Standard Proforma Research Articles

Clinical Profile and Risk Factors for Complication of Type 2 Diabetes Mellitus at the National Referral Hospital, Bhutan: A Descriptive Cross-Sectional Study.

Globally, diabetes mellitus is a major public health concern affecting 10.5% of the population. Nearly 90% of these people have Type 2 diabetes mellitus (T2DM). In Bhutan, T2DM is prevalent in 5.6% of the population, and around 60% are unaware of their diagnosis of diabetes. There is no baseline information on the rate and the risk factors for complications of diabetes in Bhutan. The study assessed the clinical profile and the risk factors for complications of T2DM at the Jigme Dorji Wangchuk (JDW) National Referral Hospital, Bhutan. A descriptive cross-sectional study was conducted at the JDW National Referral Hospital, Bhutan, from January to December 2019. Patients with T2DM attending diabetic clinics were included in the study. Demographic variables and metabolic profiles were recorded using a standard pro forma. Descriptive statistics were used to express the results. The association of clinical profiles with the microvascular complication was assessed using multivariate logistic analysis with statistical significance at p < 0.05. There were 292 patients with T2DM during the study period. The rate of microvascular complication is around 25% in T2DM. Among the complications, diabetic retinopathy occurred in over 51%, followed by neuropathy (29.7%) and nephropathy (18.9%). Over 1/3rd of patients had a duration of diabetes over 10 years with a mean duration of 6.3 (5.4) years, and around 44% (127/292) of them had poor glycemic control (HbA1C ≥ 7%). The age ≥ 60 years and the duration of diabetes ≥ 10 years were independent risk factors for microvascular complications in T2DM patients. Regular exercise prevents retinopathy (OR 0.4, 95%CI 0.2-0.9, p = 0.026). There is a microvascular complication in 1 in 4 of type 2 diabetic patients. Age over 60 years and a duration of diabetes of more than 10 years are independent risk factors for microvascular complications, and regular exercise is preventive for microvascular complications.

Translational Quotient as an Innovative Outcome Parameter to Assess the Effectiveness of Training Methods: A Feasibility Study in Assessing the Baseline Psychiatric Skills of Primary Care Doctors in their Real-world Live Outpatient Clinic

Background: The effectiveness of training methods in medical education is critical, particularly for primary care physicians (PCPs) who frequently encounter psychiatric issues in their practice. Traditional assessment methods often fail to evaluate skill acquisition in real-world clinical practice. The Translational Quotient (TQ) is proposed as an innovative outcome measure to assess PCPs’ ability to apply psychiatric skills in their live outpatient consultation among their general patients. This study aims to evaluate the feasibility of using the TQ in real-world outpatient clinics and to understand the baseline psychiatric skills among PCPs using TQ. Methods: Actively practicing MBBS-qualified PCPs enrolled in the Diploma in Primary Care Psychiatry (DPCP) program across various districts were invited to participate. Baseline TQ assessments were conducted in the PCPs’ live clinics, with psychiatrists observing live consultations either remotely or in-person for the first five consecutive general consultations. Each consultation was scored using a standardized TQ proforma, which evaluated six criteria: elicitation of psychiatric symptoms, clinical reasoning, medication choices, counseling, time management, and overall clinical skills. Results: A total of 25 PCPs participated, with an average baseline TQ score of 15.7% (4.72 out of 30). Most participants (72%) scored 5 or less, highlighting significant gaps in psychiatric skills. Analysis revealed no significant associations between TQ scores and PCP demographics such as age, gender, and prior psychiatric training, but regional differences were noted, with lower scores in Karnataka compared to Bihar. Conclusions: The TQ is a feasible and practical tool for assessing real-world psychiatric skills among PCPs. The baseline scores indicate a pressing need for targeted psychiatric training to bridge the treatment gap in primary care. Future training programs should focus on enhancing diagnostic accuracy, treatment planning, and patient communication to improve mental healthcare outcomes in primary care settings.

POLR3B is associated with a developmental and epileptic encephalopathy with myoclonic-atonic seizures and ataxia.

