Group Mean Age Research Articles

FORENSIC IMPLICATIONS OF CARPAL TUNNEL SYNDROME IN RELATION TO RADIOLOGICAL AND ORHOPEDITION

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with significant clinical and forensic implications. The condition is characterized by compression of the median nerve within the carpal tunnel, leading to pain, tingling, and functional impairment. Accurate diagnosis is crucial not only for clinical management but also for forensic evaluations, especially in cases of occupational claims and medico-legal disputes. Objective: The purpose of this research is to investigate the forensic consequences of carpal tunnel syndrome regarding radiographic and ophthalmic examinations. Methods: This prospective study included 180 individuals, aged 18 to 65 years, of both genders. This study was conducted at the Department of Forensic Medicine LUMHS from January 2023 to June 2023. Group I comprised 90 patients diagnosed with CTS, while Group II included 90 individuals without CTS, serving as controls. Demographic data, including age, sex, and BMI, were recorded. CTS was confirmed using ultrasonographic and other diagnostic modalities. The cross-sectional area of the carpal tunnel at the pisiform (CSAp) and the carpal tunnel at the hook of the hamate (CSAc) was measured. Delta CSA was calculated as the difference between CSAc and CSAp. Sensitivity and specificity for CTS diagnosis were evaluated. Statistical analysis was performed using SPSS Version 26.0. Results: The study found a predominance of females in both groups, with 63 (70%) females in Group I and 58 (64.4%) in Group II. The mean age in Group I was 47.34 ± 8.58 years with a mean BMI of 25.13 ± 10.49 kg/m², while Group II had a mean age of 49.53 ± 12.74 years and a BMI of 26.34 ± 11.61 kg/m². Group I demonstrated significantly higher CSAc values (18.5 ± 3.35 mm²) compared to Group II (9.8 ± 7.25 mm²; p < 0.004). The delta CSA was also higher in Group I (7.37 ± 8.32 mm²) compared to Group II (1.3 ± 2.13 mm²; p < 0.005). The CSAp values showed no significant differences between groups (Group I: 9.4 ± 3.6 mm²; Group II: 7.12 ± 9.6 mm²). A delta CSA threshold of 2 mm² demonstrated high diagnostic accuracy, yielding a sensitivity of 99.1% and specificity of 100% for Group I wrists. Conclusion: Delta CSA is a highly reliable parameter for diagnosing CTS, surpassing CSAc in accuracy. Advanced ultrasonographic techniques, including high-frequency probes and enhanced power Doppler imaging, represent the gold standard for CTS diagnosis, providing robust evidence for both clinical and forensic applications.

Conventional Versus Two Ports Plus One Puncture Laparoscopic Cholecystectomy: A Clinical Trial

Background: The gold standard treatment for calculus cholecystitis is laparoscopic cholecystectomy (LC). In the conventional laparoscopic cholecystectomy (CLC), three instruments are most useful in ensuring the critical view of safety. The two ports plus one puncture laparoscopic cholecystectomy (TPPOP LC) assisted needle grasper approach upholds the laparoscopic triangulation principles and allows an accessible critical view of safety. This technique successfully reduces port numbers while maintaining equivalent surgical outcomes. Method: The main objective is to compare clinical outcomes of conventional and two ports plus one puncture laparoscopic cholecystectomy. This is a single-center hospital based interventional double-blinded randomized controlled trial that included 98 patients undergoing laparoscopic cholecystectomy at No. (1) Military Hospital (700 bedded) from 01/12/2019 to 31/07/2021. The patients were randomized into group A (CLC) (n = 49) and group B (TPPOP LC) (n = 49). This trial was registered in the ISRCTN registry with the registration number ISRCTN50339464. Results: Among total of 98 patients, 46.9% were male patients and 53.1% were female patients. Mean age in group A was 49.86 ± 7.77 years and in group B was 49.33 ± 7.69 years. Mean operation time in group A was 57.9 ± 6.7 minutes and in group B was 58.5 ± 7.1 minutes, with no significant difference (p = 0.66). Although 4.1% of patients in CLC group and 12.2% in TPPOP LC group experienced bile spillage, no other major intraoperative complications were noted. A significant difference was observed at 36 and 48 hours postoperatively (VAS: 2.69 ± 1.16 in group A and 1.94 ± 0.83 in group B at 36 hours; p = 0.005 and VAS: 1.69 ± 0.92 in group A and 1.33 ± 0.63 in group B at 48 hours; p = 0.002). Postoperative minor wound infection was detected 6.1% in group A and 4.1% in group B (p = 0.64). The mean duration of the postoperative hospital stay was 5.24 ± 1.01 days in group A and 4.98 ± 0.92 days in group B (p = 0.17). Conclusion: This clinical trial concludes that two ports plus one puncture laparoscopic cholecystectomy is as effective and safe as conventional four-port laparoscopic cholecystectomy.

