The Professional Medical Journal

Time to revive grand round once again! A meticulously planned grand round in cardiac surgery involving multiple institutions.

Muhammad Tariq — 2024-07-01

HIGHLIGHTS

Grand rounds in cardiac surgery prove to be an effective means for residents to glean insights from each other's experiences.
A panel of consultants can assess residents during their presentations.
Consultants from different institutions can share their perspectives on managing rare and interesting cases presented.

• It should be conducted at least every three months.

Objectively Structured Practical Examination (OSPE) in traditional examination system versus integrated modular system: Perception of teaching faculty at a Public Sector Medical College of Punjab.

Menahal — 2024-07-01

Objective: To access the perception of teaching faculty regarding traditional OSPE and integrated modular OSPE. Study Design: Cross-sectional study. Setting: Sahiwal Medical College, Sahiwal. Period: February 2024 to March 2024. Methods: To collect data on the perceptions of the teaching faculty (n=29) (who were performing duty as examiners in first year professional examination), towards the newly introduced mode of assessment; integrated modular OSPE (which consists of OSPE, OSVE, PERLs and OSCE stations). Convenient sampling technique was used and a validated questionnaire was distributed through WHATSAPP in as Google form. Data was analyzed through SPSS version 20. Results: According to the teaching faculty, out of which 11(36.7%) were males and 19(63.3%) were females, integrated modular OSPE is relatively lengthy and stressful for the students 25(83.3%), while traditional OSPE is comparatively more transparent, fair, objective 17(56.7%) and in line with the curriculum 19(63.3%). Furthermore, traditional OSPE is comparatively easier to pass 23(76.7%), easier to conduct 21(70%) and also easier for the students 24(80%). According to teaching faculty, traditional OSPE has low probability of bias comparatively 20(66.6%). Conclusion: As per the perception of the selected teaching faculty. Traditional OSPE is comparatively a better mode of assessment.

Efficacy of antenatal magnesium sulfate in the prevention of necrotizing enterocolitis: A randomized case-control study in preterm neonates.

Sabika Iftikhar — 2024-07-01

Objective: To assess the efficacy of administering antenatal magnesium sulfate in reducing the occurrence of necrotizing enterocolitis in preterm infants. Study Design: Randomized Case-control study. Setting: Hameed Latif Hospital Lahore. Period: August 2023- February 2024. Methods: The study including 80 preterm neonates (26 to 32 weeks gestation) was conducted at Neonatology & Gynaecology Unit Hameed Latif Hospital, Lahore. These neonates were divided into two groups: Group A included infants whose mothers were given magnesium sulfate before preterm birth, while Group B comprised of infants whose mothers did not receive magnesium sulfate. The primary outcome was the incidence of NEC in infants born to mothers exposed to magnesium sulfate, with secondary outcomes covering other neonatal morbidities and maternal side effects. Data analysis utilized SPSS Statistics software version 24, employing t-tests and multivariate logistic regression to evaluate the association between antenatal magnesium sulfate exposure and NEC incidence, considering a significant p-value of ≤ 0.05. Results: The overall NEC incidence was 5%(n=2). No NEC cases were reported in the control group. The difference in neonatal outcomes between both groups was statistically insignificant (p>0.05). Conclusion: Administering antenatal magnesium sulfate has no effect in decreasing the incidence of NEC in preterm infants.

Clinical spectrum of acute flaccid paralysis among pediatric patients at the National Institute of Child Health, Karachi, Pakistan.