POLR3B encodes the second largest subunit of RNA polymerase III, which is essential for transcription of small non-coding RNAs. Biallelic pathogenic variants in POLR3B are associated with an inherited hypomyelinating leukodystrophy. Recently, de novo heterozygous variants in POLR3B were reported in six individuals with ataxia, spasticity, and demyelinating peripheral neuropathy. Three of these individuals had epileptic seizures. The aim of this article is to precisely define the epilepsy phenotype associated with de novo heterozygous POLR3B variants. We used online gene-matching tools to identify 13 patients with de novo POLR3B variants. We systematically collected genotype and phenotype data from clinicians using two standardized proformas. All 13 patients had novel POLR3B variants. Twelve of 13 variants were classified as pathogenic or likely pathogenic as per American College of Medical Genetics (ACMG) criteria. Patients presented with generalized myoclonic, myoclonic-atonic, atypical absence, or tonic-clonic seizures between the ages of six months and 4 years. Epilepsy was classified as epilepsy with myoclonic-atonic seizures (EMAtS) in seven patients and "probable EMAtS" in two more. Seizures were treatment resistant in all cases. Three patients became seizure-free. All patients had some degree of developmental delay or intellectual disability. In most cases developmental delay was apparent before the onset of seizures. Three of 13 cases were reported to have developmental stagnation or regression in association with seizure onset. Treatments for epilepsy that were reported by clinicians to be effective were: sodium valproate, which was effective in five of nine patients (5/9) who tried it; rufinamide (2/3); and ketogenic diet (2/3). Additional features were ataxia/incoordination (8/13); microcephaly (7/13); peripheral neuropathy (4/13), and spasticity/hypertonia (6/13). POLR3B is a novel genetic developmental and epileptic encephalopathy (DEE) in which EMAtS is the predominant epilepsy phenotype. Ataxia, neuropathy, and hypertonia may be variously observed in these patients.

Prevalence and Risk Factors of Diabetic Retinopathy among Type 2 Diabetic Patients in Tertiary Care Hospital of Gandaki Province of Nepal

Background Diabetic retinopathy (DR) is one of the commonest causes of blindness in Nepal. This study aimed to determine the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients in a tertiary care hospital of Gandaki Province of Nepal. Methods This was a hospital based cross-sectional study conducted among 162 patients of type 2 diabetes aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and diabetic retinopathy was classified according to Early Treatment of Diabetic Retinopathy Study Classification. Results The mean ±SD of age of the study sample was 61.99 ±11.69 years. The prevalence of diabetic retinopathy was 41.98%. Among the patients with diabetic retinopathy, the prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR and PDR were 51.47%, 25%, 11.76%, 1.47%, and 10.29% respectively. There was statistically significant association of diabetic retinopathy with duration of diabetes and chronic kidney disease. However, there was no statistically significant association of diabetic retinopathy with gender, family history, hypertension, history of smoking, history of alcohol, treatment history and physical activity. Conclusions There is high prevalence of diabetic retinopathy among the diabetic patients. Longer duration of diabetes and chronic kidney disease were the significant risk factors for diabetic retinopathy. Early diagnosis and treatment of diabetic retinopathy is essential to reduce blindness in diabetic patients.

Assessing Initial Functional Outcomes Following Arthroscopic Release for Stiff Shoulder in Periarthritis Shoulder

Adhesive capsulitis can manifest as either primary/idiopathic or secondary, often linked to systemic illnesses. Primary adhesive capsulitis is characterized by limited range of motion without underlying systemic or precipitating shoulder conditions and lacks intrinsic pathology. In contrast, secondary frozen shoulder is associated with identifiable intrinsic factors such as diabetes, thyroid disorders, cardiac disease, stroke, prolonged immobilization, trauma, and rotator cuff disease. Our study aims to assess the initial functional outcomes, average recovery duration, and related comorbidities in arthroscopic release for adhesive capsulitis of the shoulder.The study was carried out at the Department of Orthopedics in Saveetha Medical College and Hospital, Thandalam, spanning from June 1, 2022, to June 31, 2023. It comprised 30 patients diagnosed with adhesive capsulitis who met specific criteria. The treatment regimen consisted of Arthroscopic Release followed by intensive physiotherapy and prescribed home exercises. Follow-up appointments were scheduled at regular intervals to track progress, using assessment tools like the UCLA Score and VAS score, and all data were meticulously recorded in a standardized proforma.30 individuals who met specific criteria were diagnosed with adhesive capsulitis. Of these, 12 out of 18 participants were female, and 16 patients experienced more frequent impairments on the left side. The average age of the patients was 65 years, ranging from 57 to 78 years old. Stage 2 was the most common among the approximately 19 patients. Prior to surgery, the UCLA score had a mean of 23, ranging from 18 to 26, while the mean preoperative VAS score was 8, with a range of 7 to 9. Following surgery, significant improvements were observed in the UCLA score, ranging from 26 to 35, and the post-operative VAS score ranged between 2 and 5. In our study, arthroscopic release appears as a safe procedure with favourable postoperative results. This consequently enables early mobilization of the shoulder joint and decreases complication rates.