Case–control Comparative Study of Porous Metal Augments versus Bone Graft in Management of Segmental Acetabular Defect in Hip Arthroplasty Procedures

Abstract Introduction: Acetabular bone loss represents a great challenge during hip arthroplasty procedures. This study aims at evaluating the efficacy and functional outcome of cost-friendly alternatives (autograft or allograft) when compared to the porous metal augments during reconstruction of acetabular defects in either complex primary or revision total hip replacement. Patients and Methods: This is a retrospective matched control study for evaluation of short and midterm results of metal augments versus bone graft during hip arthroplasty procedures. Inclusion criteria included adult patients who suffered from segmental acetabular defect and underwent hip arthroplasty procedure. The study included 34 cases divided into 2 groups. Group 1 cases were reconstructed with augment reconstruction. Group 2 was the control group which was reconstructed using graft reconstruction. Results: The mean age for Group 1 was 52.29 years (range: 30–68) and for Group 2 was 52.1 years, (range from 32 to 71 years). The mean follow-up period was 74.8 months in Group 1 (range: 66–85 months) and 71.5 months in Group 2 (range: 60–102 months). Both the groups included 13 males and 4 females. Group 1 had a mean postoperative Harris Hip Score (HHS) of 90.5 (range from 85 to 94), and Group 2 had a mean postoperative HHS of 88.7 (range from 80 to 94) with P = 0.236. Conclusion: Acetabular reconstruction using cost-friendly alternatives shows similar short-to-midterm results when compared to trabecular metal augments in a budget-conscious health setting.

Association of Chronic Urticaria With Hepatitis C Infection In Female Patients Visiting Tertiary Care Hospital In Pakistan

Objective: To evaluate association of chronic urticaria with hepatitis C infection in female patients. Study Design: comparative cross-sectional study. Place and Duration of Study: Fauji Foundation Hospital Rawalpindi. One-year duration (Jan 2020-Jan 2021). Methodology: One Hundred female patients (group 1) of age 60 years or less with chronic urticaria were enrolled in this study. Patients with chronic liver disease or signs of hepatic decompensation were excluded. Equal number of age and gender matched patients not having urticarial symptoms were selected as group 2. Anti-Hepatitis C Virus Antibody (HCV ab) was evaluated by Enzyme linked immunosorbent assay (ELISA). Disease severity was calculated by Urticaria activity score 7(UAS 7). Association of HCV infection with chronic urticaria and its severity was analyzed by applying appropriate statistical tests. Results: Anti HCV antibody positivity frequency was 14/100(14%) in group 1 and 4/100(4%) in group 2 (p value: 0.013; significant). Mean ages in group 1 and 2 were 39.88+1.38 and 38.79+1.35 years respectively (p value: 0.57; insignificant). Mean UAS 7 calculated in the HCV negative Urticaria cases was 6.73+2.94 while it was significantly higher in HCV positive group i.e. 8.78+6.459 (p value 0.01). Frequency of HCV positivity in patients with well controlled urticaria and mild urticaria was 6/59(10.0%) and 5/36(13.8%) respectively while in moderate urticaria was 3/5(60%) which was significantly higher (p value 0.04). Conclusion: There is a significant association of chronic urticaria with anti HCV antibody positivity. HCV positive patients have more severe disease as compared to HCV negative patients.