Fatima Ismail — 2024-07-01

Objective: To evaluate the clinical spectrum and immediate outcomes of acute flaccid paralysis (AFP) in children presenting at National Institute of Child Health, Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Pediatrics, NICH, Karachi, Pakistan. Period: August 2023 to January 2024. Methods: A total of 121 children of either gender, aged 1-15 years, and presenting with AFP were analyzed. AFP was diagnosed by nerve conduction study. Causes of AFP, like Guillian Barre Syndrome (GBS), transverse myelitis, traumatic neuritis were noted. Outcomes were noted in terms of discharged from hospital, left against medical advice, and mortality. Results: In a total of 121 children, 75 (62.0%) were boys. The mean age was 6.00±2.88 years, ranging between 1-12 years. There were 74 (61.2%) children who were fully vaccinated as per age. The most common cause of AFP were GBS, transverse myelitis, and hypokalemic paralysis, noted in 49 (40.5%), 19 (15.7%), and 15 (12.4%) children, respectively. Ninety (74.4%) children were discharged after the treatment, 10 (8.3%) left against medical advice, whereas mortality was noted in 21 (17.4%) children. Children leaving against medical advice were left out from the analysis to compared final outcomes with respect to various study variables. Incomplete vaccination status (p=0.0006), and presentation with sensory loss (p=0.0003) were found to have significant association with mortality. Conclusion: Guillian Barre Syndrome was found to be the most common cause behind acute flaccid paralysis in children. Incomplete vaccination history, and presenting with sensory loss were associated with poor outcomes.

Comparison of serum selenium levels in anaemic and non-anaemic Pakistani children.

Fatima Babar — 2024-07-01

Objective: To compare the serum selenium levels in anemic and non-anemic Pakistani children. Study Design: Case-control Prospective study. Setting: PAEC General Hospital, Islamabad, Pakistan. Period: 1^st March 2022 to 31^st August 2022. Methods: A case control study was conducted wherein comparison of Selenium levels in anemic and non anaemic Pakistani children was investigated. Age, serum selenium level and haemoglobin were the quantitative variable of this study and were subjected to median and standard deviation. Severity of anemia, mean being qualitative (ordinal) variables were expressed in terms of percentages. Bar graph and tables were used to display results. Chi square test was applied to compare both the groups. Odd ratios were also calculated. A total of 60 samples from anemic and control population were selected using consecutive non-probability sampling method. Selenium levels of the serum were determined using atomic absorption spectrometry. SPSS 19 version software was used for data analysis. Results: The findings in this study indicated that 33% of cases were Selenium deficient, while 27% among controls had low Selenium levels. (p=0.57). Conclusion: This study showed no association of selenium deficiency with anaemia.

Prevalence of chronic kidney disease in children of school going age visiting outpatient department of A Tertiary Care Hospital in Karachi, Pakistan.

Erum Parker — 2024-07-01

Objective: To determine the prevalence of chronic kidney disease (CKD) among children of school-going age. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: A total of 130 children of both genders, aged between 5-15 years, visiting outpatient department of pediatric medicine were analyzed. Demographic and clinical information were noted. Laboratory investigations like urinalysis and serum creatinine were performed. CKD was diagnosed on the basis of “Kidney Disease Outcomes Quality Initiative (KDOQI)” guidelines. Results: In a total of 130 children, 67 (51.5%) children were male. Overall, the mean age was 8.43±2.45 years. Hypertension was diagnosed in 10 (7.7%) children. Anemia was present in 103 (79.2%) patients. The mean hemoglobin, serum creatinine, and blood urea nitrogen were 9.41±1.98 g/dl, 0.48±0.37 mg/dl, and 34.20±33.18 mg/dl, respectively. CKD was diagnosed in 10 (7.7%) children. Among these 10 children diagnosed with CKD, 7 were having CKD stage-1 whereas CKD stage-2 was noted in 3 children. Presence of hypertension (p=0.006), and albuminuria (p<0.001) were associated with CKD. Conclusion: The prevalence of CKD in school going age children was 7.7%. Presence of hypertension, and albuminuria were linked with CKD.

Evaluation of Procalcitonin and Presepsin in prediction for early onset neonatal sepsis.