FP7.12 - A Three-Year Retrospective Analysis of Variables and Their Relationships as Outcome Indicators Following Emergency Laparotomies in Octogenarians: Insights from a Single Institutional Experience

Abstract Aim This retrospective study aims to evaluate the morbidity and mortality outcomes associated with emergency laparotomies in individuals aged 80 years and above, referred to as octogenarians. Against the backdrop of the National Emergency Laparotomy Audit's data from the Eighth Year (2020–2021), which indicates a slight increase in overall in-hospital mortality rates across all age groups, the specific focus on octogenarians intends to provide insights into the unique challenges and outcomes experienced by this elderly population undergoing emergency laparotomies. Methods This retrospective analysis focused on emergency laparotomies in octogenarians between June 2020 and June 2023, comprising 62 cases out of 370. Using a standardized proforma, data was collected and statistical analysis was done with SPSS. Results In this study involving 62 elderly patients (mean age 84) undergoing emergency laparotomies, common diagnoses included Adhesional Small Bowel Obstruction and Large Bowel Obstruction due to Diverticular Disease. Despite the absence of geriatrician involvement, the overall mortality rate was 21%, emphasizing the potential impact of geriatrician reviews. While factors like sepsis and bowel resection did not significantly influence outcomes, the study identified associations between ASA Score, diagnosis type, and predicted mortality rate with patient survival. Complications and comorbidities, such as AKI and atrial fibrillation, were linked to increased mortality. Conclusion In summary, emergency major abdominal surgery poses significant risks, particularly for frail and elderly individuals with multiple co-morbidities. Recognizing frailty as an independent risk factor is crucial. While assessing frailty is complex, open discussions with patients and families about the substantial surgery-related risks are imperative. Establishing realistic expectations is vital for informed decision-making and patient-centered care.

Knowledge of epilepsy surgery: A survey among medical doctors in Nigeria

BackgroundEpilepsy surgery has been shown to significantly improve the quality of life of patients with drug resistant epilepsy. Despite this, epilepsy surgery remains remarkably underutilized in Nigeria. There are high misconceptions about epilepsy and its management among physicians and trainees. MethodsThis study aims to identify knowledge gaps in epilepsy surgery among medical doctors in Nigeria and factors associated with their level of knowledge of the procedure. A cross-sectional study was carried out among 566 medical doctors in Nigeria, at different levels of post-graduate training (House officers, Medical officers, Resident doctors and Consultants). An online survey with a 24-item questionnaire adapted from a standardized pro forma was utilized. Binary and multiple logistic regression were used to identify associations between the independent variable and outcome variable (good or poor knowledge) ResultsMajority of the respondents were medical officers (post-intern physicians) comprising 65.7 % of the participants. Significant predictors of poor knowledge included being a medical officer [P=0.006], working in north-central [P=0.017] and north-western Nigeria [P=0.045], seeing less than 20 epilepsy patients per month [1–10 patients, P=0.015; 11–20 patients, P=0.011], and enrolment in online epilepsy course [P=0.004]. ConclusionComprehensive education and awareness about epilepsy surgery are important in overcoming the knowledge gap and improving access to care.

Multipsychiatric Comorbidity in People With Epilepsy Compared With People Without Epilepsy: A Systematic Review and Meta-analysis.