AHP SO04 - ''Effectiveness of a surgical wound care bundle for reducing surgical site infection after emergency abdominal surgery''

Abstract Background Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery. Method This cross-sectional analytical study was carried out with a total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24. Results Mean age of Group A and Group B was 44.88 ±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p<0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p>0.05).Group-B patients had higher frequency of SSI development compared to Group-A(43.3% vs. 15%, p-0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p<0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075). Conclusion Surgical wound care bundle reduce surgical site infections in patients with emergency surgery. However, further multicenter studies are warranted.

Functional Outcome of Cast Immobilisation and Functional Treatment in Management of Lateral Ankle Sprain (Grade 1 and 2)

Background: Pain and functional constraints from ankle sprains, which mostly impact the lateral ligamentous complex, can lead to the consumption of medical facilities and unavailability from workplace. No single technique is regarded as the most effective, despite the fact that this injury occurs frequently. This study evaluates the management modalities for lateral ankle sprain i.e. functional treatment and cast immobilization with pain and function as outcome variables.  Materials and methods: Seventy patients with lateral ankle sprains (grade 1 and 2) were included in this study. Each alternate participant was placed in a functional treatment (group A), while the other participants were placed in a cast immobilization group (group B). Every patient was assessed at a follow up of 2 and 6 weeks using Visual analog scale and Karlsson score for quantifying pain and function respectively.  Results: Thirty-two patients in the functional therapy group and twenty-eight in the cast immobilization group finished the study. The functional therapy group's mean age was 27.7 years, while the cast immobilization group's was 29.4 years. While both the right and left ankles were similarly impacted in the cast immobilization group, the dominant ankle involved in the functional treatment group was the right ankle in 19 patients and the left ankle in 16 patients. In both groups, a male preponderance was seen. By the end of the study, the mean differences between the two groups' Karlsson scores and visual analog scale scores were statistically significant.  Conclusion: Our study's findings show that a functional treatment outperforms immobilization in terms of both functional outcome and pain reduction.

Assessment of Insulin Resistance, HOMA-IR, and QUICKI Levels in Patients with Endometrial Cancer and Hyperplasia

Aim: To analyze insulin resistance and related parameters in patients with endometrial cancer and hyperplasia. Methods: The study included 102 patients in 3 groups. Group I and II included patients with a histologic diagnosis of endometrial cancer (n=41, 40.2%) and endometrial hyperplasia (n=31, 30.4%) based on the final pathology report. Group III was the control group and included patients who had undergone surgery for a benign indication other than endometrial hyperplasia (n=30, 29.4%). Age, body mass index (BMI), menarcheal age, menopausal status, gravidity, parity score, diabetes, oral contraceptive status, fasting glucose levels, insulin levels, endometrial thickness, HOMA-IR and QUICKI scores were assessed. Results: The mean age of group I was statistically higher than that of group II (55.3±9.5 vs. 48.8±7.1, p=0.002). The average BMI of the two groups was similar (p=0.076). When fasting glucose values were evaluated, group I showed significantly higher values compared to group II. The mean insulin and HOMA-IR values in the control group were significantly higher than those in group I (p

Comparative Study Of Fentanyl Versus Tramadol As Adjuvant With Low Dose Local Anaesthetic Ropivacaine (0.1%) For Epidural Labour Analgesia

Background: Epidural nerve block is widely used for labor analgesia because of its effective pain relief, reduced maternal stress response, improved parturient satisfaction, and potential ability to provide anesthesia. The quality of analgesiais improved with the combined use of a local anesthetic and an opioid when combined with the use of either agent alone. An example of avcombination epidural therapy that provides excellent sensory block with relatively little motor block includes a co-administration of ropivacaine and fentanyl or tramadol. Materials and Methods: The study was carried out at the Department of Anaesthesiology, Katihar Medical College & Hospital, Katihar, Bihar, study was done for 1 Year, 100 individuals were enrolled, Group F (Fentanyl Group) with 50 patients received Ropivacaine and Fentanyl and Group T (Tramadol Group) with 50 patients received a Ropivacaine and Tramadol. Every variable was subjected to statistical analysis within the same individual and between 2 treatment categories using a suitable biostatistical methodology. Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 23.54±2.5, mean age in group T (ropivacaine with tramadol) was 23.86±2.17, and weight in group F was 56.78±2.75 and group T was 56.68±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (p>0.05). More side effects were seen in group F. Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

