Dyslipidemia and mean lipid profile in patients with liver cirrhosis

Background: Patients with liver disorders are often found to have deranged lipid profile. Clear decline is observed in the levels of cholesterol as well as TG among individuals having severe hepatitis and liver failure as synthesis of lipoprotein is reduced. This study was done to determine the frequency of dyslipidemia and the mean lipid profile values in patients of liver cirrhosis.Methods: A cross sectional, descriptive study, done at the Department of Medicine, Medical Unit-1, Bahawal Victoria Hospital, Bahawalpur, from July to December 2019. A total of 246 patients presented with cirrhosis of liver of age 20-60 years and both genders were included. Analysis for serum total cholesterol (TC) level, serum triglycerides level, low density lipoprotein (LDL) and high density lipoprotein (HDL) were done and findings were noted.Results: Mean age was 51.67±6.21 years. Out of the 246 patients, 153 (62.20%) were male and 93 (37.80%) were females with male to female ratio of 1.6:1. Mean values of lipid were, LDL cholesterol 95.76±29.65 mg/dl, HDL 43.37±11.46 mg/dl, TC 147.51±42.69 mg/dl and TG 101.29±21.59 mg/dl. Dyslipidemia was found in 59 (23.98%) patients, whereas there was no dyslipidemia in 187 (76.02%) patients.Conclusions: Frequency of dyslipidemia in cirrhotic patients is high. Evaluating patients of liver cirrhosis, dyslipidemia need to be considered for early recognition and analysis.

Incidence of Alveoloplasty Post Extraction in prosthetic Patients – A Retrospective Study

An Alveoloplasty is a pre prosthetic procedure that smoothens the jawbone. This procedure is done in areas where teeth have been extracted or lost. Alveoloplasty can be done alone, but is usually done at the time of extraction. The aim of this pre prosthetic procedure is to improve the quality of oral supporting structures that provide better retention and stability to dental prostheses. Reason: This study is done to implement protocols to reduce the need of secondary Alveoloplasty as the procedure causes extra financial and surgical burden to the patients. The aim of the study is to analyze the advantages of Alveoloplasty at the time of extraction. Objective: The objective of this study is to determine whether Alveoloplasty, if performed at the time of extraction saves time and ends in faster prosthetic rehabilitation when compared to secondary Alveoloplasty. Methods: This study was done and 30 cases were selected out of which 15 cases that have undergone extractions have undergone alveoloplasty done on the same day and the remaining 15 patients have undergone alveoloplasty after few days of extraction. Results: Results showed that the mean time taken for the completion of prosthetic replacement is quite higher in cases that had alveoloplasty done on a different day of extraction compared to those cases that had alveoloplasty done on the same day of extraction. Conclusion: We conclude that alveoloplasty done on the same day of extraction aids in faster correction of the edentulism

Etiology, Clinical Features, and Complications of Urethral Stricture.

Introduction: Most urethral strictures are either idiopathic or iatrogenic secondary to urethral instrumentation or failed surgery for hypospadias and complications of prostatectomy. Sometimes, it also presents as a surgical emergency. Aim: The aim of the present study was to study the etiological, clinical features, and complications of urethral stricture. Materials and Methods: A total of 50 cases of urethral stricture were studied over a period of 2-year in Katihar Medical College, with emphasis on various aspects of urethral stricture. Results: Maximum 24% of the cases were in the age group of 31-40 years followed by age group 41-50 years (20%). All the patients in this study were males. The disease was mostly prevalent among people of lower socio-economic status. Acute and chronic retention of urine were the most common complication comprising of 50% of the total cases. A maximum number of cases were traumatic in nature. Conclusion: Urethral stricture is a disease of varying symptoms and lots of complications affecting the psyche of the patient. The treating surgeon must be competent in the use of various techniques to deal with conditions of the urethra presented at the time of surgery.

Preparedness of the teachers for Team-Based Learning: Liking, disliking and suggestions of faculty.