Sadia Israr — 2024-07-01

Objective: To determine the presepsin and procalcitonin significance in cord blood and compare with lactate and C-Reactive protein for early prediction of neonatal sepsis. Study Design: Case Control Study. Setting: Military Hospital Rawalpindi. Period: Sep 2018 to July 2019. Methods: Mothers, having deliveries with early or prolonged rupture of membrane, preterm, dai handled, meconium and failure of induction have been included. Out of 60 neonates, nineteen were cases with a clearly documented suspicion of sepsis and confirmed by neonatologists, remaining were control. Mean and Standard Deviation were calculated. The difference in all biochemical markers levels among case and control groups were assessed by independent t-test. Sensitivity, specificity, accuracy, and predictive value of both markers were calculated by medcalc diagnostic calculator. Regression analysis to access the strength. Receiver Operating Characteristics curve for most accurate cut off values and Area Under the Curve was calculated. Results: Independent sample t test revealed the strong association of procalcitonin and presepsin with neonatal sepsis. Presepsin has higher positive predictive value 83.33% and negative predictive value 90.48% with 88.33% accuracy while procalcitonin has positive predictive value 62.50%, negative predictive value 88.89% and accuracy 78.33%. Stepwise regression analysis showed better in combination than single in predication of neonatal sepsis. The cutoff value for procalcitonin was 0.4ng/ml (AUC of 84.5%.) and for presepsin was 305pg/ml (AUC of 86.5%). Conclusion: In comparison to lactate and CRP, a prediction model that incorporates two biochemical indicators, procalcitonin and presepsin, can reduce infant mortality and morbidity by spotting neonatal sepsis early.

Pattern and management of bile duct injuries presented to Hepatobiliary Unit of Shaikh Zayed Hospital Lahore.

Abubakar Siddiqui — 2024-07-01

Objective: To find out the pattern and management of Bile Duct Injuries (BDIs) presented to Hepatobilliary unit. Study Design: Descriptive Cross Sectional. Setting: Hepatobiliary Unit, Shaikh Zayed Hospital Lahore. Period: November 1, 2022, to April 30, 2023. Methods: Total of 79 patients with Bile duct injuries were included. Demographic data and relevant investigations were performed. BDIs severity was classified using the Strausberg Classification. Patients underwent appropriate surgical interventions, with follow-up for period of 6 months postoperative complications. Results: The mean age was 39.89±10.01 yrs, primarily females (81%). BDI resulted from laparoscopic cholecystectomy in 44.3%, open cholecystectomy in 51.9%, and conversion to open surgery in 3.8% cases. Jaundice (58.2%), bile leak (38.0%), and itching (3.8%) were common presentations. Surgical procedures included hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). BDI classification revealed E2 (57.0%), E3 (36.7%), and E4 (6.3%) cases. Surgical site infection was observed in 11.4% of cases. Postoperatively 5.1% patients experienced anastomotic leaks and only the site of BDI was a significant factor for leak with the p value of <0.001. Conclusion: In conclusion the majority of BDIs were E2 (57.0%), E3 (36.7%), and E4 (6.3%).Procedure performed were hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). Anastomotic leaks were significantly linked to the site of BDI.

Frequency of fistula in patients operated for primary cleft palate repair in a tertiary care center.

Nasir Hayat Khan — 2024-07-01

Objective: To determine the frequency of fistula in patients undergoing primary cleft palate repair. Study Design: Descriptive Case Series study. Setting: Burns and Plastic Surgery Center, HMC, Peshawar. Period: February 2023 to December 2023. Methods: Patient of both genders males and females undergoing primary cleft palate repair were included in the study with age ranging from 9 to 18 months age excluding patients with comorbids and syndromic patients. Non-probability consecutive sampling was adopted. The data was acquired from patients and hospital record and analyzed with statistical package for social sciences (SPSS). Results: Our study shows that among 169 patients, mean age was 10 months with SD ± 5.11. 100(59%) patients were male and 69(41%) patients were female. More over 3(2%) patients had fistula while 166(98%) patients didn’t had fistula. Conclusion: In this study we observed an internationally acceptable frequency of post-palatal repair fistula for primary cleft palate in our study population.