Effect of Propofol and Isoflurane on Hemodynamic changes during Spinal Surgery Under General Anesthesia

Background: Hemodynamic stability are vital requirements of up-to-date anesthesia. Both propofol and isoflurane meet these criteria though the clinical effects like postoperative nausea vomiting after administering propofol and isoflurane have been studied in various surgeries but have not been much evaluated or studied in patients undergoing major surgical procedures like spine surgeries, There’ is definite advantage of one technique over the other. Isoflurane has a low blood gas partition coefficient, which contributes to rapid induction and emergence from anaesthesia than with other volatile anesthetics in current clinical use. Propofol has been established as the intravenous agent that provides faster and smoother recovery & peri operative hemodynamic stability. Objective: To compare the effects of isoflurane and propofol regarding hemodynamic status in spinal surgery under general anaesthesia. Methods: After getting ethical approval, a randomized controlled trial study design was performed where patients were selected in the pre-anesthetic checkup room based on inclusion and exclusion criteria for those who were scheduled for spine surgeries under general anesthesia is admitted in the Department of Neurosurgery in East West Medical College from January 2023 – December 2024. A total number of 40 patients were selected. 20 patients were enrolled each in group A and group B by lottery method in a sealed envelope. They were divided into two groups by randomization; Group A and Group B. A written informed consent was taken from all selected patients. Patients were advised to fast for at least 8 hours before intervention. In Group A, anesthesia is maintained with propofol infusion, nitrous oxide (66%), and oxygen (33%) while in Group B, anesthesia is maintained with Isoflurane, nitrous oxide (66%), and oxygen (33%). All patients were given N2O in oxygen and 1.25% inspired concentration of Isoflurane (MAC -1.15). In Group A propofol infusion at rate of 80 μg/kg/min (fixed from the beginning). All data was collected at –Just after starting, 15 minutes, 30-minute, 1 hour, and >1 hour interval per operatively. Data was compiled, edited and plotted in tabular and figure form. P value was determined as significant when it was <0.05. Results: 40 patients yielded the following results. The mean age of Group A and B were 32.56±12.55 years and 34.6±12.5 years. Mean difference of heart rate was lower in Group A than that of Group B. Other parameters in both groups were confined to good and acceptable categories. But interestingly, there was a statistically significant difference found between Group A and Group B in Systolic Blood Pressure (SBP) & Diastolic Blood Pressure (DBP). The scoring was far better in Group A than Group B. Mean SBP was higher in Group B than Group A (p= >0.05). Similarly, mean DBP was also higher in Group B than Group A (p = >0.05). Conclusion: Propofol is better for maintaining hemodynamic status than Isoflurane for Spine surgery under General anaesthesia. EWMCJ Vol. 12, No. 1&2, January-July 2024: 21-26

Revascularization strategies in elderly patients with acute coronary syndromes and multivessel disease: comparative analysis of culprit-only vs complete revascularization

