Mayo Hospital Research Articles

RDSSMM: A FUZZY EXPERT SYSTEM FOR ENHANCED MALARIA DIAGNOSIS AND MANAGEMENT IN ENDEMIC REGIONS

Malaria continues to be a pressing public health issue in tropical regions, with its deleterious effects on human health well documented. While a minority of cases may be life threatening, delayed diagnosis can significantly worsen the severity of malaria. This paper presents the Recommender and Decision Support System for Malaria Management (RDSSMM), designed to assist researchers, physicians and healthcare professionals in malaria endemic areas. RDSSMM is made up of four main components: a knowledge base, fuzzification module, inference engine, and defuzzification module. Mayo Hospital Lahore, Pakistan was used to develop the fuzzy expert system based on experts’ opinions in the field of medicine. For ease of access, a mobile application has been included which allows patients to get primary diagnosis by keying in their physical signs that are then transformed into fuzzy membership functions. The data was collected from the outpatient department of Mayo Hospital Lahore as one way of evaluating RDSSMM’s effectiveness. Comparing its predictions to expert medical diagnoses and reports pointed out this system’s performance. Malaria risk was correctly predicted 80% of the time by RDSSMM. These findings show that RDSSMM can greatly improve malaria management in rural areas through provision of quick and accurate results, which would facilitate timely decisions regarding malaria testing and monitoring.

Managing Maggots in the Eye: A Case Series

Purpose: To describe the presentation and management of ocular maggots and to identify the factors contributing to their occurrence. Study Design: Retrospective case series. Place and Duration of Study: Department of Ophthalmology Mayo Hospital Lahore from 2015 to 2022. Methods: The study involved retrospective chart analysis of patients who presented with Ophthalmomyasis and managed in the eye department. Data regarding age, gender, occupation, clinical findings, co-morbidities, associations and environmental factors were analyzed.Larvae were removed one by one under microscope. Follow up was done after 1 week, 1 month and 3 months. In patients with orbital myasis having distorted, large ulcerated wounds/socket, turpentine oil was used and larvae were removed mechanically under microscope. Results: There were 15 fifteen patients included in the study. Underlying co-morbidities were present in 60% patients and the most common being basal cell carcinoma (46.6%). Seventy four percent patients had some systemic disease; Diabetes Mellitus, Hypertension, AIDS, Hepatitis C etc. One thirdpatients had external ophthalmo-myasis while two third had orbital myasis. Patients who did not complete follow-up were 33%. Use of suffocating agents like turpentine oil, periodic removal of larvae, topical and systemic antibiotics, topical lavage with copious irrigation with sterile fluids resulted in good outcome in all cases that completed the follow up. Conclusion: The majority of patients came from rural communities and had underlying co-morbidities. Timely management resulted in good outcomes for all patients who completed the follow-up, highlighting the importance of comprehensive and sustained treatment protocols.

Assessment of Pain and Functional Outcomes in Individuals with Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a pathological condition of the patellofemoral joint characterized by knee pain in the peripatellar, anterior, and even retro patellar regions. Between 15% and 45% of persons in their 20s to 40s experience patellofemoral pain. Objective: To assess pain and functional outcomes in individuals with patellofemoral pain syndrome. Methods: At Mayo Hospital and the University of Lahore Teaching Hospital, 87 people enrolled in this cross-sectional study using a non-probability convenience sampling technique during the period of 20th January 2024 to 20th July 2024. Both male and female patients between ages of 20 to 40 years with a positive patellar grind test were included. The numeric pain rating scale and Kujala score were used for data collection to assess pain and functional outcomes respectively. Data were analyzed using IBM SPSS Statistics 25.0. All qualitative variables were shown as frequency and percentages; all quantitative data were provided as Mean ± S.D. Results: Mean age of participants was 30.68 ± 5.62 years. Out of 87 participants, there were 41 (47.1%) females and 46 (52.9%) males. The mean score of the Numeric Pain Rating Scale was 6.31 ± 1.56 and the Kujala score was 46.37 ± 10.36. Out of 87 participants, 6 (6.9%) had mild pain, 62 (71.3%) had moderate pain and 19 (21.8%) had severe pain. The NPRS and Kujala Score have a very weak correlation of 0.049 with a p-value of 0.655. Conclusion: It was concluded that this study had a significant impact of patellofemoral pain syndrome on pain and functional outcomes in affected individuals.