Dexamethasone effect on serum glucose concentration in diabetic versus non-diabetics patients undergone laparoscopic cholecystectomy: A randomized controlled trial.

Afnan Amjad — 2024-07-01

Objective: To evaluate dexamethasone’s effect on serum glucose concentration in diabetic versus non-diabetics patients undergone laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesiology, Lady Reading Hospital, Peshawar. Period: January 2022 to December 2022. Methods: One hundred and eight patients presenting for laparoscopic cholecystectomy were included. Patients were divided in two groups, fifty four patients in diabetic group and fifty four in non-diabetic group. Dexamethasone was administered in both groups prior the anesthesia induction. Blood glucose levels were recorded at baseline, at 6^th and 12^th hours in both groups. Results: Total 108 patients divided in two groups, 54 in diabetic group, and 54 in non-diabetic group. Patient’s mean age was 38.67±13.66 years in diabetic group while 42.31±12.58 years in non-diabetic group. Mean BMI was 25.27±2.34 kg/m² in diabetic group while 24.96±2.20 kg/m²in non-diabetic group. The gender distribution of the patients in both groups is presented in Figure-1. No noteworthy significance in the rise of blood glucose levels was discerned between the two groups from baseline to the 6th hour. However, a substantial increase in blood glucose levels at the 12th hour was evident in the non-diabetic group (P = 0.0001). Conclusion: We conclude that 8 mg dexamethasone triggers a significantly elevated hyperglycemic surge in non-diabetic patients as compared to diabetics.

Factors leading to surgical site infection (SSI); a 6 years analysis of general surgical cases in a newly developed teaching hospital.

Saira Aleem — 2024-07-01

Objective: To determine the major factors leading to surgical site infection in elective surgeries. Study Design: Retrospective Cross Sectional study. Setting: Department of Surgery, Government Teaching Hospital Shahdara, Lahore. Period: January 2016 to December 2021. Methods: The cases of surgical site infections were collected from well-organized data according to health care commission’s format of recording data in surgical site infection Register. Emergency patients were excluded. Each infected case was thoroughly investigated according to Performa and presented in meeting of infection control committee. Demographics were recorded and the factors were determined in individual case. Frequency and percentages of infected cases and main factors in all cases were analyzed by SPSS version 24. Results: We had 61 cases of SSI out of 2962 cases operated during the study period with calculated rate of 2.06%. Seventy two percent cases had age more than 40 years. 39(63.93%) were female and 22(36/07) were male. Mean age was 43.02 years with standard deviation of ± 8.98. 72% of infected cases. BMI in infected cases was 29.56 mean and Standard deviation ± 2.74 and 27.29 in non-infected cases (significant). Diabetes and Rank of surgeon had significant difference with increased infection in resident level. Smoking and gender of patients had no statistically significant impact. Conclusion: High Body mass index, diabetes, longer duration of procedure, rank of surgeon and use of mesh are the leading factors causing surgical site infection. Smoking, age and gender had no significant effect on SSI.

Functional outcome of pertrochanteric fractures undergoing Dynamic Hip Screw versus Proximal Femoral Nail Anti-Rotation Techniques at a Tertiary care hospital of Karachi.