Abstract Background Acute coronary syndromes (ACS) are more challenging in elderly patients, particularly when related to multivessel disease (MVD). Concerns about outcomes, and the lack of evidence, lead to more conservative treatment. While benefits of complete revascularization are well established among the youngest, doubts persist in older patients. Despite FIRE trial having showed superiority of complete revascularization with coronary physiology, in older patients with ACS and MVD, more evidence is needed. Methods Multicenter retrospective cohort of 629 patients, older than 75 years, with ACS and MVD, was divided into complete or culprit-only revascularization groups. In-hospital outcome of death and major adverse cardiovascular events (MACE) and follow-up outcome of death and cardiovascular hospital admission were assessed. Results From the 629 patients, 383 (61%) were submitted to PCI, of which 66% (n=254) were submitted to culprit-only revascularization and 34% (n=129) to complete revascularization. Culprit-only group's mean age was 83±5 years and median age in complete revascularization group was 81 (IQ 78-84) years. There was similar number of female patients in both groups (42% and 37%, p=0,26), and the culprit only group was significantly older (p=0,006). There were more ST-segment elevation myocardial infarctions in culprit- only group (p<0,001). Regarding diabetes, previous ACS, Killip classification, heart failure, stroke, peripheral artery disease, and chronic kidney disease, there were no statistically significant differences between groups (p>0,05). Complete revascularization was associated with lower in-hospital events, with 36% against 48% in culprit-only (p=0,025 OR 0,62 [0,4-0,9]), mainly due to lower in-hospital deaths, with 3% against 13% (p<0,01 OR 0,3 [0,15-0,67]) but also due to lower in-hospital MACE with 29% against 27% (p=0,02 OR 0,6 [0,4-0,9]). The mean follow-up was 13±7 months, during which, in complete revascularization group, there was non-statistically significant decrease of deaths, with 13% against 15% (p=0,4), hospital readmissions, with 21,8%, in comparison with 24,9% (p=0,2), and composite outcome, with 35% and 40% (p=0,16) of composite events in the culprit-only group There was a non-statistically significant decrease of the mean for survival time for culprit only group which was 10±8 months comparing with complete group of 13±8 months (p=0,16). Conclusion In older patients with ACS and MVD the ideal strategy is yet to be determined. Still complete revascularization strategy showed a statistically significant decrease of in-hospital death and MACE, and non-statistically significant decrease in follow-up mortality and readmissions. This study suggests, like FIRE trial, that when clinically and anatomically feasible, it seems legit to attempt complete revascularization in elderly patients with ACS and MVD.

Comparative Analysis of Critical Shoulder Angle and Acromion Index in Patients with or without Rotator Cuff Tear

Background: Recent evidence suggests that a high value of radiographic acromial indices such as critical shoulder angle (CSA) and acromial index (AI) may be associated with a higher incidence of rotator cuff tears (RCTs). The objective of this observational study was to evaluate the relationship between RCTs, CSA, and AI. Materials and Methods: We divided 68 patients with shoulder pain into two groups: Group 1, RCT and Group 2, normal cuff. Patients were evaluated with standard true anteroposterior (AP) radiographs. CSA and AI were calculated on true AP X-ray. Twenty-four males and 10 females were selected for Group 1 whereas 23 males and 11 females for Group 2. Results: The mean age for Group 1 was 53.23 years and for Group 2 was 47.53 years. CSA findings (mean ± standard deviation [SD]) were 37.5 ± 4.37 for Group 1 and 32.23 ± 3.19 for Group 2. Mean ± SD for AI were 0.72 ± 0.07 and 0.66 ± 0.09 for Groups 1 and 2, respectively. CSA and AI revealed a statistically significant P < 0.0001 for both groups. Logistic regression confirmed CSA and AI to be strong predictors of an RCT. Conclusions: Higher CSA and AI are associated with degenerative RCT. Level of Study: Level III.

Efficacy of Topical Finasteride 0.25% With Minoxidil 5% Versus Topical Minoxidil 5% Alone in Treatment of Male Pattern Androgenic Alopecia.

Androgenetic Alopecia (AGA) (male pattern hair loss) is the most common form of alopecia in men, affecting 30% of men by the age of 30 years and 50% by the age of 50 years. To compare the efficacy of topical finasteride 0.25% with minoxidil 5% versus topical minoxidil 5% alone in the treatment of male pattern androgenic alopecia. A total of 164 male patients aged between 30 and 60 years, presenting with androgenic alopecia of more than 2 months duration, were included in this single-blind study conducted at the Department of Dermatology, JPMC, Karachi. The patients were randomly divided into two groups: Group A (topical finasteride 0.25% with minoxidil 5%) and Group B (topical minoxidil 5% alone). Patients were followed up for 12 weeks, and hair regrowth was assessed at each visit. The mean age in Group A was 33.99±5.97 years, and in Group B, it was 33.91±5.71 years. At baseline, the mean salt score was 1.8±0.7 in both groups. The efficacy of the treatment was significantly higher in Group A (86.7%) compared to Group B (69.1%; P=0.006). The combination of topical finasteride 0.25% with minoxidil 5% provides superior efficacy in the treatment of male pattern androgenic alopecia compared to topical minoxidil 5% alone. These findings support the use of this combination therapy as a potential treatment option for patients with androgenic alopecia. J Drugs Dermatol. 2024;23(11):1003-1008. doi:10.36849/JDD.7826.