Dermoscopic Features and Algorithm- A Guide to Detecting Pre-Malignant Facial Pigmented Skin Lesions in Ethnic Skin

Introduction: Detection of pre malignant facial pigmented lesions on a photo damaged ethnic skin has been crucial for dermatologists in preventing malignant transformation. Facial Pigmented Skin Lesions (FPSLs) that render a diagnostic challenge include, Pigmented Actinic Keratosis (PAK), early Seborrheic Keratosis (SK), Solar Lentigo (SL) and Lentigo Maligna (LM). Dermatoscopy or epiluminescence microscopy, is skin surface microscopy that has demonstrated to be a non-invasive, in vivo, high yield technique to evaluate a pigmented macule for an atypical evolution. Objective: To establish dermatoscopic findings of clinically challenging FPSLs conforming PAK, SK, SL and LM and derive an Algorithm with diagnostic features for detecting Premalignant Facial Pigmented Skin Lesions. Subjects and Methods: We here in conducted a largest case study a cross-sectional analysis of clinically challenging 182 flat FPSLs, evaluated dermoscopic images consistent to pigmented AK, early SK, SL and LM and subsequently biopsied for histopathological evidence. Four major dermoscopic features were appraised: pigment pattern, sharp demarcation, vascular criteria and follicular/epidermal pattern. Study Design: Cross sectional validation-study Setting: Department of Dermatology Unit II, King Edward Medical University, Mayo Hospital Lahore. Study was conducted for a period of six months. Result: We derived an “Algorithm” elucidating diagnostic findings of FPSLs. Pigmented AK on dermoscopy has strawberry pattern in 42% of lesions (pink to red pseudo-network with erythematous background, prominent follicular ostia fenced by a white targetoid halo), while Sharp demarcation (57.15%) and follicular/epidermal pattern (cerebriform pattern 100% of lesions, milia-like cysts, 50%, and comedo-like openings 38.57%) are distinctively observed SK. In SL, homogenous structureless pigmentation is significant entirely (100%). However, in LM predominates pseudonetwork (89.47%), homogenous structureless pigmentation (78%) and vascular patterns while strawberry pattern is observed in (26.31%) of lesions. Conclusion Our “Dermoscopic Algorithm” constitutes diagnostic characteristics of “Facial Pigmented Skin Lesions,” that would not only aid in early corrective detection of clinically similar lesions with different biologic behavior, but serve the the purpose to prevent vigorous malignant transformation in photo damaged ethnic skin, particularly Lentigo Maligna turning into a potential Melanoma, Hence, Sharp demarcation with cribriform pattern is specific of Sebhorric Keratosis (SK), while homogenous structureless pigmentation without prominent vascular pattern is distinctive of Solar Lentigo (SL). Pigmented Actinic Keratosis (AK) is described by prominent strawberry pattern. Nonetheless, homogenous structureless pigmentation and vascular pattern with pseudonetwork are featured in Lentigo Maligna (LM), lacking of prominent strawberry pattern. Conflict of Interest: The Authors have no conflict of interest to disclose.

