years; women (70%). In group 2 it was 81 years with a female dominance (71.4%). Admission status: Garden types 1 and 2, group 1 n = 13/7 and group 2 n = 15/6. Subsequent femoral neck fracture displacement (Y/N) (in case of operation, before operation) group 1 n = 14/6 and group 2 n = 6/15.ConclusionAccording with our results, patients sustaining Garden type 1 femoral neck fractures, depending on age and comorbidities, should be treated conservatively with weight bearing and under physiotherapeutic instructions. In case of femoral neck fractures Garden type 2, a surgical treatment should be performed in order to avoid femoral neck fractures to slip after weight bearing by lacking of fracture impaction.

Evaluation of tautening method in repair of advanced mallet finger without bone fracture

Many different repair methods have been described in the frequently seen mallet finger deformity, but without consensus. The present study aimed to present an alternative tautening technique in mallet finger repair and to compare it versus classical direct repair. Patients with untreated chronic mallet finger of more than three months’ progression, treated surgically between March 2017 and October 2020, were included. Two surgical methods were applied to restore extensor function of the distal interphalangeal joints. In the first group, the granulation tissue was excised and the extensor tendon was repaired directly. In the second group, granulation tissue was not excised, and the extensor tendon was tautened by plication. Outcomes were evaluated according to Miller’s criteria. Fort-six patients were included: group 1, 25 patients; group 2, 21 patients. Mean age in group 1 was 36.2 years and 33.4 years in group 2. Mean follow-up in group 1 was 14.8 months and 13.9 in group 2. Extensor lag was similar (5.6°) in both groups at the end of the sixth month. On Miller’s mallet finger criteria, group 1 scored 3.4 points and group 2 3.4 points (p > 0.05). The tendon tautening method helps to start physiotherapy early, the learning curve is short, and it provides functionally positive results and a low complications rate. We think that this method should be evaluated in chronic mallet finger deformities without bone fracture.

“Correlation between Electrocardiographic Left Ventricular Hypertrophy &amp; Adverse Outcome Following Acute Myocardial Infarction in Hypertensive Patient”

Introduction: Myocardial infarction is one of the most serious pathological condition in which the heart is irritated, inflamed and influenced by multiple factors to cause high mortality and morbidity in the developed and underdeveloped countries. Objectives: To see correlation between Electrocardiographic left ventricular hypertrophy and adverse outcome following acute myocardial infarction in hypertensive patient. Materials and Methods: A Cross sectional analytical study was carried out at the Department of cardiology, Mymensingh Medical College Hospital, Mymensingh Bangladesh from March - 2014 to February- 2015. Patients admitted into cardiology department with Acute Myocardial Infarction with hypertension who fulfill the inclusion and exclusion criteria of the study. Due to time and cost limitation, 65 cases were selected. Results: A total number of sixty five patients were studied of which 56(86.15%) were male and nine (13.84%) were female. The age range was 40 to 70 years. Mean age of male was 52.9±8.4 and female was 56.5±7.5. The patients were divided into two groups on the basis of presence of absence of electrocardiograph left ventricular hypertrophy. All patients had myocardial infarction with evidence of hypertension at admission or known case of hypertension. Group A consisted of 38 patients (58.45%) with ECG-LVH and group B with no ECG_LVH consisted of 27 patients (41.55%). The mean age of group A was 54.25 ±8.9 and group B was 52.55 ± 8.15. Majority patients (34) belonged to 40-50 years age group (52.30%). Twenty one patients belonged to 51-60 years group (32.30%). Ten patients belonged to 61-70 years age group (15.4%), male: female ratio was 6.2: 1. Out of total 68 patients, 43 patients (64.42%) had hypertension on admission and 24 cases (35.38%) had normal blood pressure on admission. Of the 38 patients of group A, 24 had anterior myocardial infarction (63.15%) and 14 had inferior myocardial infarction (36.84%) and 7 had both anterior and inferior myocardial infarction (10.76%). The statistical analysis was highly significant in between group A &amp; group B. The incidence of QMI was highly significant (P= &lt;0.01) between Group A &amp; Group B. QMI was for more common in group A, the incidence was higher in presence of ECG –LVH. In group A hospital stay (days) was 6.74±1.53 days, and 14% had mortality. On the other hand, in group B, it was found that hospital stay (days) was 5.28±1.06 days, and 2% had mortality. 30 patients (81.89%) developed arrhythmia and 8 cases (21.05%) did not developed arrhythmia in group A. In Group B 16(51.85%) developed arrhythmia and 13 cases (48.14%) didn’t develop arrhythmia. Statistically, relation between Group A &amp; Group B was significant (p &lt;0.05). Statistical relationship between group A &amp; group B was significant and this signifies the higher possibilities of occurrence of mortality in ECG-LVH due to hypertension with acute myocardial infarction than without ECG. Conclusion: The study concluded that ECG-LVH changes following acute myocardial infarction in patients with hypertension had more adverse in-hospital outcomes.