Pervaiz Hashmi — 2024-07-01

Objective: To find out the functional outcomes as per Harris hip score (HHS) among patients of pertrochanteric fractures undergoing dynamic hip screw (DHS) versus proximal femoral nail anti-rotation (PFNA) at a Tertiary care hospital. Study Design: Non-randomized Controlled Trial. Setting: Orthopedic Section, Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan. Period: 1^st August 2023 to 30^th January 2023. Methods: A total of 40 patients of age 18 and older with confirmed pertrochanteric fractures were non-randomly allocated to ether fixation with DHS or PFNA. Intra-opeative blood loss and duration of surgery were recorded. The functional outcome assessment was assessed using HHS. Results: In a total of 40 patients, 31 (77.5%) were female. The mean age was 67.63±15.13 years (ranging between 23 to 89 years). The most common mechanism of fall was tipped over loose carpet, noted in 17 (42.5%) patients. The mean intra-operative blood loss in DHS and PFNA groups were 73.75±20.06 ml, and 72.75±23.14 ml, respectively (p=0.885). The mean duration of surgery were 76.6±14.7 minutes, and 115.1±18.3 minutes in DHS and PFNA groups, respectively (p<0.001). Excellent, good, fair, poor, and failed outcomes were reported in 3 (7.5%), 17 (42.5%), 6 (15.0%), 10 (25.0%), and 4 (10.0%) patients respectively. When both groups were compared for outcomes, no statistically significant differences were observed (p=0.339). The mean HHS in DHS, and PFNA groups were 75.26±11.41, and 73.46±14.57, respectively (p=0.666). Conclusion: Functional outcomes as per HHS were relatively similar with DHS and PFNA approaches in patients with pertrochanteric fractures.

MRI of knee: high signals in STIR sequences and its relation with anterior knee pain our population.

Rabeea Khan — 2024-07-01

Objective: To evaluate the significance of high signals in STIR sequences in MRI in patients presenting with non-traumatic knee pain. Study Design: Cross-sectional study. Setting: Department of Radiology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2023 to August 2023. Methods: The patients presented for MRI of knee joint for knee pain unrelated to trauma were analyzed. Data were collected through a proforma based on 9 questions that included demographic data and questions related to the cause of pain. The total calculated sample size was 86 patients Data was analyzed through SPSS. Descriptive statistics were calculated. Association was determined using chi-square test considering p-value ≤0.05 as significant. Results: Our study showed no statistical correlation between knee pain and high STIR signals seen in pre-patellar bursa with 90.9% showing high signals with pain, while 85.3% showed high signals without pain. In our study this signal was found in about 20-30% that were mostly female household help and carpet layers. Conclusion: There is no statistical correlation between knee pain and high STIR signals seen in pre-patellar bursa.

Efficacy of platelet rich plasma (PRP) injection in the treatment of knee pain in patients with osteoarthritis knee.

Haroon Yousaf — 2024-07-01

Objective: To assess the efficacy of intra-articular PRP injections in patients with knee osteoarthritis. Study Design: Cross Sectional. Setting: Orthopedic Department of Mardan Medical Complex. Period: 13^th August to 14^th December 2023. Methods: Involving 50 diagnosed osteoarthritis patients at demographic data, grades of osteoarthritis, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded pre-treatment. Patients received PRP injections at three intervals, and post-treatment WOMAC scores were assessed. Statistical analysis included mean, standard deviations, and a paired t-test. Results: The study comprised 66% female patients, with a mean age of 50.08±5.82 and mean BMI of 27.16±3.53. Regarding grades of osteoarthritis, grade 1, grade 2 and grade 3 comprised of n=14(28%), 19(38%), 17(34%) respectively PRP treatment significantly reduced WOMAC scores from a pre-treatment mean of 56.62±5.70 to 27.54±4.79 (p < 0.001). Conclusion: The significant reduction in WOMAC scores post-treatment suggests that intra-articular PRP injections may serve as a valuable intervention in the short term management of knee osteoarthritis.

Frequency and involvement of lymph nodes in squamous cell carcinoma of oral cavity in cross sectional population.