Evaluation of some haematological, liver, and renal function biomarkers in different job categories at Kufa cement factory workers: a cross-sectional study.

To evaluate the workplace health-related environment of workers in various job categories at a cement factory. The cross-sectional study was conducted at the Kufa Cement Factory, Najaf, Iraq, from November 12, 2021, to January 12, 2022 and comprised adult male non-smoking factory workers in group A, and healthy, unexposed non-smokers in control group B. Subjects in group A were subdivided into factory, kiln and packing workers. All the participants were subjected to blood tests for liver and kidney functions. Data was analysed using SPSS 27. Of the 90 subjects, 45(50%) were each of the 2 groups. The mean age of group A workers was 46.581±1.559 years and they had a mean duration of exposure 15.953±0.873 years. There were 15(33.3%) factory workers and as many kiln and packing workers. Group A subjects worked for at least 7-8 hours per day. The subjects in control group B had a mean age of 45.01±8.17 years and were matched for gender. There was significant elevation in total leukocyte count, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase in group A compared to group B (p<0.05). Neutrophils were significantly high in factory workers than controls and packing workers (p<0.05), while total bilirubin level was significantly high in factory and kiln workers than controls (p<0.05). There was no significant difference in the mean serum creatinine level between the groups (p>0.05). Workplace exposure to cement particulate in a factory environment was found to have a harmful impact on health.

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population. Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children. Study Design: Prospective comparative study. Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024. Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations. Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287). Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Analysis of retinal thickness using spectral domain optical coherence tomography in hypertensives and normotensives: A comparative study

: The change in the retinal thickness is the indicator of retinal disease. These changes can be measured with Spectral-domain optical coherence tomography (SD-OCT). This study was conducted to compare the central macular thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell inner plexiform layers (GCIPL) thickness using SD-OCT in hypertensive and normotensives.: All patients with systemic hypertension above the age of 18 years were included in Group A and the age-matched normotensive patients in group B. A history of hypertension was obtained and blood pressure was measured. A standard eye examination and retinal imaging were performed using SD-OCT. The main parameters studied were CMT, RNFL, and GCIPL. An odds ratio and t-test were performed. A probability value of &amp;#60;0.05 is considered significant.: There were 60 eyes in each group. The mean age in group A was 52.43±10.35 years. The mean standard deviation of the duration of hypertension in group A was 6.41±6.28 years. The mean standard deviation CMT was 251.03±18.25µm and 256.77±15.09µm in group A and B respectively. There was no statistically significant difference in CMT of hypertensive and normotensives. The hypertensive patients had significant thickening of RNFL in the nasal quadrant compared to normotensive individuals.: The present study supports the concept that CMT is less likely to be influenced by systemic HTN. RNFL thickness may increase in hypertensives compared to normotensives.

Comparing surgical techniques: ThuLEP and transurethral BPEP for prostate over 80 grams. Intraoperative and postoperative results. A prospective randomized trial

ABSTRACT Background and purpose Though TURP remains the primary treatment for BPH, advancements in energy and technology have introduced innovative transurethral surgical options. In this study, we assessed and compared the effectiveness and safety of using thulium laser and bipolar for endoscopic enucleation of prostate exceeding 80 g. Patients and methods Between January 2022 and July 2023, this study enrolled patients with LUTS due to BPH and a prostate size of ≥80 g. Group A underwent the BPEP procedure using a 26 Fr continuous flow resectoscope with plasma kinetic system enucleation loops, while Group B underwent the ThuLEP procedure using a 120–200 W Revolix DUO® Thulium laser. Data collection included prostate size, PSA levels, enucleation and morcellation time, and postoperative IPSS and IIEF-5 scores at one, 3, 6, and 12 months. Results A total of 108 patients, divided into Group A (BPEP) and Group B (ThuLEP), completed a 12-month follow-up. The mean age for group A was 67.72 ± 7.02 compared to group B which was 62.33 ± 5.86. While Group A compared to group B had higher mean enucleation (75.22 ± 10.55 vs. 67 ± 12.18) and total operative times (117.22 ± 17.76 vs.90.5 ± 18.29) (p = 0.037 & <0.001 respectively), no significant differences were observed in resected tissue weight, blood transfusion, and morcellation time. The ThuLEP group exhibited a shorter mean catheter period 2.94 ± 0.94 d compared to BPEP 3.33 ± 0.91 d and shorter mean hospital stay period of 1.94 ± 0.54 compared to2.11 ± 0.32, though not statistically significant. Postoperative outcomes, including IPSS, Qmax, PVRU, and IIEF-5 at 1, 3, 6, and 12 months, showed no differences between the groups. Conclusion ThuLEP shows better perioperative parameters in comparison to BPEP. Nevertheless, there are no notable differences in functional results and complications between the two techniques.

