VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment

To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment [VAAFT] is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula. This is followed by an operative phase of fulguration of the fistula tract using glycine solution mixed with manitol, curetting the tract with curette and fistula brush. Internal opening is closed with a Vicryl 1 suture. Total of 40 patients were operated using VAAFT from October 2013 to March 2014. Three were re-operated. The other 37 cases were followed up at 6 weeks, 3 months and 6 months. Primary healing took place in 20 [50%] cases at 6 weeks. In the remaining 17 [42.5%] cases, minor discharge occurred with itching which resolved till the next visit at 8 weeks and 12 weeks. As the main aim in treating fistula is proper identification of the internal opening, excision of the tract and sparing the sphincter function, VAAFT achieves all aims with additional benefits of patients' satisfaction and negligible scaring

Comparison of periodontal health status of smokers versus non-smokers

This study aims to compare the periodontal health status of current smokers versus nonsmokers. The study was carried out in the Dental department, Pakistan Institute of Medical Sciences [PIMS] between May 2009 and June 2010. A total of 280 male subjects, married, over the age of 18 were selected to take part in the study and their periodontal health was assessed by presence of calculus, bleeding on probing and pocket depth greater than four millimetres. Patients including smokers and non smokers were selected on the basis of the inclusion and exclusion criteria. Subjects were clinically evaluated by using a specially designed CPITN probe which was used to measure pocket depths in the mouth. The mouth was divided into six sextants. The other variables examined included bleeding on probing and presence of calculus. The data was subsequently analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. There was decreased incidence of bleeding on probing [31.7%] in smokers than non-smokers [53.5%] however, there was an increased incidence of calculus formation among smokers [89.4%] compared to the subjects who did not smoke [69.6%]. There was a significant difference between the overall mean pocket depth in smokers [3.7 +/- 1.4] and non-smokers [3.0 +/- 1.1]. All of the above differences were found to be statistically significant. There was a marked association between cigarette smoking and periodontal disease

Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

STUDY DESIGN: Cross sectional and observational. PURPOSE: To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. OVERVIEW OF LITERATURE: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. METHODS: This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. RESULTS: During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92+/-11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). CONCLUSIONS: Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life.

Socioeconomic status and impact of treatment on families of children with congenital heart disease

To assess the socioeconomic status, treatment being offered and the impact of congenital heart disease treatment on families. Observational study. The Children's Hospital / Institute of Child Health, Lahore, from 1st March to 31[st] August 2010. All patients undergoing a cardiac surgical or angiographic intervention were enrolled. Socioeconomic status was assessed by Kuppuswamy socioeconomic status scale with income group modification. The impact was measured by the source of financing, effect on family financing source and schooling and health of siblings. Of 211 patients undergoing treatment in the study period, surgery was the definitive treatment in 164 [77.7%] and angiographic intervention in 47 [22.3%] patients. Male to female ratio was 1.5:1. The mean age of the patient was 39.1 +/- 3.2 months [range 01 day to 15 years]. Majority of families belonged to middle [66.4%, n=140] and lower [27%, n=57] socioeconomic class. The mean cost of medicines and disposables was PKR 78378.2 +/- 8845.9 [US$ 933.1 +/- 105.3] in open heart surgery, PKR 12581 +/- 7010.8 [US$ 149.8 +/- 83.5] in closed heart surgery and PKR 69091 +/- 60906 in angiographic interventions. In 63.1% patients, families contributed towards these costs either completely [12.3%] or partly [50.8%] with significant contribution from the hospital. Adverse effect on families ranged from leave without pay to losing jobs or business [46%], and selling their assets [11.3%]. It also affected schooling and health of siblings [22.7% and 26.1% respectively]. Majority of children with congenital heart disease belonged to middle and lower socioeconomic status in this study. Main definitive treatment was surgery. The cost of health care facilities posed a marked socioeconomic burden on those families

variation in the circulus arteriosus: a case report

This article described a variation detected in the cerebral arteries. In general the right arteries were found larger than the left. The left vertebral artery was found very small. Both anterior cerebral arteries originated from the right internal carotid and there was a small connecting branch from the left internal carotid to the left anterior cerebral artery

Traumatic injuries of the permanent maxillory incisors at dental department, Pakistan institute of Medical Sciences Islamabad: a retrospective study

The study aims to ascertain the prevalence of traumatic dental injures of the maxillary permanent incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad during the years 2003-2005. Information concerning age, sex, cause, type of tooth, number of injured teeth and patterns of tooth injury were recorded retrospectively from 336 patients aged between 8-40 years, comprising 498 traumatized teeth. The dental records of all the patients presenting with dental trauma were examined for collection of data relating to age, sex, cause, number of injured teeth, type of tooth and type of tooth trauma. Type of tooth trauma was recorded according to the Andreason classification. The data was subsequently processed and analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. Of the 336 patients, 227 were males [67.6%] and 109 were females [32.4%]. The gender difference was statistically significant [P < 0.0001]. The patients had a total of 498 traumatized teeth. A large number of dental trauma occurred in patients aged between 9-11 years. Most injuries involved one tooth in 227 patients [67.6%]. However two teeth in 90 patients [26.7%], three teeth in 11 patients [3.2%] and only in 8 patients [2.3%] four teeth were involved. Fractures in enamel only occurred in 74 teeth [14.6%]. Uncomplicated crown fractures in 208 teeth [41.9%] were the most commonly encountered dental trauma. 137 teeth [27.6%] suffered complicated crown fractures, 44 teeth [8.9%] uncomplicated crown-root fractures, 19 teeth [3.8%] complicated crown-root fractures and avulsion in 16 teeth [3.2%] only. The main causes were falls in 225 patients [66.9%], collision with objects in 40 patients [11.9%], road traffic accident in31 patients [9.2%] violence in 21 patients [6.2%], and sports in 19 patients [5.6%]. The maxillary central incisor was traumatized in 384 teeth showing a high percentage of 77%. Raising public dental awareness regarding the serious outcome of traumatic dental injuries is mandatory to improve the prognosis of dental trauma and to avoid complications

Risk factors for dental caries in Pakistani children

The present study was carried out to determine any possible association of caries with oral hygiene and food habits. This was prospective descriptive study. Total [n= 543] patients with dental caries between 6-9 years were selected from dental OPD of Children's Hospital, PIMS, Islamabad. Questions regarding brushing habits and food habits were asked by interviewing the accompanied adults and caries status of teeth after intra oral examination were recorded in questionnaire. X-ray was not taken to diagnose the caries. The frequency of caries was higher in age group of eight and nine. Children who ate candies daily had statistically [p<0.05] high caries. Negative correlation was found between mother's education, father's education and caries- Significantly high frequency of caries [P<0.05] was found in children who ate bread in their breakfast with sugar sweetened tea and patients used fluoride containing toothpaste had less caries. Surprisingly, in comparison of food habits between male and female subjects no significant difference was found