Itrat Jawaid — 2024-07-01

Objective: To find out the frequent site of squamous cell carcinoma of oral cavity and pattern of neck node involvement in cross sectional population. Study Design: Prospective Study. Setting: Department of Otorhinolaryngology Head and Neck Surgery, Abbasi Shaheed Hospital Karachi and Karachi Medical and Dental College. Period: 01-06-2023 to 31-12-2023. Methods: Patients who biopsy proven squamous cell carcinoma of oral cavity visited ENT department Abbasi Shaheed Hospital were include in this study. Proforma was made in which detail history and examination were noted. Oral cavity examined to see the size and site of tumor. Neck was palpated to see palpable cervical lymph node. CT scan head and neck with contrast was done. Those patients who fulfilled the inclusion and exclusion criteria included in this. Result: 56 patients were selected in this study who fulfill the inclusion criteria. Male were 37 (66%). Maximum number of patients were between the 41-50 years of age, 24 patients (42.8%). Most common site of carcinoma was buccal mucosa 27 (48.2%). Highest number of patients presented with T3 stage 22 patients (39.2%). The frequency of lymph node involvement noted in 35 (62.5%) patients while 21 (37.5%) came with no lymph node. Level I was the most frequent level involved, it was involved in 28 patients (50%). Conclusion: Oral squamous cell carcinoma usually reported late. Early referral to otorhinolaryngologist and educate patient to consult Otorhinolaryngologist as earliest for early diagnosis and appropriate treatment plan.

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

Farhan Khan — 2024-07-01

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.

Comparison of the rate and indications of caesarean section in primigravida and multigravida in a maternity hospital of Pakistan.q

Laiyla Shinwari — 2024-07-01

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value <0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

Comparison of Post-Tonsillectomy Hemorrhage rate in patients undergoing two commonly used Tonsillectomy Methods.

Farzana Batool — 2024-07-01

Objective: To compare the cold steel method and bipolar diathermy in tonsillectomies in terms of post-tonsillectomy hemorrhage. Study Design: Randomized Controlled Trial. Setting: Department of ENT, Head & Neck Surgery, Ayub Teaching Hospital, Abbottabad. Period: 29^th October 2020 to 1^st June 2022. Methods: A total of 102 patients of both genders with ages 3 to 59 years undergoing tonsillectomy were included. Patients undergoing antiplatelet therapy, experiencing bleeding diathesis, possessing a high anesthetic risk, having uncontrolled medical conditions, suffering from anemia, or currently dealing with acute infections were not included in the study. Patients were divided into two groups A & B. Group A patients were operated by the Cold steel method and Group B were operated by Bipolar diathermy. All the surgeries were performed by the same surgical team. Both tonsils were fully exposed by Boyl Devi's mouth gag under general anesthesia. Complete removal of both tonsils was done with the Cold steel method in group A and by using Bipolar diathermy in group B. Post-operative hemorrhage (occurring 24 hours after surgery) without the necessity to return to the operation theatre for intervention was assessed. Results: The mean age of patients in group A was 20.0 ± 13.83 years and in group B was 19.12 ± 13.17 years. The majority of the patients 79 (77.45%) were between 3 to 30 years of age. Out of 102 patients, 63 (61.76%) were males and 39 (38.24%) were females with male to female ratio of 1.6:1. Frequency of secondary hemorrhage in Group A (cold steel method) was found in 01 (1.96%) while in Group B (bipolar diathermy) was 06 (11.76%) (p-value = 0.050). Conclusion: This study concluded that the frequency of post-tonsillectomy hemorrhage is higher in patients operated by bipolar diathermy as compared to the cold steel method.

Exploring protective potential of Vitamin E in mitigating liver steatosis in alcoholic liver injury.