Persons with epilepsy (PwE) have a higher risk of developing psychiatric comorbidities compared with the general population. There is limited knowledge about the prevalence of multiple psychiatric conditions in PwE. We summarize the current evidence on the prevalence of multipsychiatric comorbidities in PwE compared with persons without epilepsy. A systematic review of multipsychiatric comorbidities in PwE compared with persons without epilepsy was performed, and the results were reported using the Preferred Reporting Items of Systematic Reviews and Meta-analyses reporting standards. The search was conducted from January 1945 to June 2023 in Ovid MEDLINE. Embase, and PsycINFO, using the search terms related to "epilepsy," "psychiatric comorbidity," and "multimorbidity," combined with psychiatric disorders. Abstracts were reviewed in duplicate, and data were independently extracted using standard proforma. Data describing multipsychiatric comorbidities in PwE compared with persons without epilepsy were recorded. Descriptive statistics and, when feasible, meta-analyses are presented. The risk of bias of the studies was assessed using the Newcastle-Ottawa Scale and the International League Against Epilepsy tool. A total of 12,841 records were identified from the systematic database search, and 15 studies met the eligibility criteria. All included studies were deemed high-quality in risk of bias according to both tools. The prevalence of multipsychiatric comorbidity was greater in persons with compared with those without epilepsy. The pooled prevalence of concomitant depression and anxiety disorder in PwE in 2 population-based studies was 15 of 163 (9.2%), which was significantly higher than 250 of 10,551 (2.4%) in patients without epilepsy (odds ratio [OR] 3.7, 95% CI 2.1-6.5, p-value <0.001, I2 = 0%, Cochran Q p-value for heterogeneity = 0.84). In 2 hospital-based studies, the prevalence of concomitant depression and attention-deficit/hyperactivity disorder in PwE (14/97, 14.4%) was significantly higher than in patients without epilepsy (5/126, 3.9%), with an OR 5.2 (95% CI 1.8-15.0, p-value = 0.002, I2 = 0%, Cochran Q p-value for heterogeneity = 0.79). PwE experience elevated levels of multipsychiatric comorbidity compared with those without epilepsy. However, very few studies have empirically evaluated the extent of multipsychiatric comorbidity in PwE compared with persons without epilepsy nor their associations and consequences to prognosis in PwE.

Procalcitonin-A Marker of Sepsis

Background: Sepsis remains a significant health concern, particularly in resource-limited regions like Bangladesh. Despite available diagnostic methods, identifying bacterial infections in septic patients proves challenging, prompting the exploration of biomarkers. Procalcitonin (PCT) has emerged as a promising biomarker for bloodstream infections like sepsis. Objective: This study aims to evaluate the utility of measuring serum PCT levels in diagnosing and assessing the severity of sepsis, with a focus on enhancing early treatment in intensive care units (ICUs). Method: A prospective study was conducted on 50 patients admitted to the Combined Military Hospital, Dhaka ICU, exhibiting clinical manifestations of sepsis between April and September 2015. Patients of all ages and genders were included, while those with recent major surgery, trauma, or burn history were excluded. Detailed clinical assessments and laboratory investigations were performed, with data recorded on a standardized proforma. Result: Of the 50 patients evaluated, 64% were male, and 36% were female, with a mean age of 56.11±10.89 years. Sepsis was more prevalent in patients aged &gt;50 years (60%) and in males (64%). Respiratory tract infection (RTI) was the most common source of sepsis (40% of cases), with Klebsiella pneumonia being the predominant organism. Higher Sequential Organ Failure Assessment (SOFA) scores correlated significantly with elevated serum PCT concentrations. Serum PCT demonstrated a significant difference between non-septic and septic groups (p-value &lt;0.001), exhibiting sensitivity and specificity of 91% and 83.3%, respectively. Conclusion: Serum PCT emerges as a promising marker for sepsis in critically ill patients, enhancing diagnostic certainty and informing patient management. Its addition to routine work-ups could improve outcomes and patient care in ICUs.

P-676 Obstetric and perinatal outcomes in women with Turner Syndrome: A systematic review and meta-analysis