Faculty development is an integral part of institutional development. This paper describes liking, disliking and suggestions of faculty members on a 2-days Team-Based Learning faculty training workshop, where 39 faculty members were attended. Participants liked the lively and informal discussions through which they got a new technique to teach students more interactively. However, they disliked too short demonstration and short notification given them to read pre-assigned material and suggested more workshops with more practical demonstration before its implementation. Faculty developers should address the needs of the faculty while organizing developmental workshop aimed to link between theory and practice for a sustainable development.

Benign Breast Lesions in a Teaching Hospital in Rural Bihar.

Background: Breast diseases has captured attention of surgeons throughout the ages with its uncertain cause. Study of a pattern of benign breast diseases (BBDs) is a challenge due to variants in occurrence and presentation in different age groups and different geographical areas. The breast is a complex structure and any unnatural change affects the body and psyche of the person. Aim: The aim of this study was to observe age distribution, clinical signs, symptoms and pathology of benign breast lump and correlate them with pathological findings. Materials and Methods: A total of 124 cases of benign breast lump were included in this study. These cases were selected among patients visiting the outdoor clinic of Department of General Surgery in Katihar Medical College, Katihar, Bihar, India. The selected cases belonged to different etiology, age group and sex. Results: Maximum cases of benign breast tumors were observed in age group of 21-30 years (third decade). Fibroadenoma was the most common presentation. The majority of patients reported within 1 year of onset of disease. The painless lump was the most common mode of presentation. The right breast was involved in a more number of cases with maximum lesions noted in the upper outer quadrant. Conclusion: BBDs are common in female patients. Clinical, sonological, mammographical, and pathological studies need to be conducted in a systemic way to find answers of complexities posed by the confusing pattern of BBDs.

Training standardized patients for undergraduate Psychiatry examinations: experience of a Malaysian university

Simulated/ standardized patients (SPs) have become one of the significant components in today’s medical education and students’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A wellstructured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.

Antimicrobial and antioxidant screening of N'-substituted sulphonyl and benzoyl derivatives of 4-Pyridine carboxylic acid hydrazide

In this research program, the antibacterial, antifungal and antioxidant activities of six N_-substituted sulfonyl and benzoyl derivatives of lead molecule PCH were reported. Out of these compounds, sulphonyl derivatives 2,3 and benzoyl derivative 5 showed moderate to good activity against different strains of gram-positive and gram-negative bacteria including B. cereus, B. subtilis, B. thruingiensis and S. pyogenes, S. fecalis and E. coli ATCC 8739. Moreover, upon antifungal screening, the compound, N?-[[2,4,6-trimethylbenzene] sulfonyl]pyridine-4-carbohydrazide possessed good antifungal activity against Candida species, a causative agent of systemic fungal infections. Antioxidant study demonstrated more than 50% inhibition in DPPH assay for sulphonyl derivative 2 indicating its potential as antioxidant while the other derivatives expressed low level of radical scavenging property

Traditional bone setters; preference and patronage

Objectives: To evaluate the factors for preferring the traditional bone setters by people

Study Design: Observational study

Setting: Department of Orthopedics and Spine Surgery Hayatabad Medical Complex Peshawar

Period: October, 2013 to March, 2014

Materials and Methods: Sixty consecutive patients who presented at orthopedics out-patient clinic after attending Traditional Bone Setting Centers were recruited for the study. Information about the patients' bio data, mechanism of injury, who advised them to contact TBS and what are the factors that compelled them to attend TBS were obtained and filled into prepared proforma. The data obtained was recorded and analyzed on SPSS version 17

Results: The mean age was 25.57 years with minimum age 5 years and maximum 65 years. Sixteen patients were females and 44 were male. Two [3.3%] patients first attended Modern orthopedic service [MOS] and 58[96.7%] patients attended TBS.47[78.3%] patients were taken by their own immediate family members to TBS, 20% were referred by friends and 1.7% were self-referral. Thirty seven [61.7%] opted for TBS because of their belief, 11[18.3%] considered this service cheap, 7[11.7%] attended it because it is quick service and 5 [8.3%] reverted to TBS because of attitude of hospital personals

Conclusion: A considerable of people still have great trust on TBS regarding management of musculoskeletal problems. Belief is the most leading cause of consulting traditional bonesetters, other causes include low cast, quick service and attitude of hospital personnel

Educational Environment in a Multicultural Society to Meet the Challenges of Diversity.