Data on Violence and Abuse Among Nurses and the Use of Antidepressant Medications

This study investigates the impact of physical and emotional violence on emotional exhaustion among nurses and explores the moderating role of antidepressant use. Conducted at Mayo Hospital in Lahore, the study surveyed 126 nurses to examine the relationships between violence exposure, emotional exhaustion, task interruptions, and the use of antidepressants. The research utilized a structured questionnaire covering demographic details, experiences of violence, emotional exhaustion levels, task interruptions, and antidepressant use. The results reveal that both physical and emotional violence significantly contribute to emotional exhaustion, with emotional exhaustion itself playing a substantial role in predicting antidepressant use. Emotional exhaustion was found to partially mediate the relationship between physical and emotional violence and the use of antidepressants. Additionally, task interruptions were identified as a mediator between violence exposure and emotional exhaustion, though they did not significantly moderate the relationship between emotional violence and antidepressant use. The study's findings underscore the severe impact of violence on nurses' emotional well-being and the crucial role of antidepressants in managing emotional exhaustion. The results suggest the need for targeted interventions to address workplace violence and its psychological effects, as well as recommendations for reducing task interruptions to improve overall nurse well-being and efficiency.

Orbital Lesions: A bird's eye view of series of 2068 cases in 27 years in a tertiary care hospital in Pakistan.

To determine the relative frequency of orbital lesions based on the site of origin and histopathology at a Tertiary care hospital (Mayo Hospital, Lahore Pakistan) from 1996 till 2022 (27 years). This descriptive case series included 2651 patients of all age groups presenting with orbital lesions who initially got enrolled at Institute of Ophthalmology Mayo Hospital, Lahore from 1996 till 2022. Of these, 583 patients left against medical advice. So, clinical data of 2068 patients were completely analyzed. Lesions were managed medically and/ or surgically. Final clinical diagnosis, with the help of histopathology, was used to classify the lesions. There were 1258 (60.9%) adults and 810 (39.1%) children, 1358 (65.66%) were neoplastic while 710 (34.33%) non-neoplastic lesions. Amongst the neoplastic lesions, 405 (29.8 %) were benign and 953 (70.2%) malignant. Primary orbital lesions were 1676 (81.04%), Secondary orbital lesions were 300 (14.51%), Endocrine/ hematopoietic reticulo-endothelial system lesions were 84 (4.06%) and Metastatic lesions from distant organs were 08 (0.39%). Retinoblastoma, rhabdomyosarcoma, optic nerve gliomata were common in children. Pleomorphic adenoma & adenocystic carcinoma of lacrimal gland, cavernous hemangioma, optic nerve meningioma, neurofibroma, schwannoma, squamous cell carcinoma of eyelid, carcinoma of maxillary antrum and lymphomas were more common in adults.

Comparison of treatment of volar Barton's fracture with T plate using distal end screws and without distal end screws.

To compare the functional and radiological outcomes of treatment of volar Barton's fractures using T plate with and without distal end screws. This randomized control trial was conducted at the department of Orthopedics, Mayo Hospital, Lahore, Pakistan from December 2021 to May 2022. Total 60 patients (30 in each group) were randomly allocated to either group A (T-Plate with distal end screws) or B (T-Plate without distal end screws). Patients were followed up on day-0, day-14, day-28 and day-90. Assessments of patients were done by Green O'Brien Score for pain, Modified Warden Score for callus formation on radiographs at 12-weeks of follow-up and Stewart Score for displacement of fracture. At 90th day, significant difference was seen in Green O'Brien Score (Excellent score: Group-A: 80% vs. Group-B: 90%, p=0.278) while Stewart scores remained comparable (Excellent Score: Group-A: 93.33% vs. Group-B: 96.67%, p=0.221) between treatment groups. Fracture healing assessed with Modified Warden score for score 4 did not show significant difference between both groups at 90th day. i.e. (Group-A: 96.67% vs. Group-B: 96.67%). However, callus formation assessed with Modified Warden score for score 3 showed significant differences between groups at 90th day. i.e. (Group-A: 53.33% vs. Group-B: 86.67%, p=0.001). Both treatment approaches appear to yield comparable outcomes in terms of clinical assessment, Stewart scores, and fracture healing, with a potential advantage for T-plate without distal end screw in callus formation at the 90th day.Trial registration: IRCT20221231056999N1.

Comparison Between Pregabalin and Sertraline in the Treatment of Uremic Pruritus in Patients With Maintenance Hemodialysis.

