The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle: our clinical experience

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey's syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection

E-Cadherin as a Marker for Nodal Metastasis in Head and Neck Squamous Cell Carcinoma

Aim: Head and neck cancers, all over the world, contribute greatly to the number of deaths, despite the advancements in the therapeutic strategies. It is characterized by locoregional disease with a tendency for metastasis to the cervical lymph nodes. The pre-operative detection of lymph node metastasis is critical for the effective treatment of patients with head and neck squamous cell carcinoma. Therefore the objective of this study was to identify E-cadherin as a marker for prediction of lymph node metastasis in head and neck squamous cell carcinoma (HNSCC).Study Design:Cross-sectional study.Place and Duration of Study: Dow University of Health Sciences, Karachi. 1 Year duration.Methodology:Cross-sectional analysis of 54 subjects with HNSCC, who underwent neck dissections, was carried out. Expression of E-cadherin was evaluated using immunohistochemical analysis and traditional histological parameters, and correlation of E-Cadherin with histologically verified presence of regional metastases was determined. Data was subjected to descriptive statistics and chi-square using Spss v.16.0.Results:54 patients included 33 males (61.1%) and 21 females (38.9%) aged from 18 to 73 (mean 44.8±12.7). A statistically significant relationship between the Downregulation of E-cadherin and histologically verified presence of nodal metastasis was established. (p value= 0.01).Conclusion:This study shows that low E-cadherin expression is useful for predicting lymph node metastases in cases of head and neck carcinoma.

Errors in Patients’ Information Leaflets of Marketed Medicines in Pakistan.

The curing of patient is the top most priority of health associated professionals. Complete and proper information of medicine is always the willing of the patients and their close ones. The primary source of information for patients’ regarding the medicine is patients’ information leaflet (PIL). The main aim of the present study is to evaluate the errors and incomplete information in leaf inserts sold with marketed medicines in Pakistan. For the present study, 11 different classes of oral medicines of different multinational and national pharmaceutical industries were purchased from different community and hospitals pharmacies in Karachi. The present study has been revealed incomplete information related to medicines in PILs. 9 out of 11 PILs have 48.84% (n= 63) major while minor errors were 51.16% (n= 66). The major errors were included incomplete information of indications, adverse drug effects, drug mechanism, dosage errors, drug-drug and drug-food interactions, precautions and warning, pharmacokinetic profile and pregnancy and lactation. Whereas, omission of structural formula, molecular formula, molecular weight, chemical names, laboratory tests, clinical trials data, font size, paper quality, and use of national language (Urdu) have been observed as minor errors. It has been concluded that majority of PILs sold with marketed medicines were not up to the mark and met the regulatory requirements. In countries like Pakistan, with high illiteracy rate and low financial status, patients’ were unaware about the importance of PILs. Mainly pharmaceutical industries have not called attention on information of marketed drugs medicines in Pakistan which has been proven a shocking situation regarding the negligence of healthcare matter in Pakistan.

Impact of cyclosporin immunosuppression on serum magnesium and its fractional excretion in renal transplant recipients

To evaluate the effect of cyclosporine [CSA] on serum magnesium and its fractional excretion in renal transplant recipients. A cross sectional comparative study on 50 live related renal transplant recipients on CSA therapy with serum creatinine <2.0 mg/dl and 30 healthy controls. Serum creatinine, magnesium and its fractional excretion and CSA levels were monitored. Patients were followed at 6 months. The mean serum creatinine in patients was 1.41 +/- 0.42 mg/dl, cyclosporine 210 +/- 66 ng/ml at a dose of 4.8 +/- 1.4 mg/kg/day. The serum magnesium was 1.77 +/- 0.32mg/dl vs 1.98 +/- 0.17mg/dl in healthy controls [p<0.05].Fractional excretion was 5.05 +/- 2.53% in patients vs 2.8 +/- 1.05% in controls [p<0.05]. No correlation was found between CSA levels [100-400 ng/ml] and serum magnesium [r = 0.053] or FEMg% [r = 0.215]. Of the 50 recipients 27 [54%] had FEMg% in the control range. At 6 months follow up no difference in CSA levels was found between recipients with FEMg% in the normal range vs those with FEMg >5%. However, serum creatinine increased from 1.42 +/- 0.30 mg/dl to 1.68 +/- 0.82mg/dl [p< 0.05]. CSA therapy lowers serum magnesium as compared to healthy controls and there is marked increase in FEMg% in 50% of the patients. Patients with FEMg >5% developed renal function deterioration. FEMg% can thus be a good follow up marker of CSA chronic toxicity in stable transplant recipients