Educators in a multicultural-environment face complex-tasks in teaching for diversity. The objective of this study was to determine the educational environment in a Malaysian medical school, aimed to face the diversity. This cross-sectional study was conducted utilising “Dundee Ready Education Environment Measure”, a validated instrument that contained 50 items rated 0-4 with a maximum 200 score under five sub-scales. Sub-scales were perceptions of: learning, teacher, academic-self, atmosphere and social-self. Respondents were 193 year-5 medical students of session 2011-2012, comprised of Malays, Chinese, Indians and Other ethnic-group. The overall mean score perceived by all ethnicity was 130/200 (65%). All sub-scales perceived >60% scores except social-self and atmosphere. The social-self sub-scale perceived the lowest score (53.57%) by the Other ethnic group while interestingly social-self also perceived highest (75%) by the Indians. Atmosphere sub-scale perceived a score of 58.33% by Other ethnic-group. Positive perceptions of educational enviornment among the students of diverse ethnicity reflects that educational environment at the medical school is well equiped to meet the challenges of diversity. However, there is opportunity to increase further positivity in general and social-self and atmosphere sub-scales in particular. Educators in a multicultural-environment must work to avoid monocultural instructional methodoligies to promote a multicultrul society.

Efficacy of ponseti method in management of club foot

Objective: to determine the efficacy of ponseti method in the treatment of club foot

Material and Methods: this descriptive case series was conducted at Department of Orthopaedic Surgery, Services Institute of Medical Sciences [SIMS]/ Services Hospital Lahore. Sample size of 100 was calculated with 95% confidence using non probability purposive sampling technique. Children of age 6 month to 1 year with club foot of either sex were included, while those with any associated congenital anomaly were excluded. Children with idiopathic club foot having skin disease and pressure sore due to POP cast were also excluded. All children had six casts at weekly interval by Ponseti's technique. Prior to the fifth cast percutaneous Achilles tenotomy was done under local anesthesia if dorsiflexion was not possible beyond neutral. Following the removal of the last cast all the feet were placed in a Foot Abduction Orthosis [AFO]. Sixth months after the completion of plaster treatment all feet were assessed by Pirani score

Results: a total of 100 children were included in the study. The mean age was 5.78 +/- 3.21 months. Majority of the patients were between 0-9 months of age i.e. 63% [n=63], and between 10-12 months 37% [n =37]. Male to female ratio was 1.127:1. Percutaneous Achillies tenotomy was done in 82% of cases. Pirani score six months after cast treatment was calculated which showed 88% [n=88] children had good results and 12 % [n=12] didn't have effective results. Efficacy of Ponseti method in the treatment of club foot reveals Pirani score <1 in 88% [n =88] while >1 in 12% [n=12]. Stratification for efficacy of Ponseti method with regards to age before treatment reveals that out of 88 cases 68.18% [n=60] were between 0-9 months of age and 31.82% [n=28] were between 10-12 months of age. Stratification for efficacy of Ponseti method with regards to initial Pirani score before treatment reveals that out of 88 cases 88.64% [n=78] had< 4 and 11.36% [n =10] had >4 Pirani score

Conclusion: we concluded that Ponseti method is highly effective for the management of club foot in children up to 12 months of age and need for extensive corrective surgery is greatly reduced. We recommend the Ponseti method as standard therapy in clubfoot management