Introduction Pruritus, a medical symptom also known as itch, is characterized by an unpleasant feeling coupled with the urge to scratch. Patients with chronic kidney disease (CKD) often have symptoms of pruritus due to uremia, which has adversely affected their quality of life. The treatment protocol for CKD pruritus is still being debated due to its unclear etiopathogenesis. Pregabalin, an anticonvulsant medication, and sertraline, an antidepressant medication, have been used to treat uremic pruritus (UP) patients on maintenance hemodialysis. Objectives There are no adequate investigations comparing the efficacy of pregabalin and sertraline, particularly in under-resourced countries such as Pakistan. Method The research was a randomized trial for a period of four weeks at the nephrology department of the Mayo Hospital, Lahore. A total of 62 patients were randomly assigned to take either pregabalin (aged 48.06±13.44) or sertraline (aged 47.45±10.97) tablet once a day, a total of 31 patients to each group. The pregabalin group was specified 25 mg for the first week, 50 mg for the second week, and 75 mg for the third and fourth week. Similarly, sertraline was prescribed 25 mg for the first week and 50 mg for the remaining three weeks. However, if the patient shows improvement on the lowest dosage, therapy with the same minimum dose was proposed to be continued. Lastly, the itching score was assessed on the 5D pruritus scale. The Visit 1 (no drug) score was evaluated against post-therapy scores at two-week intervals as Visit 2 (week 2) and Visit 3 (week 4). Statistical analysis was done using the Statistical Product and Service Solutions (SPSS, version 26;IBM SPSS Statistics for Windows, Armonk, NY) with a significance level set at p<0.05 and 95% confidence level. Conclusion This research concluded that both pregabalin and sertraline significantly improved itching intensity in each treatment group; however, there was no significant difference between the two drugs in reducing UP based on the 5D itching scores. In each domain of the 5D pruritus scale, a significant difference was found in post-follow-up pregabalin and sertraline therapy.

Risk factors associated with influenza A (H1N1)pdm09: a nested case control study of TB patients with ILI in Lahore District, Pakistan

BackgroundCo-morbidity with respiratory viruses including influenza A, cause varying degree of morbidity especially in TB patients compared to general population. This study estimates the risk factors associated with influenza A (H1N1)pdm09 in TB patients with ILI.MethodsA cohort of tuberculosis (TB) patients who were admitted to and enrolled in a TB Directly Observed Therapy Program (DOTs) in tertiary care hospitals of Lahore (Mayo Hospital and Infectious Disease Hospital) were followed for 12 weeks. At the start of study period, to record influenza-like illness (ILI), a symptom card was provided to all the participants. Every participant was contacted once a week, in person. When the symptoms were reported by the participant, a throat swab was taken for the detection of influenza A (H1N1)pdm09. A nested case control study was conducted and TB patients with ILI diagnosed with influenza A (H1N1)pdm09 by conventional RT-PCR were selected as cases, while those who tested negative by conventional RT-PCR were enrolled as controls. All cases and controls in the study were interviewed face-to-face in the local language. Epidemiological data about potential risk factors were collected on a predesigned questionnaire. Logistic analysis was conducted to identify associated risk factors in TB patients with ILI.ResultsFrom the main cohort of TB patients (n = 152) who were followed during the study period, 59 (39%) developed ILI symptoms; of them, 39 tested positive for influenza A (H1N1)pdm09, while 20 were detected negative for influenza A (H1N1)pdm09. In univariable analysis, four factors were identified as risk factors (p < 0.05). The final multivariable model identified one risk factor (sharing of towels, P = 0.008)) and one protective factor (wearing a face mask, p = < 0.001)) for influenza A (H1N1)pdm09 infection.ConclusionThe current study identified the risk factors of influenza A (H1N1)pdm09 infection among TB patients with ILI.