Abstract Study question What is the pooled risk of adverse obstetric and neonatal outcomes in pregnancies in women with Turner Syndrome (TS)? Summary answer TS women experience high rates of adverse outcomes. Risks are increased in egg donation pregnancies and multiple pregnancies compared to singleton spontaneous pregnancies. What is known already TS affects 1 in 2,000 live female births. The 2017 ‘Clinical Practice Guidelines for the Care of Girls and Women with Turner Syndrome’ acknowledges women with TS are at increased risk of adverse obstetric and perinatal outcomes. Several retrospective cohort studies reporting obstetric and neonatal outcomes in TS pregnancies have been published in recent years. However, these studies are often limited to a single centre cohort, within one country and thus increasing risk of bias. Overall pooled risk estimates for each outcome have yet to be reported. Study design, size, duration A prospectively registered systematic review and meta-analysis was conducted and reported in line with PRISMA guidelines. Overall pooled rates of each outcome Is reported with 95% confidence interval. Pooled risk ratios comparing spontaneous and egg donation pregnancies are also reported. A comparative meta-analysis reports on dichotomous outcomes using summary risk ratio (RR) with 95%CI and on continuous outcomes using weighted mean difference (WMD) with 95%CI. Publication bias was assessed using the Newcastle-Ottawa Scale. Participants/materials, setting, methods A comprehensive literature search was undertaken. Eligibility screening was conducted by 2 independent reviewers. Studies were limited to English language with no time limit. Case reports were excluded. 30 studies reporting obstetric or perinatal outcomes in pregnancies of women with TS were included in the analysis. Outcome data was extracted and tabulated using a standard proforma. Main results and the role of chance 1724 pregnancies were included. Pooled risks: Obstetric outcomes: caesarean section (62.8%)(95%CI:57-76%), pregnancy-associated hypertensive disorders (21%)(95%CI:13-29%), pre-eclampsia (10%)(95%CI:6-14%),gestational diabetes mellitus (6.0%)(95%CI:4-8%), aortic dissection (1.1%)(95%CI:0-2%), intrahepatic cholestasis of pregnancy (4.6%)(95%CI:0-7%), post-partum haemorrhage (17.9%)(95%CI:-3-37%), and maternal mortality (0.3%)(95%CI:0-1%). Perinatal outcomes: prematurity (14.1%)(95%CI:8-18%), low birthweight (25.1%)(95%CI:12-23%), and perinatal mortality (1.2%)(95%CI:0-1%). Egg-donation pregnancies yield significantly higher rates of: caesarean section (82.8% vs. 55.7%) (RR1.49) (95% CI:1.27-1.76), pregnancy-associated hypertensive disorder (33.0% vs 12.9%: p=0.001), pre-eclampsia (16.9% vs 8.2%: p=0.0023), gestational hypertension (17.9% vs 0.0%: p=0.082), low-birthweight (43.0% vs 1.9%: p&amp;lt;0.001) and preterm birth (17.5% vs 0.0%: p&amp;lt;0.001) than spontaneous pregnancies. Multiple pregnancies resulted in high rates of prematurity (70.0%), low birth-weight (73.3%) and pregnancy-associated hypertensive disorders (60.9%). Limitations, reasons for caution Most studies were retrospective and included cases from many years ago so may not be reflective of current obstetric practice and improved care. Most studies were geographically clustered in Europe and North America. Estimations of risk may therefore not be generalisable to other ethnicities and middle and lower income countries Wider implications of the findings This study quantifies the risk of adverse outcomes in pregnancies in women with TS. Risk is increased further in egg donation pregnancies and strategies should aim to screen and prevent complications, particularly hypertensive disorders of pregnancy. Multiple pregnancy should be avoided through use of single embryo transfer. Trial registration number N/a

1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit

Abstract Introduction Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note. Aim This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement. Method All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance. Results 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions. Conclusions While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.

To assess the effectiveness of Mirabegron in reducing urodynamic detrusor overstimulation in patients with Overactive Bladder Syndrome (OAB).

Objective: To investigate the efficacy of mirabegron in treating overactive bladder by assessing its impact on urodynamic detrusor overactivity (DO). Study Design: Cross-sectional study. Setting: Center for Urology and Transplantation in Sindh. Period: April 6, 2022, to October 4, 2022. Methods: Sixty-four individuals presenting OAB symptoms and without prior OAB medication use were included after obtaining informed consent and conducting relevant medical evaluations. Patients demonstrating signs of detrusor overactivity were evaluated through urodynamic assessments. Collected data, including patient history and study outcomes, were recorded using a standardized Proforma (Annexure I). Patient demographics, age, and gender distribution were documented. Patients with urodynamic detrusor overactivity were administered 50.0 mg mirabegron tablets once daily for a period of 13 weeks. A noteworthy percentage of patients reported substantial success after three months of treatment. Results: The average age of study participants was 50 years. The mean duration of OAB symptoms was 20.22 ± 15.38 months. Of the total 64 patients, 41 were female (64.06%) and 23 were male (34.94%). Notably, successful treatment outcomes were observed in 49 cases (76.56%). Conclusion: Mirabegron emerges as a valuable therapeutic option for individuals dealing with overactive bladder. This study underscores its efficacy in managing OAB sympt0oms, with a notable success rate of 76.6%. These findings contribute to the growing body of evidence supporting mirabegron as an effective treatment for overactive bladder syndrome.