Comparison of clinical presentation and outcome of childhood-onset and adulthood-onset of systemic lupus erythematosus among Indonesian patients.

The clinical presentation of childhood-onset systemic lupus erythematosus (SLE) is generally perceived to differ from that of adult-onset SLE. We aimed to compare the demographic and clinical manifestation between childhood-onset vs. adult-onset SLE in a cohort of Indonesian patients at tertiary care centers. This retrospective study included patients in the Hasan Sadikin Lupus Registry from 2008 until December 2017. The demographics, clinical presentations, and outcomes were compared between childhood-onset SLE (<18years old) (Group 1) and adult-onset SLE (≥18years old) (Group 2). Eight hundred seventy patients were involved into this study. The proportion of childhood-onset SLE was 20% (174 patients). The mean age of group 1 versus group 2 was 13.56 ± 3.04 vs 30.41 ± 8.54years. The following clinical manifestations at SLE diagnosis were significantly more common in childhood-onset than in adult-onset SLE patients: hematological disorder (p = 0.033) and arthritis (p = 0.006). While discoid rash (p = 0.036) and photosensitivity (p < 0.001) were significantly found higher in adult-onset SLE. Cyclophosphamide therapy was significantly more common to be used in childhood-onset (38.5% vs 21.0%, p = <0.001). However, frequency of mortality on follow-up tended to be higher in childhood-onset group (11.5% vs 7.0%, p = 0.208). Arthritis and hematologic involvements at SLE diagnosis were more prominent in childhood-onset compared to adult-onset patients, and mortality in childhood-onset SLE during follow-up relatively higher. This data may suggest the need for more aggressive management approach to childhood-onset patients with SLE.

Does Patients with Higher Education Have Better Postoperative Results After LVAD Implantation?

<h3>Purpose</h3> Left ventricular assist devices (LVAD) implantation have increase throughout the years due to the inability to keep up with the heart transplant demand. However, scarceness of data exists regarding the association of degree of education with outcomes after LVAD implantation. <h3>Methods</h3> We evaluated patients that underwent an LVAD implantation between January 2018 to December 2020. Patients were divided into two groups based on their level of education. Patients who had less than 12 years of education (group I) and patients who had more than 12 years of education (group II). Baseline demographics and clinical characteristics were summarized using descriptive statistics. A significance level of 0.05 was used. <h3>Results</h3> 135 patients were included in the study. Eighty-three patients (60%) were included in group I and 52 (40%) were included in group II. Mean age for group I and II were 52 (12) and 53 (12) years (<i>p</i>=0.907). No statistical difference was found in preoperative variables such as: Diabetes Mellitus (<i>p</i>=0.6.95) atrial fibrillation (<i>p</i>=0.906), stroke (<i>p</i>=0.751) and hypertension (<i>p</i>=0.654). More patients from group I had a postoperative arrhythmia (31% vs. 15%) (<i>p</i>=0.071). The outcomes for group II were better, they had a lower mortality (15% vs 7.7%) and more patients were bridged to a heart transplant (23% vs. 6%) (<i>p</i>=0.009). <h3>Conclusion</h3> Despite both groups having similar demographic and postoperative variables, group II had substantially higher rates of heart transplantation. Higher education may be a variable that is associated with improved survival after LVAD implantation and a higher chance for heart transplantation.

