Mean Scores Of Patients Research Articles

Examination of the relationship between health literacy and health perceptions in hemodialysis patients

Introduction: Patients’ high levels of health literacy and positive perception of health are effective in their compliance with the treatment. Objectives: The aim of this study was to examine the relationship between health literacy and the perception of health of hemodialysis patients. Patients and Methods: In the study, the sampling method was not performed, but it was performed with patients who received hemodialysis treatment and fulfilled the research criteria within the 3-month period. The descriptive study was conducted with a total of 110 patients in two dialysis centers Sivas province of Turkey. Results: Data were collected using the patient information form, Health Literacy Index (HLI) and perception of health scale (PHS) to determine demographic characteristics. Around 56.4% of the patients had been receiving hemodialysis treatment for 0-4 years. The mean score of patients’ health literacy was 77.40±12.94, and they received the highest score from the appraisal of the subscales. Perception of health mean score was 47.56±4.10. When sociodemographic characteristics were examined, health literacy levels were found to be high in males between the ages of 36-45 years, those with a long duration of chronic kidney disease (CKD) and those with higher education level. Conclusion: According to results patients’ health literacy and disease perception were found to be slightly above the middle level. We found a positive relationship between health literacy level and perception of health, and patients’ health literacy since the perception of health should be increased in order for the hemodialysis treatment process to be effective.

Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study.

BackgroundColonoscopy is the method of choice to evaluate colonic mucosa and the distal ileum, allowing the diagnosis and treatment of many diseases. Appropriate bowel preparation necessitates the use of laxative medications, preferentially by oral administration. These include polyethylene glycol (PEG), sodium picosulfate, and sodium phosphate (NaP). Lactulose, a semi-synthetic derivative of lactose, undergoes fermentation, acidifying the gut environment, stimulates intestinal motility, and increases osmotic pressure within the lumen of the colon.MethodsIn this prospective randomized controlled study, we analyzed 40 patients who presented with symptomatic bleeding per rectum and underwent bowel preparation either with lactulose or polyethylene glycol for colonoscopy. The quality of bowel preparation and other variables like palatability, discomfort, and electrolyte levels were analyzed.ResultsThe majority of the patients (90%) were comfortable with the taste of lactulose solution, whereas the PEG group patients (55%) were equally divided on its palatability. On lactulose consumption, 40% of patients reported nausea/vomiting and around 10% of patients complained of abdominal discomfort. Serum sodium levels showed insignificant changes from 4.33 ± 0.07 mEq/L to 4.21 ± 0.18 mEq/L while potassium also remained similar from 4.26 ± 0.03 mEq/L to 4.22 ± 0.17 mEq/L. The mean Boston Bowel Preparation Score (BBPS) in patients who received lactulose solution was 6.25 ± 0.786 and in those who received PEG solution, it was 6.35 ± 0.813 (P-value = 0.59).ConclusionsLactulose is a significantly more palatable form of bowel preparation and causes minor discomfort. It has a good bowel cleansing action comparable to PEG without causing any hemodynamic changes. It can be considered a cheaper and safe alternative for bowel preparation in colonoscopy in low-resource settings.

Observation of the curative effect of intraocular lens in patients with cataract and establishment of the intraocular lens database.

Intraocular lenses are widely used in the treatment of cataract patients, but currently clinical, procedural and product information is incomplete in many hospitals and there is an urgent need for a database to improve surgical safety, and outcomes. Data on the brand and specifications of the intraocular lens, and the postoperative outcome of cataract patients after intraocular lens implantation from January 2017 to June 2018 were collected to create an intraocular lens database as an online public platform. A total of 96 cataract patients were divided into groups A and B based on preoperative corrected visual acuity. At 3 months after surgery the visual acuity of patients in group A recovered from 1.51±0.19 to 0.76±0.18, and the in group B it recovered from 1.02±0.27 to 0.49±0.13. Overall, the postoperative visual acuity of all patients improved significantly (P<0.001). We also used the NEI-VFQ-25 visual function questionnaire to evaluate the visual function of the patients before and after surgery. At 3 months after surgery, the mean score of patients in group A increased from 21.89±14.21 to 59.97±18.29 and in group B it increased from 38.26±17.57 to 70.28±12.37. Overall, the patients' postoperative scores increased significantly (P<0.001). Cataract phacoemulsification and intraocular lens implantation can effectively and safely restore and improve the visual function of cataract patients. Information sharing through establishment of an intraocular lens information database will assist in further advances and consistency in the treatment of cataract patients.

Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection.

Background: COVID-19 pneumonia is responsible for the latest pandemic. Usage of pulmonary computed tomography (CT) scan is known to be an important method in the diagnosis of COVID-19. Here, we aimed to evaluate the relationship between CT severity score and capillary blood oxygen saturation in patients with COVID-19 infection.Methods and material: This is a cross-sectional study performed in 2020 on patients with COVID-19 infection. All patients underwent pulmonary CT scan and CT severity score was calculated. The initial capillary oxygen saturation by the time of admission was also collected. Data were collected and analyzed.Results: A total number of 270 patients diagnosed with COVID-19 infection entered the study. The initial mean capillary oxygen saturation was 89.65 ± 8.09%. The mean score in patients was 15.16 ± 8.08. We also indicated that 27 patients had hypoxia by the time of admission and these patients had significantly higher CT severity scores (p = 0.001). Diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic obstructive pulmonary disease (COPD) (p = 0.03) and totally having an underlying disease (p < 0.001) were significantly associated with decreased capillary oxygen saturation. Patients with hypertension (p = 0.001) and patients with the previous medical disease (p = 0.01) had significantly higher CT severity scores than others. There was a significant reverse relationship between CT severity score and capillary oxygen saturation (r = −0.44, p < 0.001).Conclusions: We showed that there was a significant reverse relationship between CT severity score and capillary oxygen saturation which has great clinical importance. Furthermore, we indicated that previous medical history could also play an important role in CT severity score.How to cite this article: Aalinezhad M, Alikhani F, Akbari P, Haji Rezaei M, Soleimani S, Hakamifard A. Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection. Indian J Crit Care Med 2021;25(3):279–283.

Comparison of Analgesic Efficacy of Transversus Abdominis Plane Block Versus Infiltration of Local Anaesthetic into Surgical Wound In Emergency Laparotomies: A Randomized Control Trial

Objective: To compare mean pain score of bilateral TAP block versus infiltration of local anaesthetic into surgical wound on for emergency laparotomies. Method: Randomized control trial. Emergency Operation Theatre in Department of Anaesthesiology at Mayo Hospital, Lahore from 1st April 2016 to 31st October 2016. Laparotomy 150 patients were arbitrarily allocated two groups Group T (receiving bilateral TAP block) and Group L (local infiltration) by random number table method after informed consent. TAP block was administered bilaterally by using 20ml of 0.25% bupivacaine in group T using a 21-gauge needle with the help of “Double Pop Technique” at midaxillary point at height of umbilicus. While in group L surgical incision site was injected with 20ml of 0.25% bupivacaine immediately after closure of skin. Pain was evaluated by Visual analogue scale (VAS) at 6-hour interval postoperatively. Results were statistically analysed using SPSS version 20.0 and t-test was applied to compare mean pain score of two groups. Results: Mean pain score in patients receiving bilateral TAP block 3.000±0.717 were significantly reduced (p value 0.003) versus mean scores in patients receiving infiltration of local anaesthetic into surgical wound in emergency laparotomies 6.08±1.171. Conclusion: Bilateral TAP block reduced post-operative pain significantly in patients undergone emergency laparotomy. Key Words: Emergency laparotomy, TAP block, local anaesthetic, bupivacaine, post-operative pain, analgesia. How to Cite: Anwar A, Nabi H.A, Bangash L.R, Arshad F, Nawaz S. Comparison of analgesic efficacy of transversus abdominis plane block versus infiltration of local anaesthetic into surgical wound in emergency laparotomies: a randomized control trial. Esculapio.2020;16(04):8-13.

