Anterior saggital anorectoplasty; the treatment of anorectal malformations in female children

Anorectal malformation is the common congenital malformation. Ectopic anus and vestibular fistula are Intermediate types of anorectal malformations [ARM], which are the most common in female babies. Many surgical procedures have been described for the treatment of ARM. Anterior Saggital Anorectoplasty [ASARP] is not only convenient for the anesthetist for maintenance of anesthesia but also gives better exposure of surgical structures during surgery. To determine the technical suitability and outcome of ASARP in intermediate types of ARM in female children. This Descriptive study with prospective collection of data according to a set protocol. The study was carried out at the department of Pediatric Surgery, Military Hospital, Rawalpindi, Pakistan. November 2010 to March 2014, over the period of 3 years and 5 months. The data of all female patients presenting with intermediate types of ARM and undergoing ASARP, during the study period were analyzed, with respect to age, type, associated anomalies, complications and cosmetic outcome. A total of 36 patients of intermediate variety underwent ASARP. Age ranged from 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery, posterior vaginal wall tear occurred in 2 patients [5.5%]. Postoperatively, 2 patients [5.5%] had retention of urine, 2 patients [5.5%] developed wound infection with superficial disruption, anal stenosis occurred in 2 patients [5.5%] and 1 patient [2.7%] had rectal mucosa prolapse. None of them required re_ do surgery. Cosmetic outcome was excellent in 31 patients [86.1%], while it was satisfactory in 5 [13.8%] patients. Anorectoplasty through anterior approach is not only technically easy but has good cosmetic results in intermediate type of imperforate anus in female children

Comparison of risk factors profile in patients below and above forty years of age presenting with acute myocardial infarction

To compare the frequency of conventional risk factors in patients below and above forty years of age presenting with acute myocardial infarction. It was a three years retrospective comparative descriptive study conducted in Cardiology Department, PGMI, Lady Reading Hospital, Peshawar. Computerized data of patients admitted with acute myocardial infarction [AMI] from 1st September 2006 to 31st August 2009 was reviewed. Patients with age <40 years were assigned Group-I while those with >/= 40 years as Group-II. Conventional risk factors were age, sex, pertinent family history, smoking, hypercholesterolemia, hypertriglyceridemia, hypertension and diabetes mellitus. Using SPSS version 16, data was analyzed. A total of 4935 patients were admitted with AMI over the study period. Mean age was 58.4 +/- 12.37 [20 to 99] years. Group-I had 252 patients [79.4% males], while Group-II had 4683[65.9% males].Positive family history in Group-I vs. Group-II was 43[17.1%] vs. 426[9.1%], [p<0.001], respectively. Hypertension in Group-I vs. Group-II was 57[22.6%] vs. 1666[35.6%], [p<0.001], respectively. Diabetes mellitus in Group-I vs. Group-II was 29/252[1.5%] vs. 1059[22.6%], [p<0.001], respectively. Hypercholesterolemia in Group-I vs. Group-II was 63[25%] and 583[12.4%], [p<0.001], respectively. Hypertriglyceridemia in Group-I vs. Group-II was 68[27%] vs.1188 [25.4%], [p<0.001], respectively. Smokers in Group-I vs. Group-II were reported in 24[9.5%] vs. 76[1.6%], [p<0.001], respectively. Positive family history, hypercholesterolemia, hypertriglyceridemia and smoking were more frequent in younger age group while hypertension and diabetes mellitus were the predominant risk factors in older age group

Supracondylar fracture of humerus; radiological assessment of closed reduction by Baumann angle

To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction and percutaneous pinning. This prospective study of 50 patients who presented with displaced supracondylar fracture of humerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar over period from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperative reduction was assessed by Baumann angle. All patients were followed for one year. Mean age of the patients was 7.02 years +/- 2.25 SD. Loss of Baumann angle in injured side was range from 2° to 8°. Loss of carrying angle in injured side was range from 3° to 9°. When Baumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 +/- 2.22 SD and 4.320 +/- 1.52 SD respectively. Using Flynn's criteria 36 [72%] patients out of 50 patients with carrying-angle loss considered to be excellent results and 14[28%] good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Baumann angle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylar humeral fractures in children

Does anxiety and depression cause acute myocardial infarction?

To study the frequency of depression and anxiety in patients admitted with acute myocardial infarction [AMI]. Two hundred consecutive patients of AMI without complications presenting to the coronary care unit of Cardiology department of Lady Reading Hospital and 200 healthy controls among patient's attendants were interviewed with standard scales of HADS and HRS for the presence of depression from to date. Two hundred consecutive patients of AMI and 200 healthy controls among patient's relatives were assessed on HADS and HRS scale for the presence of depression. Sixty three percent of the patients were male in both groups. Mean age of patients was 59 +/- 11 years while that of controls was 52 +/- 10 years. Although significantly different between the two groups, age had no significant effect on the presence of depression in any group [p < 0.4]. A significant difference was noted in the number of events reported between patients of AMI and control group, 4.21 +/- versus 2.71+ respectively [p<0.001]. On Hospital Anxiety and Depression Scale [HADS] 77.5% of the acute MI patients had depression compared to 64% in the control group [p< 0.003]. When HADS was used to asses the level of anxiety and depression in the two groups, 83% of patients in the AMI group reported abnormal i.e. scores above 17 compared to 70% in the control group [p< 0.001]. Depression was more common in patients presenting with acute myocardial infarction as assessed by standard scales as compared to controls

Iatrogenic ulnar nerve injury after percutaneous pinning of displaced supracondylar fractures of the humerus