Spine surgery; complication of iliac crest bone graft harvesting

The objective of this study is to find out the complication directly related to iliac bone graft harvest in spine surgery. Observational prospective study. Department of Orthopedic and Spine surgery, Hayatabad Medical Complex Peshawar. January 2007 to April 2012 on 139 patients. Only those cases were included in whom bone grafting was done for fusion as part of their spine surgery and were successfully followed for at least 6 months. Out of 139 patients 59[42.4%] were female patients while 80[57.6%] were male. Minimum age of the patients was 4 years while maximum was 70 years. In 119[85.6%] patients cortico-cancellous bone graft was taken. While in 20[14.4%] patients, tri-cortical graft was taken. In majority 106[76.3%] cases graft was obtained from the posterior iliac crest while in 33[23.7%] it was obtained from the anterior iliac crest. 45[32.4%] had some pain at the bone graft site. 8[5.8%] had early deep infection while 6[4.3%] had early superficial infection. Nine [6.4%] of our patients had nerve injury evident by parasthesia in the zone of distribution. Iliac crest is an excellent source and best available material for autogenous bone grafting. However it is not free of complications. The most common complications are persistent chronic donor site pain, infection and heamatoma

Oswestry disability index for the assessment of postoperative disability in spinal trauma

Objectives: The objective of this study was to assess functional disability measured with the Oswestry Disability Index in patients with thoracolumbar spine instrumentation

Study Design: A descriptive study

Place And Duration: Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar from July 2007 to June 2012

Methodology: This descriptive study was performed in Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar from July 2007 to June 2012 on 52 consecutive patients of either sex with age above 17 years, have unstable fracture of thoracolumbar spine with intact neurology that has been treated by posterior spinal fixation with pedicular screws and rods. Using Oswestry Disability Index questionnaire which assess the functional disability the data was collected by a proforma and analyzed with SPSS version 10

Results: There were total 52 patients. Male patients were 35 [67.3%] while female were 17 [32.7%]. Minimum age was 18 years, maximum 75 while average age was 35.90. The Oswestry disability index was grade D in 24[46.2%] patients and grade E in 28[53.8%] patients preoperatively. Postoperatively at six months the index was grade A in 33[63.5%]patients, grade B in 15[28.8%] and grade C in 4[7.7%] patients while minimum Oswestry disability index was 10%, maximum 56% and average was 22.76

Conclusion: Our study shows improved results based on Oswestry Disability Index, in patients with fracture of thoracolumber spine undergoing posterior spinal fixation with pedicular screws and rod. Our findings also document the effectiveness of surgical techniques that has been done, suggesting that a bed bound or crippled patient was enabled almost to live independently

Rutin- potent natural thrombolytic agent.

Thrombosis, the formation of blood clots, is a cause not only of heart attacks and strokes, but of deep venous throm-bosis (DVT) and pulmonary embolism as well. The number one killer of Americans is a blood clot that blocks blood flow to the heart or to the brain and approximately half of all morbidity and mortality in the United States can be attributed to heart attack or stroke. All the blood clot related conditions are life-threatening, and so there is a need for safe, effective and preventive treatment. A natural substance rutin, also called rutoside, is a citrus flavonoid glycoside found in Fagopyrum esculentum (buckwheat), the leaves and petioles of Rheum species, and Asparagus. This flavonoid compound has shown effective thrombolytic activity (prevents the formation of blood clots) by blocking the enzyme protein disulfide isomerase (PDI) found in all cells involved in blood clotting. Food and Drug Administration (FDA) has established that rutin is safe and, thus provides a safe and inexpensive drug that could reduce recurrent clots and help save thousands of lives.