Clinical and socioeconomic pattern of infective dermatoses in pediatric population at a tertiary care center of Northeast India

Background: Cutaneous disorders are one of the most important components of any health-care system, especially which including children. Infective dermatoses are the most common skin diseases in children. The pattern of dermatoses in children varies from one country to another and within the same country from one state to another due to various climatic, cultural, and socioeconomic factors. Aims and Objectives: The aims and objectives are to study the clinical and socioeconomic profile of cutaneous infections and infestations among children. Materials and Methods: All children up to 12 years presenting with cutaneous infections and infestations were taken as study participants. A detailed history of the disease, socioeconomic status, and housing condition was taken from the patients as well as from the parents. Local, general, and systemic examinations were carried out on all the children and their examination findings were recorded in a standard pro forma for analysis and interpretation of data. Results: A total number of 1932 were children aged 0–12 years patients attended the Dermatology Outpatient Department during the study period of which 665 (34%) presented with infective dermatoses. 61.20% of patients belonged to school-aged children (5–12 years) 76.7% had a family with 4–6 members. 67.67% were from the rural areas, and 77.4% belonged to the lower class. Scabies was the leading offender (29.92%) among infective dermatoses followed by Impetigo contagiosa (20.45%). Conclusion: There is an increased incidence of cutaneous infections and infestations with increasing age among children. The incidence is associated with housing conditions, family size, socioeconomic strata, and seasonal. Most of these conditions are common and controllable with easy preventive and curative measures.

To evaluate the complication and patency rate of superficial femoral vein transposition in tertiary care center.

When all access options in the upper extremity have been exhausted, an autologous access can be created in lower extremity. The purpose of this study is to report our experience with superficial femoral vein transposition (SFVT) results in terms of postoperative complication and patency rate. In the time period from January 1, 2019 to April 30, 2021, thirty-five cases of SFVT performed at our large tertiary care center Sindh Institute of Urology and Transplantation (SIUT). All patients had exhausted upper arm veins or had central vein obstructions. Medical records of all patients were traced, patients were interviewed using a standard proforma and evaluated the current AVF function in the OPD clinic or by telephone calls. Data including demographics and postoperative complications were collected. Thirty-nine cases of SFVT performed at our institute. Three were immediately lost to follow up so they were excluded from the study. Mean patient age was 30 ± 13.4 years. Most of our patients were females (57%) and 15 males (43%) with an average age of 29.05 years. The most common underlying renal diseasewas unknown in 16 (45%).Thirty-five patients included in the analysis; out of which primary failure observed in 4 patients, three patients were expired before fistula maturation and 3 were expired before 6 months. The remaining 25 fistulas patency rates were estimated. No any patient died due to fistulas related complication; patients died due to their primary disease. Our study shows that with appropriate patient selection, SFVT have low infection rates and patency that is comparable with other access types.

Role of Tranexamic Acid in Controlling Blood Loss in Hemiarthroplasty of the Hip: A Prospective and Observational Study.

Tranexamic acid, an antifibrinolytic drug, is well-established for its efficacy in reducing intraoperative and postoperative blood loss in major orthopedic surgeries, particularly total knee replacement (TKR) and spine surgeries. However, there is limited research on the role of tranexamic acid in hemiarthroplasty of the hip. This study aims to investigate the efficacy of tranexamic acid in controlling blood loss in hemiarthroplasty of the hip. The primary objective was to analyze the pre- and postoperative changes in hemoglobin levels among patients undergoing hemiarthroplasty of the hip with and without intravenous tranexamic acid administration. A prospective observational study was conducted at the Department of Orthopedics of Government Medical College, Kannur, and St. Joseph's Hospital, Karuvanchal, Kannur. Patients undergoing hemiarthroplasty of the hip with 1 gm of intravenous tranexamic acid were compared with those without tranexamic acid. The sample size was calculated to be 33 in each group. Data were collected using a standardized proforma, entered into an Excel sheet (Redmond, USA), and analyzed using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. The study comprised mainly elderly females with a mean age of 74.84 ± 8 years. There was a significant reduction in postoperative hemoglobin drop, requirement for postoperative blood transfusion, and total drain output for the initial three postoperative days among patients who received intravenous tranexamic acid. Preoperative administration of intravenous tranexamic acid significantly reduced postoperative hemoglobin drop and the need for postoperative blood transfusion in patients undergoing hemiarthroplasty of the hip. This highlights the efficacy and safety of tranexamic acid in controlling blood loss in this surgical setting.