Evaluating memory dysfunction after spinal anesthesia among patients undergoing elective surgery: Descriptive-analytical study

BackgroundAnesthesia has a number of side effects including cognitive impairment after the surgery. Postoperative cognitive impairment is commonly associated with general anesthesia. ObjectiveThe aim of this study is to evaluate the effects of Marcaine (bupivacaine hydrochloride) in memory impairment among patients undergoing elective surgery. Materials and methodsIn this study descriptive-analytical study, patients undergoing elective lower extremity or lower abdomen surgery requiring spinal anesthesia were included. Following 24 h of the surgery, standard Wechsler questionnaire was used to assess memory of the patients. Other demographic and clinical parameters such as age, gender and blood pressure, pulse rate were also recorded. The obtained data was analyzed using SPSSv18. ResultsIn this study, 105 patients where 55 (52.4%) males and 50 (47.6%) females were studied. The mean age of the subjects was 35.73 ± 10.64 years. There was a significant difference between the mean of memory scores in terms of logical memory and overall memory (P < 0.001). There was a significant relationship between the mean scores of patients' rational memory and systolic blood pressure at admission (P = 0.030). There was a significant relationship between mean associative learning scores in patients and systolic blood pressure at admission (P = 0.046) and type of surgery (P = 0.013). Furthermore, overall memory scores were significantly associated with age (P = 0.041). ConclusionBased on the results of this study, it can be concluded that spinal anesthesia had a significant effect on some areas of memory. Further studies in this area can yield more reliable results.

Coronary Artery Calcium Score: Assessment of SYNTAX Score and Prediction of Coronary Artery Disease.

BackgroundWith the advent of modern imaging technologies, non-invasive assessment of the coronary system is not only possible but its complexity and plaque burden can be quantified. This study aims to determine whether calcium score on computed tomography coronary angiography (CTCA) can be associated with the complexity of coronary artery disease (CAD), which is determined by the SYNTAX score on coronary angiography, as well as to determine which cut-off value of coronary artery calcium (CAC) score can predict severe CAD in our population.MethodologyThis was a cross-sectional study conducted at the Rawalpindi Institute of Cardiology, Pakistan from January 2019 to March 2020. The calcium score of all patients with low-to-intermediate pretest probability of CAD was calculated on CTCA. All patients who had significant disease on CTCA were subjected to conventional coronary angiography and SYNTAX score was calculated, which was later used to determine the association between calcium and SYNTAX score.ResultsA total of 90 patients were included in the study. CAC and SYNTAX score were found to be positively correlated (Pearson coefficient [r] = 0.354; p = 0.001). The total CAC score with a cut-off value of 212 recognized patients with the SYNTAX score of >27. The sensitivity was 66.7% and specificity was 70.5% with an area under the curve of 0.743. The mean calcium score of patients in our study group was 223, with the maximum score of 1,216 and the minimum score of zero.ConclusionA CAC score greater than 212 is associated with a high SYNTAX score indicating complex disease. Only age is an independent predictor of calcium score.

An investigation of hospital anxiety and depression and associated factors in COVID-19 patients

Context: The high incidence of anxiety and depression in patients with corona can be associated with serious complications in recovery and increased mortality.Aim: This study was performed with the aim of determining the anxiety and depression of patients with corona and related factors.Setting and Design: This study was conducted in general and special wards (coronary care unit) in Iran (Imam Khomeini and Bu Ali Sina in Sari and Razi hospitals in Ghaemshahr) in 2020.Materials and Methods: Patients were selected by accessible sampling. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression.Statistical Analysis Used: This descriptive-analytical study was performed on 150 patients with Covid-19 admitted. Data were analyzed using SPSS software version 21, descriptive statistics and inferential statistics such as t-test, Chi-square, Fisher, Pearson correlation coefficient, and multiple linear regression test.Results: The mean score of patients' anxiety was 6.83 ± 5.16, and the mean score of depression was 7.09 ± 4.37. According to the multiple linear regression test, depression with standard β (ß =0.53) and with standard β (ß =0.21) explore 42% of variance of anxiety. Anxiety (β =0.56), temperature (β =0.2), anorexia (β =0.18), and respiratory rate (β =0.12) explore 45% of variance of depression, respectively.Conclusion: The results of this study indicated a high prevalence of anxiety and depression in hospitalized patients with corona disease. Therefore, further study of related factors and planning appropriate interventions according to the results of the study is recommended.