THE EFFECT OF PRE-MEDICATION WITH ORAL STEROIDS ON INTRA-OPERATIVE BLEEDING IN PATIENTS WITH CHRONIC RHINOSINUSITIS UNDERGOING FUNCTIONAL ENDOSCOPIC SINUS SURGERY.

An inflammation of the nasal and paranasal sinus mucosa that lasts longer than three months is known as chronic rhinosinusitis. When corticosteroids and other medicinal treatments fail to relieve a patient's symptoms, then functional endoscopic sinus surgery (FESS) is a commonly performed procedure to alleviate the symptoms. The aim of the study was to evaluate the impact of oral steroids given prior to surgery on intraoperative bleeding in patients having functional endoscopic sinus surgery for chronic rhinosinusitis. The study was conducted in ENT Department of Shifa Foundation Community Health Centre (SFCHC) and Shifa International Hospital (SIH) Islamabad, in a period of three years from June 2019 to June 2021. A total of 72 patients consisting of 36 patients in study group and 36 in control group, fulfilling the inclusion criteria were included in the study. Per-operative bleeding was assessed by measuring the amount of blood collected in suction bottle at the end of the procedure (the amount of saline used during the procedure was subtracted) and the number of surgical gauzes stained with blood (1 partially stained gauze = 5 ml and 1 completely stained gauze = 10 ml). The surgeon performing the surgery was unaware of the study group of the patient. All the collected data was entered and analyzed with SPSS v. 25. The mean age of group A (35.39±13.86 vs. 29.83±15.86, p-value > 0.05) was similar to group B. There was male dominance in both group (69.4% vs. 72%) males in group A and group B. Nasal obstruction and nasal discharge was observed in all patients of both groups. Post nasal drip (88.9% vs. 88.9%), headache (97.2% vs. 91.7%) and facial pain (97.2% vs. 94.4%) was present in majority patients of both groups without any significant (p-value >0.05) difference. Both the groups were compared on the basis of amount of blood loss per-operatively and it was seen that the mean blood loss in group A was (164.03±42.99 ml) significantly (p-value <0.05) lower as compared to (215.83±39.397 ml) in group B. This study showed that individuals with nasal polyps receiving preoperative steroids could successfully lower their perioperative morbidity, specifically intraoperative haemorrhage, after undergoing functional endoscopic sinus surgery.

Supraclavicular Brachial Plexus Block with and without Dexamethasone as Local Anaesthetics

Background: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block. Methods: In this prospective randomized, controlled, double blinded study which was conducted at Department of Anesthesia, 250 Beded Hospital, Lalmonirhat, Rangpur, Bangladesh from January to June 2023. We included 70 ASA I &amp; II patients who were aged between 18 years &amp; 60 years, underwent elective upper limb surgeries. They were divided into two equal groups. Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg (2ml). Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline (2ml). We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups. Results: In this study of patients according to their age and weight. 37.26±15.55 years were mean age in group 1 and in group 2 it was 36.56±16.86 with p value being 0.8678. 58.466± 3.9642 kg was the mean weight in group 1 and in group 2 it was 60.4±4.95 kg with p value of 0.1002. So both the groups were comparable in terms of age and weight. In this study out of 70 patients, group1 consisted of 68.6% males whereas there were 60% in group 2 and group 1consisted of 31.4% of females and 40% in group2, hence males’ outnumbered females in both the groups. The mean duration of surgery in group 1 was 50±19.95 minutes and in group 2 were 46.6±15.55 minutes with p value of 0.4646. There was no statistical difference between both the groups. The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes. The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min. The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes. The duration of post-operative analgesia was 815±13.57 minutes in group 1. The duration of post-operative analgesia in group 2 was 393.8±42.88 minutes. There were no complications in both the groups in intra operative period and post-operative period. Conclusion: Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.