Time to wound closure in facial soft tissue injuries following road traffic accidents.

The 6-hour (6-h) time to wound closure was a controversial issue as studies have shown that time was not a substantial factor. Wounds in the face are often considered to have a lower infection risk. Despite this, the cause of injury was not extensively discussed in relation to this context. The primary objective was to investigate the association between the 6-h time to wound closure and wound complications following emergency management of facial soft tissue injuries (STIs). Additionally, the secondary objective was to explore other factors contributing to wound complications. A retrospective record review was conducted in our hospital in Kuala Lumpur, Malaysia, from 1 January 2017 to 31 December 2021. Medical records of patients with facial STIs due to road traffic accidents were included. Simple random sampling was used to select records meeting inclusion criteria. Data on demographic, injury, and treatment characteristics were collected using a standardized proforma. Descriptive, univariate and multivariate analyses were performed, including chi-square tests and binary logistic regression. A total of 295 patient records were included, with most patients being males (77.3%) and of Malay ethnicity (54.9%). The median age was 31.0 years. Majority of patients were treated within 6 h of injury (93.9%). Complications were documented in 6.1% of cases, including wound dehiscence and infection. Multivariate analysis revealed a significant association between 6-h time to closure and wound complications (OR: 7.53, 95% CI: 1.90-29.81, p = 0.004). Grade of surgeon on duty (OR: 4.61, 95% CI: 1.25-16.95, p = 0.02) and diabetes mellitus (OR: 6.12, 95% CI: 1.23-30.38, p = 0.03) were also shown to have a statistically significant association with wound complications. A 6-h time to wound closure, grade of surgeon on duty and diabetes mellitus were three major factors involved in facial wound complications following road traffic accidents.

An Assessment of Death Profile of Unknown Dead Bodies, Brought for Autopsy to the Department of Forensic Medicine and Toxicology in Government Medical College of Garhwal Region, Uttarakhand: A Retrospective Study

Background:an unknown dead body always becomes a challenge to the Investigating officer and forensic expert. However, the problem of determining the identity gets aggravated and taxes for the experts, when the dead body is recovered in decomposed/ skeletonized and mutilated form. Materials and Methods: A standard proforma was designed to collect the information to ensureconsistency for the whole sample. All dead bodies that were brought as unidentified were included however identified dead bodies were excluded from the study. Results:A total of 407 post-mortem examinations were conducted at the mortuary of the department during under study and amongst them, 56 cases (13.75%) were found unidentified. Of these unidentified cases, 69.64% (39 cases) were in decomposed and 30.35% (17 cases) were in fresh state. Unidentified cases comprised 80.35% males (45 cases) and 19.64% females (11 cases). Conclusion:Unidentified dead bodies were only 13.75% of the total dead bodies coming to the autopsy in the mortuary of the Department of Forensic Medicine and Toxicology, VCSGGIMS &amp; R, Srikot, Srinagar, Pauri Garhwal, UTTARAKHAND during the study period of 5 years.

Frequency of oesophageal foreign bodies ingested by children presenting to the ENT department.

Objective: To determine the frequencies of different esophageal foreign bodies ingested by children presenting to Ayub Teaching Hospital Abbottabad. Study Design: Cross-sectional study. Setting: Department of Otorhinolaryngology, Ayub Teaching Hospital Abbottabad. Period: 2nd July 2020 to 31st December 2022. Material &amp; Methods: Following the application of inclusion and exclusion criteria, a total of 168 patients, aged between 6 months and 11 years, presenting with suspected esophageal foreign bodies, were included in the study after obtaining written consent. Socio-demographic information, clinical history, and symptoms were carefully recorded. Diagnostic procedures included neck X-rays, extended to the chest, and abdominal X-rays as necessary. Rigid esophagoscopy, performed under general anesthesia, was utilized to confirm and remove foreign bodies. Subsequently, the nature and type of the extracted foreign bodies were identified and documented using a standardized pro forma. Results: The mean age of the patients was 5.63 ± 3.097, ranging from 1 to 11 years. Regarding the gender distribution, 105 (62.5%) were male, and 63 (37.5%) were female. When considering the types of foreign bodies, 129 (76.8%) presented with coins, 12 (7.1%) with metallic objects, 7 (4.2%) with battery cells, and 9 (5.4%) with fruit seeds. Additionally, there were a few cases of chicken bones, fish bones, and safety pins, accounting for 9 (5.4%) in the category of other foreign bodies. Conclusion: This study underscores the frequent occurrence of esophageal foreign body ingestion in young children, particularly males under the age of 5, with coins identified as the predominant culprits.