Level of Knowledge About COPD Among Patients and Caregivers.

Chronic obstructive pulmonary disease (COPD) represents a major health burden worldwide. COPD-specific education may positively affect the emotional distress associated with the disease and may contribute to the patients' poor health-related quality of life. Studies have shown that education regarding COPD is lacking among disease sufferers. The aim of our study was to evaluate the knowledge of COPD among patients and caregivers. We used the Bristol COPD Knowledge Questionnaire in hospitalized and nonhospitalized patients with COPD and other pulmonary diseases, their caregivers, and healthy volunteers. Mean total knowledge score of patients with COPD was 24.27±8.44, of patients with other respiratory diseases 25.53±7.93, of caregivers of patients with COPD 21.80±5.32, of caregivers of patients with other pulmonary diseases 23.50±8.79, and of healthy subjects 25.85±9.27 (p=0.071). Our data further indicate the lack of knowledge of COPD among patients and their carers and emphasize the need of education programs.

Impact of a Clinical Pharmacist Intervention Program on the Follow-up of Type-2 Diabetic Patients.

The primary aim of this current study was to investigate the impact of the clinical pharmacist interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes in Egypt. A prospective trial was conducted on 100 patients with uncontrolled type 2 diabetes admitted in the diabetes outpatient's clinics. Patients were randomly allocated into the clinical pharmacist intervention group and usual care group. In the intervention group, the clinical pharmacist, in collaboration with the physician had their patients receive pharmaceutical care interventions. In contrast, the usual care group patients received routine care without clinical pharmacist's interference. After 6-month of follow-up, of the average HbA1c and FBG values of the patients in the clinical pharmacist intervention group (HbA1c % from 8.6 to 7.0; FBG (mg/dL) from 167.5 to 121.5) decreased significantly compared to the usual care group patients (HbA1c % from 8.1 to 7.8; FBG (mg/dL) from 157.3 to 155.9) (P < .05). Additionally, the results indicated that mean scores of patients 'diabetes knowledge, medication adherence, and diabetes self-care activities of the patients in the clinical pharmacist group increased significantly compared to the control group (P < .05). The study demonstrated an improvement in HbA1c, FBG, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The study outcomes support the benefits and the need to integrate clinical pharmacist interventions in the multidisciplinary healthcare team in Egypt.

Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19

BackgroundLow-dose chest CT (LDCT) showed high sensitivity and ability to quantify lung involvement of COVID-19 pneumopathy. The aim of this study was to describe the prevalence and risk factors for lung involvement in 247 patients with a visual score and assess the prevalence of incidental findings.MethodsFor 12 days in March 2020, 250 patients with RT-PCR positive tests and who underwent LDCT were prospectively included. Clinical and imaging findings were recorded. The extent of lung involvement was quantified using a score ranging from 0 to 40. A logistic regression model was used to explore factors associated with a score ≥ 10.ResultsA total of 247 patients were analyzed; 138 (54%) showed lung involvement. The mean score was 4.5 ± 6.5, and the mean score for patients with lung involvement was 8.1 ± 6.8 [1–31]. The mean age was 43 ± 15 years, with 121 males (48%) and 17 asymptomatic patients (7%). Multivariate analysis showed that age > 54 years (odds ratio 4.4[2.0–9.6] p < 0.001) and diabetes (4.7[1.0–22.1] p = 0.049) were risk factors for a score ≥ 10. Multivariate analysis including symptoms showed that only age > 54 years (4.1[1.7–10.0] p = 0.002) was a risk factor for a score ≥ 10. Rhinitis (0.3[0.1–0.7] p = 0.005) and anosmia (0.3[0.1–0.9] p = 0.043) were protective against lung involvement. Incidental imaging findings were found in 19% of patients, with a need for follow-up in 0.6%.ConclusionThe prevalence of lung involvement was 54% in a predominantly paucisymptomatic population. Age ≥ 55 years and diabetes were risk factors for significant parenchymal lung involvement. Rhinitis and anosmia were protective against LDCT abnormalities.