Pattern of diseases in medical wards of a tertiary care hospital of Lahore: a retrospective study

AimThe study was conducted to determine the frequency of different diseases encountered in a medical ward of a tertiary care hospital.Subject and methodsThis was a cross-sectional study carried out in the Department of Medicine at Mayo Hospital Lahore using medical records of admitted patients from September to November 2021.ResultsA total of 381 patients were included in the study. The age group with the highest admission was 56–60 years. Decompensated Chronic Liver Disease was the most common disease (19.4%), followed by Ischemic Heart Disease (17.3%), Septic shock/Septicemia (9.4%), Cerebrovascular Accident (8.4%), Meningoencephalitis (7.3%) & Chronic Kidney Disease (6.6%).ConclusionKnowledge about the most prevalent diseases in medical wards can help guide future policy making & better management of diseases on a day to day basis.

Investigating the Link Between Left Ventricular Hypertrophy and Anemia in End-Stage Renal Disease

Background:ESRD significantly burdens healthcare systems worldwide. Its related complications, such as LVH and anemia, lead to increased morbidity and mortality. Left Ventricular Hypertrophy (LVH), which mirrors an increase in myocardial mass and wall thickness, is easily identified in patients with ESRD. Anemia, a state of low hemoglobin, increases cardiac work Aims and Objective: To explore anemia and its association with LVH in ESRD patients on maintenance hemodialysis by detailed echocardiographic assessment and comprehensive blood analysis. Methodology: This comparative study was carried out at a teaching hospital, namely Ghurki Teaching Hospital and a tertiary care hospital, Mayo Hospital, Lahore, Pakistan from March 2023 to April 2024. A purposive sample of 200 adults on maintenance hemodialysis with ESRD was obtained through stratified random sampling techniques and the participants were grouped based on anemia status: anemic; (hemoglobin &lt;13g/dL in males, &lt;12g/dL in females) or non-anemic. The data were analyzed using SPSS software (Version 26) by employing independent t-test to compare the means, chi-squared test for categorical variables, A p-value &lt; 0. 05 was considered significant. Results:In patients with anemia, the LVMI was significantly (P≤0.05) higher than in patients without anemia. Anemia was found to be a significant (P≤0.05) predictor of an increase in LVMI over time, indicating its role in the development of LVH. Conclusion:The findings of present research indicated that, as shown by echocardiography, there is a substantial correlation between LVH and anemia in patients on maintenance of hemodialysis.

Risk Factors Associated With Low-Birth-Weight Babies in Tertiary Health Care Facilities in Lahore, Pakistan: A Case-Control Study.

Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575]with delivery of LBW children. Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

Association between Storage Time of Corneal Grafts and Primary Graft Failure in Penetrating Keratoplasty

Purpose: To determine association between storage time of corneal grafts and primary graft failure in Penetrating Keratoplasty (PK). Study Design: Quasi experimental study. Place and Duration of Study: Institute of Ophthalmology, Eye Unit-III, King Edward Medical University, Mayo Hospital, Lahore from June, 2019 to December, 2019. Methods: In this study, 120 patients (between 11 and 30 years of age) diagnosed with keratoconus were enrolled and divided into two groups. Group A comprised individuals who underwent PK with donor tissues stored for 8 to 14 days, while Group B consisted of patients whose donor tissues were stored for a duration not exceeding 7 days. Patients were followed up for three weeks post-operatively. The data was analyzed using SPSS version 19 and stratified for age, gender and primary graft failure. Post stratification RR was calculated with p-value ≤ 0.05 as significant. Results: The mean age of patients in Group A was 21.38 ± 6.29 years and in Group B was19.80 ± 5.81 years. In Group A there were 32 male and 28 female while in Group B there were 29 male and 31 female. In Group A 16(26.7%) patients and in group B, 4 (6.7%) patients had primary graft failure. The risk of primary graft failure was higher in Group A, with RR = 4, p-value &lt; 0.05. Conclusion: The risk of primary graft failure in PK is higher when the storage time of corneal grafts is longer. Hence, minimization of storage time may ensure better success rate of corneal grafting.

