Role of pre-operative assessment on the results of rhinoplasty in terms of patient satisfaction

The objectives of the study was to find out the importance of preoperative psychological assessment of patients in rhinoplasty and significance of excluding patients with psychiatric disorders, particularly Body dysmorphic disorder [BDD], on the overall results of surgery in terms of patient satisfaction. Randomized control trails [RCT]. This study was carried out at ENT out patients department [OPD], PNS Shifa and CMH Okara from January 2004 to Dec 2007. Patients complaining of nasal deformity with or without nasal obstruction were included in the study. A total of 85 [47 females and 38 males] patients were selected. After detailed history, examination and counseling 45 patients were selected by simple random method for psychological assessment and 40 patients not to have psychological assessment. The psychiatrist used DSM-IV TR criteria for psychological assessment and diagnosed 08 patients to be suffering from BDD and did not clear them for cosmetic surgery. Thirty seven patients being cleared for rhinoplasty [group A] and 40 patients [group B] not having psychological assessment, a total of 77 patients [42 females and 35 males] were offered cosmetic rhinoplasty. Patients were followed up for 01 year to check whether they were satisfied or not with postoperative results. The statistical data in the two groups was separately analyzed. Then by applying chi-square test the association in both the groups was calculated. Postoperatively 36/37 patients in group A were satisfied with their postoperative appearance and 32/40 patients in group B were satisfied. Chi-square test revealed the probability of <0.005, which is significant. Preoperative psychological assessment of patients has a significant role in patients undergoing cosmetic rhinoplasty as far as postoperative appearance is concerned

Euglycemic ketoacidosis

The purpose of this ariticle is to highlight the importance of not relying exclusively on blood glucose measurements when assessing sick type I diabetics. Urinary ketones and venous bicarbonate are essential in making the diagnosis of relatively low blood glucose plus ketoacidosis, that we call euglycaemic ketoacidosis

Psychiatric morbidity in patients undergoing rehabilitation at armed forces institute of rehabilitation medicine

Psychiatric morbidity is common among patients with physical disorders. This study aims to find out the frequency of psychiatric disorders in patients attending rehabilitation program at Armed Forces Institute of Rehabilitation Medicine. Impact of physical disability and personality on psychiatric morbidity was also studied. One hundred patients who were attending rehabilitation program were selected at random. All were administered Present State Examination, Functional Independence Measure. Psychiatric diagnosis was based on ICD-10 diagnostic criteria. The study was conducted at Department of Psychiatry Military Hospital Rawalpindi in collaboration with Armed Forces Institute Of Rehabilitation Medicine, from March 99 to July 99. An overall frequency of 43% of psychiatric morbidity was found by the PSE-10 and ICD-10. Adjustment disorders [32.5%] were the largest group among the cases followed by mood disorders [27.8%]. Psychiatric morbidity was comparatively higher among patients with spinal cord injury, stroke, burn injuries and amputations as compared to other categories. Mean FIM Scores were lower in cases [97.8] as compared to non- cases [108.8], this difference were statistically significant. Patients were also divided into those very severe disability and those with lesser functional impairment based on FIM scores. Calculation of the odds ratio revealed that people with severe disability were twice as likely to be suffering from psychiatric disorders as compared to those with lesser degree of disability. This study indicates that a considerable proportion of patients [>40%] undergoing rehabilitation program were suffering from psychiatric disorders. Detection and treatment of psychiatric morbidity can improve the rehabilitation outcome as well as the quality of life