Quality of life and associated factors in patients with lower limb chronic venous insufficiency

Background: Lower limb chronic venous insufficiency (CVI) is a global issue. The disease has significant effects on the quality of life (QoL) with substantial burden on the healthcare system. In Vietnam, the QoL of patients suffering from lower limb CVI has not received much attention. This study evaluated the QoL and associated factors in patients with lower limb CVI in order to improve care as well as the well-being of patients.Objectives: To identify the QoL score and associated factors in patients with lower extremity CVI.Study methods: This is a retrospective observational study of 68 randomly selected patients with lower limb CVI at Medicine and Pharmacy Hospital. All patients were interviewed using the SF-36 questionnaire. Multivariate linear regression was used to evaluate the relationship between QoL score and other factors.Results: The mean scores of patients with lower limb CVI in physical health was 51.56±14.53, mental health was 53.91±15.20, overall QoL was 52.74±10.30. Factors associated with QoL was gender, income, disease severity based on CEAP clinical classification, level of physical activities and the use of medial pressure socks.Conclusions: QoL of patients with lower limb CVI was decreased, both physically and mentally. Patients should be encouraged to exercise more and use medial pressure socks to improve the QoL.

Knowledge of Prevention Measures and Information About Coronavirus in Romanian Male Patients with Severe Mental Illness and Severe Alcohol Use Disorder.

PurposePatients with severe mental illness (SMI) and alcohol use disorder (AUD) are at higher risk for contracting coronavirus-19 (COVID-19) and for poor outcomes of COVID-19 infection. One reason for this could be the lack of knowledge regarding preventive measures against COVID-19 and the inability of the psychiatric patients to discern misinformation from facts.Patients and MethodsThe study design was cross-sectional. We applied one questionnaire that evaluated knowledge of prevention measures and information about COVID-19 (comprised of two sections, each with five questions). The first section evaluated knowledge regarding the official WHO prevention measures against COVID-19, and the second consisted of false information about COVID-19 which examined the ability to identify misinformation about COVID-19. These questionnaires were applied face-to-face to psychiatric male inpatients from a tertiary psychiatric hospital in Bucharest diagnosed with SMI or severe alcohol disorder (SAUD) and to male controls from the community, matched by age and education. Mean scores of patients and controls were compared using Mann–Whitney test.ResultsThere were 115 male psychiatric patients in total (65 SMI and 50 SAUD) and 57 controls included after the matching procedure. We found statistically significant lower (P<0.05) scores for psychiatric patients compared to controls regarding the prevention and general knowledge of COVID-19 (P<0.001), the WHO information about prevention measures (P=0.041), and the ability to identify misinformation about COVID-19 (P<0.001). The fact that psychiatric patients have less knowledge about prevention measures against COVID-19 and a reduced capacity to discern misinformation suggests that we need to identify new methods to convey correct information to these patients and also to better equip them to handle misinformation regarding COVID-19.ConclusionPatients with SMI and SAUD are less informed regarding COVID-19 infection and preventive measures compared to controls, while being prone to believing false information about COVID-19 as well.