Frequency of Autism in Nuclear and Joint family system

Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder that affects social interaction, communication, and behavior. Autism is a lifelong developmental condition that affects individual’s communication and interaction with others, as well as their understanding of the world. There is limited literature available from Pakistan, therefore this study was designed to find the frequency of autism in nuclear and joint family systems. This was a Cross-sectional observational study conducted in various healthcare settings, including the University of Lahore Teaching Hospital, Mayo Hospital, Orion Center, and Sehat Medical Complex, Pakistan from February 2023 to July 2023. Purposive sampling was the method of sampling used in this investigation (n=133). Parents or caregivers who have a minimum of one ASD-diagnosed child were included in this study. Parents or caregivers who do not have a child diagnosed with autism spectrum disorder (ASD) were excluded from this study. The investigation into the frequency of autism within joint and nuclear families’ reveals that a majority of families with autistic children lean towards nuclear family structures. While joint families exist, they are less prevalent. The study also underlines that parental engagement is high across both family types, with over 90% actively participating in caregiving and decision-making.

Implication of Orthoptic scoring system for the management of Orbital Floor Blowout Fracture

OBJECTIVES: To introduce an orthoptic scoring system that can be implicated for decision-making about the management of patients with orbital floor blowout fractures and to assess the significance of orthoptics as a decisive element in the treatment of patients with orbital floor blowout fracture (OFBF). METHOD: The Ethical Review Board of the College of Ophthalmology and Allied Vision Sciences (1479, 23), Mayo Hospital, Lahore, has approved this study. A comprehensive prospective cohort study was done on 44 Mayo Hospital, Lahore patients using a self-designed proforma. The duration of the study was from September to November, 2023. Forty-four participants were included with an age limit of 15-80 years. Complete orthoptic evaluation and review of medical records were done on each participant individually. All factors (diplopia, extraocular muscles movement, ecchymosis and others) included in this orthoptic scoring system were numbered according to individual patients' conditions. Descriptive data analysis was done by using SPSS Version 25.00. A p-value of ≤ 0.05 was used to define the significance threshold. RESULTS: Out of the 44 patients, 15.9% of patients were recommended for conservative treatment, surgery was deemed as a viable option for 29.5% of patients, and surgery was considered necessary for 54.5% of patients with an orbital floor blowout fracture. All the factors included in orthoptic scoring system were evaluated significant (p-value=0.00) CONCLUSION: The orthoptic scoring system has the potential to serve as a valuable diagnostic tool in the management of patients with orbital floor blowout fractures. The study suggests that a comprehensive orthoptic evaluation is necessary to determine the optimal treatment for patients with orbital floor blowout fractures.

Diagnostic Accuracy of Cell block Using HistoGel Tube Method in Breast Cancer in Pakistan

Background: Breast malignancy is the major cause of cancer-related deaths among women globally. Therefore, early diagnosis is the primary requisition for an effective treatment plan. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of fine needle aspirate cell blocks made by the HistoGel-tube method in patients with breast cancer. Methods: This cross-sectional study was carried out at the Department of Pathology, King Edward Medical University /Mayo Hospital, Lahore. The study duration was six months. 62 patients with breast lumps, of all ages, both genders, having easily accessible breast lesions and C III, C IV, C V smears on rapid onsite evaluation were included while patients who had received neo-adjuvant chemo- or radiotherapy and those reported as C I ,C II smears on ROSE were excluded. FNA was performed and HistoGel cell blocks were made in addition to the conventional smears. Data was entered in SPSS version 26. Results: The mean age of patients included in the study was 47 ± 13 years. 61(98.4%) patients were female while only 1(1.6%) patient was male. Sensitivity, Specificity, Positive predictive value, Negative predictive value and diagnostic accuracy came out to be 96%, 69%, 92%, 81%, and 90% respectively. Conclusion: HistoGel cell blocks have overall good diagnostic accuracy for the evaluation and diagnosis of breast malignancy.

Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of post operative pain and healing.

To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures. The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26. Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030). Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.