Olecranon fracture

The objective of the study is to assess the clinical and radiological outcome after tension band wiring of olecranon fractures. Descriptive study. Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar. July 2007 to June 2010. 29 consecutive patients of either sex with age above 20 years, having olecranon fracture. Fracture osteosynthesis was achieved with the insertion of two parallel 1.8 mm Kirschner wires from the tip of the olecranon and an 18 gauge wire in a figure of eight fashion. Then functional outcome is evaluated with Mayo Elbow Performance scores [MEPS] while radiological outcomes is evaluated with standard radiographs. Out of 20 patients, male were 19[65.5%] while female were 10[34.5%]. Minimum age was 20, maximum 80 and average age was 47.5 years. There were 7[24.1%] patients with type A, 6[20.7%] type B, 9[31%] type C, 6[20.7%] type E and 1[3.4%] with Schatzker type F fracture. Mayo Elbow Performance Score was Excellent in 13 [44.8%], Good in 10[34.5%], Fair in 4[13.6%] and Poor in 2[6.9%] patients. There were 10[34.5%] complications including prominent wire in 3[10.3%], osteoarthritis in 1[3.4%], broken skin in 3[10.3%], irritation of skin in 1[3.4%], erythema in 1[3.4%] and serous discharge in 1[3.4%] patient. There was no non union recorded in this study. Olecranon fractures heal well in most instances achieving recovery of normal function in more than 95% of patients. Functional outcome is dependent on fracture severity, length of immobilization, and patient factors

Comparison of Ponsetitechnique with Turco's posteromedial release in the management of congenital talipes equinovarus

To compare the results of Ponseti technique with one stage Turco's posteromedial release for correction of clubfoot in children of less than 12 month of age Comparative study Department of Orthopedics and Spine Surgery Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from October 2008 September 2010. Patients were randomly selected by drawing lots, with even number included in group A [Ponseti Technique] and odd number in group B [Turco's posteromedial release]. Patients of either sex with age less one year having congenital talipes equinovarus were evaluated preoperatively by Pirani score, postoperatively by Mac Key score and were followed up for 2 years. Out of sixty patients, 23[38.3%] were males and 37 [61.7%] females. Fourteen [23.3%] patients had bilateral while 46 [76.7%] had unilateral deformity. Minimum age was 2 week, maximum 52 week and average 5.58 week. Using Pirani score preoperatively, there were 36[60%] patients with severe abnormality and 24[40%] feet were moderately abnormal. Using Mac Key score the functional results at last follow up in Group A were excellent in 16[26.7%], good in 13[21.7%] and failure noted in 1[1.7%] patient. At last follow up, functional results in Group B were excellent in 14[23.3%], good in 10[16.7%], fair in 4[6.7%] and poor in 1[1.7%] patient. Ponseti technique for an idiopathic clubfoot should be the choice for clubfeet. When there is recurrent deformity or resistant club foot then operative treatments may be considered

Postoperative analgesia with tramadol in orthopedic surgery: continuous infusion versus repetitive bolus administration

To compare the effect of infusion of tramadol with repetitive administration of bolus on postoperative pain in orthopedic surgery. Comparative study. Department of Orthopedics and Spine Surgery Hayatabad Medical Complex Peshawar, form October 2009 to April 2010. Patients with American Society of Anesthesia clinical grade I and II, age >18 year scheduled for ambulatory orthopedic and trauma surgery were included. Half of the randomly selected patients were placed in infusion group [Group I] who received an initial intravenous loading dose of 100 mg tramadol followed by an infusion of 12 mg/hour tramadol for 24 hours after recovery from anesthesia; if necessary, repeated bolus of 50 mg tramadol was given. Half of randomly selected patients were in bolus group [Group II].These patients received a placebo infusion instead of tramadol infusion and only received bolus doses of 50 mg on demand. The pain relief was assessed as excellent or good by 78% of group I and 70% of group II patients. In group I, 65% requested only one or no repetitive bolus, compared with 40% in group II, while two or more bolus were demanded by 30% in group I and 60% in group II. The average analgesic consumption after 6 hours was 222 +/- 50 mg tramadol in group I and 200 +/- 50 mg tramadol in group II, respectively. After 24 hours it was 438 +/- 50 mg tramadol in group I and 250 +/- 50 mg tramadol in group II. While the consumption during the first 6 hours was comparable. From then on the consumption in group I increased significantly. Side effects were reported by 30% in both the groups. Continuous infusion is better than bolus in term of easy administration and better pain control throughout postoperative care