The Role of Preoperative Skin Traction in Reducing Pain in Patient with Hip Fracture

Background: Hip Fracture including neck of femur and trochanteric fractures are very common in young and old age. These types of injuries in young age are mainly due to malnutrition, tumor, physical inactivity and athletic participation causing high energy trauma. In old age it is mainly due to osteoporotic bones especially in females. Objective: To compare mean pain score in patients with hip fractures treated with and without skin traction prior to surgical intervention. Study Design: Randomized control trial. Settings: Orthopedics department, Chaudhry Muhammad Akram Teaching & Research Hospital, affiliated with Azra Naheed Medical College Lahore-Pakistan. Duration: 2 Years from 01-01-2017 to 31-12-2019. Methodology: Data of all the hip fractures presenting in Orthopedic emergency was collected. This includes fracture neck of femur and trochanteric fractures. Results: Application of skin traction did not result in improvement of pain score significantly. 15.0% of respondents were in the age groups of 25-40 years, 38.0% patients were between 41-60 years of age and 47% patients more than 61 years of age. 69.0% were female patients and 32.0% were male patients. Mean preoperative visual analogue score (VAS) score of all patients 2.3900 (out of 10 score). Mean Preoperative visual VAS score of patients (with skin traction) 2.5400. In other group (without skin traction), mean preoperative VAS score 2.2400. Conclusion: Preoperative skin traction in hip fractures of adult patient should not be considered mandatory in reducing pain and hence it is not useful.

Intramuscular Pressure Is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness.

Widespread pain in fibromyalgia syndrome (FMS) is conventionally viewed as arising from disordered central processing. This study examines intramuscular pressure in the trapezius as an alternative mechanism for understanding FMS pain. One hundred eight patients who satisfied the American College of Rheumatology criteria for FMS and 30 patients who met the ACR criteria for another rheumatic disease comprised the study groups. Muscle pressure was measured in mmHg using a pressure gauge attached to a no. 22 needle inserted into the mid-portion of the trapezius muscle. In addition, patients with FMS and rheumatic disease controls had dolorimetry testing, digital palpation, and reported pain scores. Muscle pressure was substantially higher in patients with FMS with a mean value of 33.48 ± 5.90 mmHg. Only 2 of 108 patients had muscle pressure of < 23 mmHg. The mean pressure in rheumatic disease controls was 12.23 ± 3.75 mmHg, with a range from 3-22 mmHg. Patients with FMS were more tender than controls based on both dolorimetry (P < 0.001) and digital palpation (P < 0.001). The mean pain score in patients with FMS and controls was 6.68 ± 1.91 and 1.43 ± 1.79, respectively (P < 0.001). Pressure in the trapezius muscle of patients with FMS is remarkably elevated and may be an intrinsic feature of FMS that could be monitored as part of the diagnostic evaluation. The burden of the pressure abnormality may help explain the diffuse muscle pain of FMS. Therefore, FMS as a disorder of exclusively central pain processing should be revisited. Therapeutically, the reduction of muscle pressure may change the clinical picture significantly.

Patient Reported Outcome Analysis after Posterior Decompression and Posterolateral Fusion Surgery in Lumbar Degenerative Spondylolisthesis

Introduction: Lumbar degenerative spondylolisthesis is an acquired slippage of a vertebra due to degenerative arthritis of the facet joints without any defect in the vertebral ring. Degenerative spondylolisthesis is commonly treated with posterior decompression and posterolateral fusion. This study aims to evaluate the clinical outcome of posterior decompression and instrumented posterolateral fusion surgery by analysing patient reported outcome measures.&#x0D; Materials and Methods: A retrospective study in which patients who had posterior decompression and instrumented posterolateral fusion for lumbar degenerative spondylolisthesis between September 2017 and August 2019 at Nepal Mediciti Hospital were included in the study. Other types of spondylolisthesis managed with similar technique and patients who had follow up period of less than three months were excluded. Functional outcome was assessed by comparing pre and post-operative patient reported outcome measures: VAS leg pain, VAS back pain and Oswestry Disability Index (ODI). The paired t-test was used for statistical analysis.&#x0D; Results: Of the 16 patients, 81.25% were female. Mean age and mean follow up period were 58.81± 10.47 years and 13.56±7.15 months respectively. Seventy five percent had grade I spondylolisthesis. Most common level of spondylolisthesis was L4/5 (62.5%). Fourteen patients reported improvement in their symptoms after surgery. The changes in functional outcome scores between baseline and at follow up evaluation were as follows: 32.70 ± 17.44 points for ODI, 3 ±1.89 for VAS leg pain, and 5.37 ± 2.36 for VAS back pain (P&lt;0.001). Superficial wound infection was the most common complication observed in 18.3%.&#x0D; Conclusion: In our case series, 87.5% had improvement in their symptoms after surgery. The change in mean score of patients’ reported outcome measures before and after surgery was statistically significant. We recommend a prospective comparative study between decompression alone and the fusion technique for the evaluation of long term functional outcome.