Assessment of recovery time for the functional status of infraorbital nerve in open versus closed reduction of zygomatico-maxillary complex fractures: a comparative study

&lt;p&gt;Background and Objective: Zygomatico-maxillary complex (ZMC) fractures and associated infraorbital nerve paresthesia are the most prevalent features of facial trauma associated with road traffic accidents, accidental falls, and violent assaults. The objective of this study was to assess the recovery time of the infraorbital nerve functional status in individuals with paresthesia after open and closed reduction of ZMC fractures.&lt;/p&gt; &lt;p&gt;Method: A comparative cohort study was conducted in the Oral and Maxillofacial Surgery Department of Mayo Hospital in Lahore. The study comprised 100 patients with unilateral isolated en bloc ZMC fractures and post-traumatic paresthesia. Patients were equally divided into two groups: Group A comprised of patients who underwent closed reduction while patients of Group B had open reduction with micro plate osteosynthesis. Demographic information, infraorbital nerve healing, post-op complications, and patients&amp;rsquo; satisfaction were documented. To compare the outcomes of the two groups, statistical analyses were done and p-value &amp;lt;0.05 was taken as statistically significant.&lt;/p&gt; &lt;p&gt;Results: The age distribution revealed a mean age of 37.43 &amp;plusmn; 11.06 years, with 72% of the participants being males. In 63% of patients, there was overall functional nerve recovery. After 6 weeks, 74% of those in Group A (closed reduction) had functional nerve recovery, as compared to 52% of those in Group B (open reduction) (p = 0.023). Age subgroup analysis revealed no significant differences in the recovery rates. When compared to Group-A, patients in Group-B showed faster sensory improvement and better satisfaction levels. Complication rates were equal for both approaches.&lt;/p&gt; &lt;p&gt;Conclusion: In ZMC fractures with paresthesia, both open and closed reduction procedures yielded good results in recovering infraorbital nerve function; however, the open reduction technique demonstrated quicker sensory recovery and more patient satisfaction.&lt;/p&gt;

Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial.

To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures. A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant. In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53). Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.

Early Tracheostomy versus Late Tracheostomy in Patients with Moderate-to-Severe Traumatic Brain Injury.

Objective The aim of this article was to study the impact of early versus late tracheostomy on clinical outcomes of moderate-to-severe traumatic brain injury (TBI). Materials and Methods A retrospective cross-sectional study was conducted in the Neurosurgery Department, Mayo Hospital, Lahore, in which a sample size of 50 cases was calculated over a period of 6 months from January 1, 2022, to June 30, 2022. The included cases were patients who suffered from moderate-to-severe TBI, isolated TBI, needed elective ventilation, required intensive care unit (ICU) admission during their hospital stay, and were between the ages of 18 and 65 years. All the rest were excluded. A structured proforma was used by the physician to collect data after the informed consent of the patient. The results were computed and analyzed statistically using Statistical Package for Social Sciences , version 26. Results The median age of patients was 40 (interquartile [IQ] range 34) years and were predominantly male (72%). The most common mode of injury was road traffic accidents (58%). The median Glasgow Coma Scale (GCS) score at arrival was 8 (IQ range 6) and the most common pupillary light reflex at presentation was bilaterally equally responsive to light (68%). Neurologic deficits were mostly absent or cannot be assessed on presentation (86%) and in 38% of the cases multiple findings were noted on computed tomography (CT) scan while among single findings seen on CT scan, subdural hematoma was the most common (22%). Multiple regression analysis was done through two separate models using age, gender, mode of injury, presenting GCS score, number of CT-scan findings, number of days after endotracheal intubation after which tracheostomy was done, and the timing of tracheostomy (early vs. late) as predictors, and a significant relationship was noted between the timing of tracheostomy (early vs. late) and GCS at discharge ( p = 0.001) as well as extended Glasgow Outcome Score (GOS) at discharge ( p = 0.013). Conclusion This study suggests that moderate-to-severe TBIs are most common in middle-aged males and mostly involve road traffic accidents. In most cases, multiple CT-scan findings are seen as compared with a single predominant finding. In such patients, early tracheostomy is superior to late tracheostomy as it results in significantly better GCS and GOS scores at discharge as well as a decreased duration of mechanical ventilation and ICU stay.