Compartment syndrome, a neglected diagnosis

To find out the frequency of compartment syndrome in extremities using Whitesides' infusion technique. Descriptive case series. Orthopedic Department of Hayatabad Medical Complex Peshawar, from April 2008 to April 2010. All patients with fractures, either open or closed, were clinicallay evaluated for compartment syndrome initially. All clinically suspected cases then underwent measurement of compartment pressure by Whitesides' infusion technique. There were thirty six patients in the study. Minimum age was 3 years and maximum 45 years with median age of 30 years. There were 25 [69.45%] males and 11 [30.55%] female patients. There were only two [2.77%] open fractures in this series. Two [5.55%] patients had femur fracture, 4 [11.11%] had radius/ulna fracture, one [3.33%] had supracondylar fracture of humerus and 24 [66.66%] tibia fracture. Five [13.88%] patients had injury to the foot. Minimum compartment pressure was 35 mmHg and maximum was 55 mmHg with a mean of 40 mm Hg. Traumatized limbs have high risk of developing compartment syndrome. A careful clinical examination at the time of admission and diligence with serial examinations of the extremity at risk, may identify majority of compartment syndrome patients. The pressure should then be measured to confirm compartment syndrome

Radiographic outcome of adolescent idiopathic scoliosis surgical correction with posterior spinal fusion using pedicle screw and rods fixation

To evaluate the correction of deformity as measured by Cobb's angle with posterior spinal instrumentation and fusion [PSIF], by using rods and pedicle screw along with autologous bone graft in adolescent idiopathic scoliosis [AIS]. Descriptive case series. Department of Orthopaedics and Spine Surgery Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from January 2007 to April 2011. Patients of aged more than 10 years of either sex were included in the study. All patients were managed by posterior spinal fusion using pedicular screws and rod and then evaluated by standing anteroposterior and lateral radiographs post operatively. The data was analysed with SPSS version 10. There were a total 18 patients with 14 [77.8%] females and 4 [22.2%] males. Mean age was 17 years [range 13-30 years]. The preoperative Cobb angle was 450 minimum, 1200 maximum [average 700] which was corrected to 50 minimum, 650 maximum and 200 average postoperatively. Total correctness achieved was 250 minimum, 700 maximum and 500 average. Pedicle screw construct can result in better correction and less frequent implant failures in idiopathic scoliosis

Comparison of the two methods of percutaneous K - wire fixation in displaced supracondylar fracture of humerus in children

To compare the effectiveness and safety of fractures treated by percutaneous medial-lateral cross K-wire fixation and 2-lateral K-wire fixation. Randomized controlled trial was conducted from January 2008 to July 2009 in Orthopedics unit of Hayatabad Medical Complex Peshawar. A total of 50 patients of displaced supracondylar fracture of humerus presenting between age 1-12 years were randomly allocated in two groups of 25 patients in each group and were subjected to medial lateral cross K wire fixation and 2 lateral K wire fixation. Mean age of patients was 7.02 +/- 2.25 years.72% of patients with carrying-angle loss was excellent results and 28% good results. The mean loss of elbow flexion and loss of elbow extension were 8.38° +/- 3.10 and 7.26° +/- 3.22 respectively. In Patients with med-lat cross K-wire fixation group 72% were excellent results and 28% good results, while similar results were found in 2-lateral K- wire fixation group. The 4% iatrogenic ulnar nerve injuries occurred with the med-lat cross K-wire fixation group, while no neurological injury occurred with 2 lateral K wire fixation with p value of 0.312. Hence, there was no significant difference in the incidence of ulnar nerve injury between the two groups of patients. Both techniques appear to be effective, 2 lateral K-wire fixation is as effective in term of stability as medial-lateral cross K- wire fixation but with less chance of iatrogenic ulnar nerve injury