Intercalary Allograft Reconstruction of the Proximal Tibia With and Without a Free Fibula Flap in Pediatric Patients.

Limb salvage of the proximal tibia can be difficult due to the growth potential of and functional demands of the pediatric patients. Multiple reconstruction techniques exist, however, the ideal form of reconstruction is yet to be elucidated. The purpose of the current study is to evaluate outcomes in patients with an intercalary resection of the proximal tibia reconstructed with an allograft with or without a free vascularized fibula flap (FVF). Seventeen pediatric patients (9 males, 8 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12±4 years. The most common diagnoses were osteosarcoma (n=6) and Ewing sarcoma (n=6). Patients were reconstructed with an allograft alone (n=6) or supplemented with an FVF (n=11). All surviving patients had at least 2 years of clinical follow-up, with the mean follow-up of 12±7 years. The mean time to union of the allograft was 11±4 months, with 6 patients requiring additional bone grafting. There was no difference in the need for an additional bone graft (odds ratio=1.14, P=1.0) between patients with an FVF and those without. Four patients underwent an amputation, all with an allograft alone, due to disease recurrence (n=2) and due to infection (n=2). As such, there was a higher 10-year overall limb-salvage rate when the allograft was combined with an FVF compared with an allograft alone (100% vs. 33%, P=0.001). At last follow-up, the mean Mankin and Musculoskeletal Tumor Society rating was 86%, with a higher mean score in patients reconstructed with an FVF (94% vs. 70%, P=0.002). Use of an intercalary allograft supplemented with an FVF to reconstruct the proximal tibia provides a durable means of reconstruction with an excellent functional outcome following oncologic proximal tibia resection in a pediatric population. Level III-therapeutic level.

FUNCTIONAL STATUS AND SLEEP QUALITY AMONG ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Background: Chronic obstructive pulmonary disease (COPD) considering one ofthe most chronic disease affecting elderly patients all over the world. Chronic obstructivepulmonary disease is a major worldwide public health problem for increasing its mortalityand morbidity. Aim: Determine the functional status and quality of sleep among elderlypatients with chronic obstructive pulmonary disease. Method: A descriptive researchdesign was used in this study. This study was conducted at kafr El sheikh Chest Hospitalaffiliated to the Ministry of health. A convenience sample of 116 elderly patients diagnosedwith chronic obstructive pulmonary disease admitted to the above-mentioned setting withina period of six months. Tools: Data was collected by using three tools; demographic andclinical data structured interview schedule, Functional Independence Measure andPittsburgh Sleep Quality Index. Results: The mean of age in the studied elderly patientswas 70.05±8.08 years in addition the mean score of patients’ functional status was 62.2 ±32.1. nearly three quarter of the studied elderly suffering poor quality of sleeping andnearly half of them reported that their functional status were very good . Also, there wasstatistically negative significant correlation between functional status and sleep quality.Conclusion: Nearly three quarters of studied elderly patients reported very good related tofunctional status, while, most of them reported poor quality of sleeping. quality of sleep wasrelated to patient’s functional health status. Recommendation: Developmentcomprehensive simple Arabic printed educational materials such as (booklet, pamphlet andposters) for chronic obstructive pulmonary disease can improve functional status andquality of sleep.