Experience with the use of hyaluronic acid solution (Diart) in the treatment of patients with degenerative-dystrophic diseases of the hip joint

Background. Degenerative-dystrophic diseases of the joints are chronic progressive pathological conditions, accompanied by such features as presence of pain syndrome, impaired functional capacity, muscle weakness, deformation and instability of the joints. The high prevalence of degenerative-dystrophic diseases of the hip joint necessitates the search for optimal non-invasive treatment methods. Objectives. This study aims to analyze the clinical results of intra-articular injections of hyaluronic acid solution (Diart) in the treatment of patients with II–III stages of degenerative-dystrophic diseases of the hip joint. Materials and methods. The clinical results of 30 patients with II–III stages of degenerative-dystrophic diseases of the hip joint were analyzed. The group included 11 (36.67%) males and 19 (63.33%) females. The mean age of group was 61.43±7.98 years. All patients underwent a course of drug therapy using hyaluronic acid solution (Diart), which included 3 intra-articular injections of the drug, which were performed with the 7-day interval. Clinical results were evaluated at the initial visit, at 7, 14, 30 and 90 days after the first injection of Diart by objective examination of patients and analysis of subjective data using the WOMAC questionnaire. Statistical analysis was performed using Statistica 13 software package. Results. The high effectiveness of intra-articular injections of hyaluronic acid (Diart) in the treatment of patients with II-III stages of degenerative-dystrophic diseases of the hip joint and the absence of complications associated with intra-articular injection of the drug have been established. Signs of post-injection sy- novitis, discomfort, swelling or other unpleasant sensations weren’t observed in any of the examined patients. Comparing the results established during remote period, on the 90th day of observation, and indicators determined at the initial visit, we proved a decrease in the intensity of the pain syndrome in the hip joint by 30.35%, in stiffness — by 29.57%, an improvement in the indicators characterizing the functional capacity by 21.34 % and the total values of the WOMAC index — by 27.37%, after a treatment course using Diart. Conclusion. The high efficiency of using intra-articular injections of hyaluronic acid solution (Diart) in the treatment of patients with II–III stages of degen- erative-dystrophic diseases of the hip joint has been proven.

Comparison of cellular versus acellular amnion in facial burns at burn center of Punjab: Our experience.

Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing. Objective: To compare the effectiveness of cellular versus acellular amnion in patients with superficial facial burns at tertiary care hospital burn center of Punjab. Study Design: Randomized Control Trial. Setting: Department of Burn and Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st September 2020 to 31st December 2021. Methods: A total of 60 patients who fulfilled the inclusion criteria were recruited after the informed consent and were randomly divided into two groups with 30 patients in Group A and 30 patients in Group B. Group A patients had acellular amnion application and Group B had cellular amnion application over the superficial facial burns. The data was noted on a predesigned proforma and analyzed by using IBM-SPSS.Version.25 and was compared in terms of outcome measures. Results: The mean age in Group A and B was 37.79.86 and 38.19.37(range20-70 years) respectively and mean pain score was 8.50.937 in group A and 8.70.897 in group B. Hypersensitivity reaction was seen in 13.33% in group A vs 26.67% patients in Group B, infection rate of 8.33% in Group A vs 25% in Group B, Healing in 31.67% vs 18.33% in Group A and B respectively while in Group A the need for skin graft was noted in 8.33% vs 20% in group B patients and the difference was significant statistically (p=0.045). Conclusion: Application of Acellular amnion is better choice than Cellular amnion over facial burns with less hypersensitivity reaction, infection rate, need of skin graft and with improved wound healing.