Strabismus Surgery: A Retrospective Comparison of Different Postoperative Treatment Regimes to Prevent Infections.

As studies have shown postsurgical polyvidone-iodine to be at least equal to postsurgical topical antibiotics, our postsurgical care regime was adjusted accordingly in 2017. Here, we retrospectively compared the postsurgical infection rate in patients who underwent strabismus surgery prior to and following this change in regimen in a routine clinical setting. In this retrospective and explorative study, data from 162 adult patients who had undergone strabismus surgery was extracted from files: 98 patients who had received topical gentamycin in a combination ointment with steroid (postsurgery) followed by 1 week of topical gentamycin with nonsteroidal antiphlogistic eye drops for 1 week (group 1) and 64 who had received polyvidone-iodine once immediately postsurgically instead. We compared both groups' postsurgical healing period regarding occurrence of bacterial conjunctival infection and conjunctival swelling and redness as well as other complications. Data were extracted from the entries of the routine follow-up dates on postsurgical days 1, 7, and at 3 months. Mean age of group 1 was 49 years and 51 years in group 2. There was no significant difference between the kind of surgeries (recessions/resections) or the number of patients who had undergone a reoperation. There was no significant difference between the groups for any of the endpoints analyzed at any of the three regular follow-up dates. From group 1, 12.04% and from of group 2, 6.25% showed bacterial conjunctivitis 1 week postsurgery. There was no endophthalmitis. Topical polyvidone-iodine given once at the end of strabismus surgery is a good alternative to topical antibiotics with a comparable healing progress. It carries a comparable risk of infection as seen with a 1-week course of topical antibiotics. The advantages are less manipulation of the eye, no bacterial resistance caused, and cost efficiency. In addition, the lack of anti-inflammatories given in group 2 did not pose a disadvantage.

Comparison of Topical Silymarin with Hydroquinone in the Treatment of Melasma

Objective: To compare the efficacy and safety of topical silymarin 0.7% with topical hydroquinone 4% in the treatment of melasma.&#x0D; Place and Duration: This Randomized Controlled Trial was conducted at dermatology OPD of Akbar Niazi Teaching Hospital, Bara Kahu, Islamabad, in a period of one year from April 2020 to April 2021.&#x0D; Patients and Methods: Female patients having melasma were included in the study. The severity of melasma was assessed using MASI score. Group A was treated with silymarin 0.7% cream and group B was treated with topical hydroquinone 4% cream. Treatment was given for 3 months and was followed up for the next 3 months to observe relapse. Clinical efficacy was assessed in terms of percent reduction in MASI score from baseline.&#x0D; Results: The mean age in group A (Silymarin 0.7%) was 35.13 ± 3.87 and in group B (Hydroquinone 4%) was 34.16 ± 3.90. Epidermal type of melasma was most common (76.8% vs 62.5%) in both groups. There was no significant (p-value &lt; 0.05) difference between both groups after one and two months treatment but mean MASI score of Hydroquinone 4% group (10.59 ± 5.74) become significantly (p-value &lt; 0.05) less than Silymarin 0.7% group (8.20 ± 4.41) after 3 months. Similar (p-value &gt; 0.05) therapeutic response was observed after one and two months treatment but it become significantly better in Hydroquinone 4% group after three months treatment. Significantly, (P-value &lt; 0.05) higher adverse effects were detected in patients treated with hydroquinone. There was no difference (P-value &gt; 0.05) in recurrence rate and patients satisfaction between both groups.&#x0D; Conclusion: topical silymarin has equal efficacy for the treatment of melasma with comparatively very less adverse effects as compared to hydroquinone.