Treatment of fistula-in-ano: Outcome comparison between traditional surgery and novel approaches. A retrospective cohort study in a single center

Aim: Fistula-in-ano is a well described disease but no definitive surgical technique has been developed. We conducted a retrospective cohort study in a single center to evaluate patients who underwent surgical treatment of a perianal fistula from 2012 to 2018 in our hospital. The aim of the study was to compare the outcome of different surgical techniques (Fistulotomy/fistulectomy and seton, Video-Assisted Anal Fistula Treatment (VAAFT), Micro-fragmented adipose tissue injection, Lipogems®).Methods: A cohort of 103 patients with anal fistula who qualified for elective surgery between 2012 and 2018 were recruited at Sant’Anna Hospital in Ferrara. All patients underwent a digital rectal examination and preoperative magnetic resonance imaging (MRI) to identify the fistula tract and internal opening. Patients were divided into 4 groups, one for each type of surgery they underwent: Fistulotomy/fistulectomy and seton, Video-Assisted Anal Fistula Treatment (VAAFT), Micro-fragmented adipose tissue injection, Lipogems®). Numerical rating scale (NRS) was used to assess subjective pain one week after surgery and documented. The scale ranged from 0 to 10, where 0 stands for no pain and 10 stands for worst pain ever faced. Primary end point was fistula recurrence at 1 year of follow-up. Secondary end point was evaluation of post-operative pain. Results: There were 71 males and 32 females, with a median age of 50 years (range 21-89 years). Among them, 79 patients were newly diagnosed, the other 24 patients had undergone previous surgery and had recurrence. In total, 118 surgical operation were performed for anal fistula. During the follow-up period, anal fistula recurrence was observed in 13 patients after VAAFT, 3 patients after Micro-fragmented adipose tissue injection, 4 after fistulotomy, 12 after fistulectomy, 10 after seton placement and 8 after Lipogems® technique. One week after surgery, pain was evaluated by all patients on a scale from 0 to 10. The mean scores of patients who underwent VAAFT, micro-fragmented adipose tissue injection, fistulotomy, fistulectomy, seton placement and Lipogems® technique were 1 (0-5), 1.5 (0-8), 5 (3-8), 6.8 (5-9), 4.2 (2-6) and 0 (0-2), respectively. Conclusion: This study presents the difficulties in managing anal fistulas and the variety of surgical options. VAAFT and Micro-fragmented adipose tissue injection appear to be safe and feasible options in the management of anal fistula, and short-term healing rates are acceptable with no sustained effect on continence. There is, however, a paucity of robust data with long-term outcomes. These techniques are thus welcome additions. Lipogems ® technique is a safe and reproducible procedure, unfortunately according to our experience, it does not promote fistula healing in patients with recurrent inter-sphincteric anal fistula. We do not suggest the use of this technique as a first-line treatment.

Potentials for implementing pressure-controlled jet injection in management of keloids with intralesional 5FU and corticosteroids.

Needle-free jet injection implements kinetic energy of liquid jet for transcutaneous delivery of drugs into soft tissues. Combination therapy of intralesional 5-fluorouracil and triamcinolone offers efficacious treatment for keloids with a reduced adverse effect of the drug monotherapy. This study evaluates safety and efficacy of the drug combination administered to keloid scars via intralesional jet injections. A retrospective analysis of the keloid treatments was performed. Efficacy was assessed by reviewing pre- and post-treatment scores of the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and by comparing baseline and photographs taken 3months after the treatments. Safety and tolerability were collected and analyzed. Twenty-one subjects (M/F=11/10) with 39 keloids received the treatments. Treatments were well-tolerated by all patients at mean injection pain of 2.0±1.0 per Numeric Pain Rating Scale (NPRS). Self-resolved lesion ulceration was observed in 4 patients. Post-treatment evaluation demonstrated a 53% decrease in total VSS score (P<0.05) and in all sub-categories. Mean patient score of POSAS decreased in the color, stiffness, thickness, and irregularity components. Pain and pruritus lessened by 69% and 79% (P<0.05 in both), respectively, among the patients with complaints prior to the treatment. Independent reviewers reported an average 51%-75% reduction in keloids. Improved appearance of keloids and symptomatic relief was achieved by intralesional administration of combined 5-fluorouracil and corticosteroid through the high-pressure jet injections. The synergy between the drug combination and the jet physical impact provided clinical effect.