Noman Ullah Wazir — 2024-07-01

Objective: To investigate and assess the efficacy of Vitamin E in preventing or reducing fatty liver changes associated with alcoholic liver injury. Study Design: Experimental study. Setting: Department of Anatomy and Animal Facility of Peshawar Medical College, Peshawar. Period: February 2018 to April 2020. Methods: The study involved eighteen male domestic rabbits (Oryctolagus cuniculus), organizing them into categories based on the time frames specified for the research. Animals in "Category E8" were subjected to an 8-week time period, while those in "Category E4" underwent a 4-week experimental duration. Each category was further divided into three groups: "Control Group A" received standard laboratory food and daily access to normal saline as drinking water, "Experimental Group B" received standard nutrition, a 30% ethanol solution in distal water (30ml per kg/day) and normal saline for drinking, and "Experimental Group C" was treated with the necessary standard diet, a 30% ethanol solution in distal water (30ml per kg/day), and "Vitamin E" (50mg dissolved in 2ml distal water per kg/day) via nasogastric tube. Liver tissue specimens from all animals were stained with H&E and Masson’s trichrome stain for quantification of fatty change. Results: A significant difference in steatosis development was observed among the E4 groups and among the E8 groups having a respective p-values of 0.001 and 0.003. This underscored the impact of alcohol within the context of alcohol-induced liver injury. However, no appreciable differences were noted between BI & CI and BII & CII (p-values > 0.05) indicating no significant distinction in liver steatosis between subjects treated with vitamin E and those not receiving vitamin E. Conclusion: In the context of alcohol-induced liver injury, the study failed to deliver anticipated protective benefits of vitamin E. There is a possibility of adverse effects, potentially rendering its use counterproductive.

Microneedling plus tacrolimus versus tacrolimus alone in conjunction with narrow band UVB in the treatment of vitiligo; A randomised control trial.

Tassmia Afzal — 2024-07-01

Objective: To compare the efficacy of microneedling plus Tacrolimus with narrow band UVB versus tacrolimus with narrow band UVB in the treatment of vitiligo. Study Design: Randomized Controlled Trial. Setting: Department of Dermatology, Madinah Teaching Hospital, Faisalabad. Period: 05-06-2023 to 5-12-23. Methods: Enrolled 28 patients with stable Vitiligo for the last 3 months, aged 15 to 60 years. Patients were assigned to group A and B, treated with microneedling plus topical tacrolimus 0.1% with narrow band UVB and tacrolimus ointment twice a day. The study focused on evaluating the repigmentation response during subsequent follow-up visits, using a comprehensive four-grade scale. The results were analyzed using SPSS 26. Results: The study involved 34 patients with face lesions. Six patients lost follow-up and were excluded. The study included 16 males and 12 females, with a mean age of 29.4 + 11 years. After the treatment, the first follow-up visit showed significant improvement in 17 of 28 patients (60.7%) in group A (microneedling pus Tacrolimus with narrow band UVB) compared to 32.1% in group B (Tacrolimus with narrow band UVB). The efficacy was categorized into five levels: 'excellent' in 25% cases in group A and 21.4% in group B, and very good' in 35.7 vs 10.7%. At 12 weeks, overall efficacy was seen in 71.4% in group A and 39.3% in group B. The study's findings suggest that microneedling plus tacrolimus with narrow band UVB may be a more effective treatment for vitiligo. Conclusion: Microneedling, a technique using delicate needles to puncture the dermis, has been shown to promote collagen synthesis and enhance the absorption of tacrolimus, a drug used for immunosuppression, potentially aiding in vitiligo repigmentation, but further localized studies are needed.

Schwannoma masquerading as a thyroid nodule: A diagnostic delimma.

Pashmal Yousaf — 2024-07-01

We present a case of a 70 years old female presenting with a long-standing neck swelling with a recent increase in size and new onset pain. It was initially diagnosed and operated on as a cold nodule of thyroid as her thyroid scan showed left cold nodule and FNAC was inconclusive. However, a final diagnosis of schwannoma with Antoni A structures was made on histopathological attributes. Schwannomas are benign peripheral nerve tumors which grow slowly on parent nerves. The mainstay of treatment is surgical excision. To avoid unnecessary or inappropriate interventions, thorough pre-operative assessment is required in case of thyroid or non-thyroidal lesions as most are hypoechogenic on ultrasonography and fine needle aspiration has low diagnostic yield. The key pre-operative investigations are ultrasound and ultrasound guided cytology and immunohistochemical staining (for example S-100, calcitonin, CEA, thyroglobulin, TTF-1, melan-A, HMB45 and Ki-67). MRI is also a good diagnostic tool in neck swellings where diagnosis is uncertain.