E003 A quality improvement project looking into retinopathy screening for patients taking hydroxychloroquine at the Princess of Wales Hospital

Abstract Background/Aims Hydroxychloroquine (HCQ) is widely used in various rheumatic and dermatological conditions and the risk of associated retinal toxicity is more common than previously considered; an overall prevalence of 7.5% in patients taking HCQ for greater than 5 years, rising to 20 to 50% after 20 years of treatment. The Royal College of Ophthalmologists (RCOphth) revised guidelines (2020) advise annual monitoring of all patients for retinopathy who have taken HCQ for &amp;gt; 5 years. Patients with additional risk factors for retinal toxicity may be monitored annually after the initiation of therapy. Methods We reviewed relevant medical records of all the rheumatology patients at Princess of Wales Hospital (POWH) on HCQ from January 2017 to February 2022. Data was collected to include patient demographics and diagnosis, duration on HCQ, whether retinopathy referral was indicated and requested and whether these patients were subsequently seen in the ophthalmology clinic. Results In total we identified 216 patients, and the median age was 60 (range 27-96). All patients had been informed of potential associated retinopathy and were advised to undergo annual assessment by an optician. 60 of these 216 patients had stopped HCQ for various reasons while 156 remained on it. 79 of these 156 were eligible for referral as per the revised RCOphth guidelines as they had received treatment for at least 5 years. 40 of these 79 were referred to ophthalmology and 15 had been reviewed by the ophthalmology service. None of these 15 patients, however, have had further annual ophthalmology reviews after initial assessment. 39 patients had not been referred to ophthalmology despite being on hydroxychloroquine for more than 5 years. If those at high risk are considered, a further 30 of these 156 patients would be eligible for referral. 14 out of these 30 had been referred and none had yet been seen by ophthalmology. Conclusion Using the criteria defined by the revised guidance, approx. 50% of eligible patients had been referred to ophthalmology; 33% of patients have undergone review. Potential reasons for poor adherence to the RCOphth guidelines would likely include the significant changes in guidelines issued in 2017, 2018 and 2020, lack of resources to cope with additional demand in the ophthalmology service and the COVID-19 pandemic which has resulted in significant delays in outpatient services. Following this project, all eligible patients have been referred to ophthalmology and the findings were shared with the dermatology service who are now undertaking a similar audit project. Given the updated referral criteria, we intend to implement a standard referral proforma to ensure all those at risk of retinopathy are identified and will work closely with ophthalmology colleagues to address how best to improve waiting times for such patients to undergo full assessment. Disclosure A. Anjum: None. S. Safdar: None. S. Duffill: None. C. Jenkins: None. S. Smale: None. U. Srinivasan: None.

Pattern and severity of injuries, risk factors and outcome of Road Traffic Accident victims attending emergency department of Birat Medical College Teaching Hospital

Introduction: Road Traffic Accidents (RTA) is considered as one of the major public health problems around the globe. It is one of the top 5 causes of morbidity and mortality in South East Asia. Objectives: To find out pattern and severity of injuries, possible risk factors and outcome of victims of RTA attending emergency ward. Methodology: This is a cross-sectional study. All the patients with history of RTA attending the emergency ward have been enrolled with written informed consent after obtaining ethical clearance. Those patients with a history of sudden accidental fall or injury by falling objects were not included. The patients are assessed based on a semi standardized study proforma. The final outcome of the patient at the emergency department is noted. Result: Young adults (17-30 years) were injured most in Road traffic accident (38.41%) Most of them had head injury (59.8%) due to light vehicle (65.2%). Most accidents occurred during evening time (64.3%). Fewer of them were under the influence of alcohol (17%). 39% of the patients were severely injured. 3% patients expired at the emergency ward and 32% of the patients got admitted in ICU. Young adults were severely injured (53.8%) compared to older adults (33.33%). Conclusion: Young adults were involved most and major accidents were due to light vehicles. The majority of the patients had a milder form of injury requiring hospital admissions. The most common pattern was head injury. fewer of them were under alcohol influence.