To assess iatrogenic ulnar nerve injuries after supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Descriptive case series. Orthopedic and Trauma Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from December 2007 to December 2010 Children between 1-12 years of age and extension-type displaced supracondylar fracture of humerus were included. Neurovascular status was assessed before operation. Closed reduction was performed under general anesthesia and confirmed with the image intensifier, followed by pinning. After surgery, a long arm back slab was applied. After the procedure, neurovascular status assessed again. The pins were removed at a mean of 5 weeks [4-6 weeks] postoperatively. The neurological complications were assessed both for sensory loss and motor loss. Clinical and electro-myographic examinations were performed at 6 and 12 weeks postoperatively in patient with ulnar nerve lesions. Eighty two patients presented during the study period. There were 62.2% [n 51] males and 37.8% [n 31] females. Left humerus was involved in 69.5% [n 57] cases. The mean age was 6.61 +/- 2.25 years. A total of three [3.7%] iatrogenic ulnar nerve injuries occurred in these patients. Electromyogram showed partial denervation and conduction blocks at the elbow at 6 weeks. Regenerative electromyogram findings were seen at 12 weeks. Sensory and motor functions in all patients returned at a mean of 8 +/- 2.34 weeks and 22 +/- 4.87 weeks respectively. In all patients nerve function returned completely. Iatrogenic ulnar nerve injury is a common complication of percutaneous pinning in displaced supracondylar fracture of humerus in children but usually it resolves spontaneously

Comparison of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children

To compare the effectiveness of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children. Comparative study. Orthopedic Department, PGMI Hayatabad Medical Complex Peshawar, from March 2010 to June 2011. This study was designed to compare above and below elbow casts for distal forearm fracture in patients aged 4-12 year. A total of 108 patients were managed during the study period. They were randomized into two groups of 54 each; group A above-elbow and group B below-elbow cast. The mean age of the children was 7.10 +/- 2.18 year. Males were 59.3% and females 40.7%. The right side was the dominant limb in both the groups. 19.6% of children in the above-elbow group required remanipulation as compared to 26.4% in the below elbow group with p value of 0.381. The time from injury to manipulation was not significantly different in the 2 groups. Differences between radius and ulna translation and angulation in the anteroposterior and lateral views of the x-rays were not significant. Twenty three children with above elbow cast and 19 children of below elbow cast had complications but the difference was not significant [p 0.324]. Three patients were lost to follow up. Below-elbow casts was as good as above-elbow cast in maintaining reduction of fractures in the distal third of the forearm in children

Mitral regurgitation in patients with mitral valve prolapse

To determine the frequency, severity and gender distribution of mitral regurgitation [MR] in patients with mitral valve prolapse [MVP] and effect of severity of MR on the left heart chambers enlargement. Echocardiography reports of patients from June 2003 to July 2006 were retrospectively searched for presence of MVP from the computerized database of Cardiology department, Lady Reading Hospital Peshawar. Demographic details and findings of comprehensive echocardiographic examination, including M-mode echocardiography, 2-dimensional echocardiography, and conventional and color Doppler ultrasonography conducted by experienced echocardiographers were recorded. Out of 25,303 echocardiographic examinations performed in the period, 1073 [4.24%] patients had MVP with mean age of 26 + 14 years. Males were 585[54.52%] and females were 488[45.48%]. MR was found in 444/1073 [41.37%] patients of which 211 [47.53%] were males and 233 [52.47%] were females. Overall MVP was more common in males however MVP with MR was more common in females. In patients of MVP having MR, mild, moderate and severe MR was noted in 312[70.3%], 54 [12.2%] and 78 [17.5%] patients respectively. In patients with MVP having severe MR, the mean LV end diastolic diameter was 6.94+0.93 cm, mean LV end systolic diameter was 4.13+0.75 cm and mean left atrial diameter was 5.56+1.12 cm. With no significant changes in gender distribution of MVP, a high proportion of patients with MVP have associated MR. Severity of MR in patients with MVP had significant effect on enlargement of left heart chambers

Pattern of valvular lesions in rheumatic heart disease

To evaluate relative frequency of cardiac lesions in Rheumatic heart disease [RHD] in patients presenting to cardiology department, Lady Reading Hospital, Peshawar. This retrospective study was conducted at Cardiology Department Lady Reading Hospital Peshawar. The data on patients undergoing transthoracic two-dimensional echo and Doppler studies were retrieved from the computerized database from July 2003 to July 2006. The data was analysed with SPSS 11 window. Out of 3060 patients of RHD [1278 male and 1782 female], 1723 [56.3%] had mixed valvular lesions. Mean age was 22 + 6 years. Mitral stenosis [MS] was the predominant valvular lesion affecting 2141 [70%] patients [1040 pure MS and 1101 in combination]. Of those, 525 [24.5%] patients had severe MS, and 811 [37.9%] had moderate MS. Mitral regurgitation [MR] affected 1793 [58.59%] patients [245 pure MR, 1548 mixed] while 404 [22.5%] patients had severe MR and 497 [27.1%] had moderate MR. Aortic regurgitation [AR] was present in 1438 [47%] patients and almost always [98 85%] in combination. One hundred and eight [7.5%] patients had severe AR. Aortic stenosis [AS] was noted in 48 [1.56%] patients, of which 30 [62.5%] were in isolation and 18 [37.5%] in combination. Out of 1723 mixed lesions, MS+MR+AR were found in 826 [47.94%] cases and MR+AR in 428 [24.84%] cases. Most of the patients had mixed Valvular lesions. The predominant lesion was mitral stenosis followed by mitral regurgitation, aortic regurgitation and aortic stenosis respectively