Biliary atresia with situs inversus: an experience shared

Biliary Atresia [BA] is a well-known entity and can present with multiple congenital anomalies. BA is one of the most common conditions in which pediatric liver transplant is performed. Identification of Biliary atresia with situs inversus [SI] has not been documented in Pakistan. We report two such cases. First was an eighty-day-old baby boy, icteric from day of birth. On further evaluation had dextrocardia, SI, gross hydronephrosis [HN] of left kidney and stasis at pelvi ureteric junction [PUJ]. Liver biopsy showed biliary cirrhosis secondary to extra hepatic biliary atresia [EHBA]. The second baby presented at two months of age. Ultrasound abdomen and hepatobiliary scintigraphy confirmed liver in left hypochondrium [SI] and findings suggestive of BA. Echocardiography confirmed SI with mesocardia. In this paper we have described the association of BA with SI in two patients presenting at the pediatric Gastroenterology, hepatology and nutrition unit

Crescentic glomerulonephritis associated with bacterial endocarditis - Antibiotics alone may be sufficient. A case report

Crescentic glomerulonephritis complicating the course of bacterial endocarditis carries a poor prognosis. Ideal treatment strategy is not clearly defined. In addition to antibiotic treatment, plasmapheresis and steroids have been used with variable results. Here we report a case of 40-year old female who was referred because of generalized body swelling and decrease urine output associated with low grade fever on and off for two to three months. She was diagnosed to have acute renal failure secondary to tricuspid valve endocarditis. Staph aureus was isolated from blood culture and renal biopsy showed crescentic glomerulonephritis. She received dialysis support and antibiotics and had complete recovery of renal function 6 weeks after initiation of therapy. Eradication of infection with antibiotics treatment may be sufficient for resolution of crescentic glomerulonephritis associated with infective endocarditis in some cases

Bilirubin Pigments in the first Meconium of newborn infants

To determine the pattern of excretion of total bilirubin IXa and IXb in the first meconium of newborn infants. First two newborns of varying gestational age were selected every week through random sampling from the neonatal unit. Of the 41 newborn infants selected 8 expired before meconium passage, hence the results are from 33 newborns. Meconium was collected and stored at -20°C, protected by aluminium foil. Samples were defrosted, vortex mixed with equal amount of dimethyl-sulfoxide, centrifuged, and analyzed by HPLC. Unconjugated Bilirubin-IXa and -IXb were identified and quantitative estimation of Bilirubin-IXa done. Bilirubin-IXb was greater than 50% of the total, in the first meconium of the newborn. Amount of bilirubin excreted in meconium was 29.2 - 90.8 mg [0.051 - 0.155 mmol] per sample of meconium passed. Amount was 9.7 mg/ Kg of body weight in term newborn and 12 mg / kg in preterm.The amount of bilirubin -IXb decreases and bilirubin-IXa increases with increasing gestational age. Newborns with birth asphyxia [BA] had significantly greater quantity of bilirubin in meconium, compared to infants without BA [JPMA 55:188;2005].

Cyclosporine induced nephrotoxicity in renal transplant recipients: clinical significance of fractional excretion of sodium, potassium and magnesium

Evaluation of fractional excretion of Sodium, Potassium and Magnesium as indicators of cyclosporine [CsA] toxicity in de-novo renal transplant recipients. A prospective study was conducted on 59 live related renal allograft recipients. Fractional excretion [FE] of sodium [Na[+]], potassium [K+] and magnesium [Mg[2+]] were calculated on day 1,3, 5 and 10 post transplant. Graft dysfunctions were evaluated by colour-doppler, CsA levels and renal biopsy. Normal ranges were determined on 30 healthy subjects. The mean creatinine on dayl was 3.1 + 1.3 mg/dl and declined to 1.6+1.2 on daylO. FE of Na[+], K[+] ; and Mg[2+] were 12+9%, 34+20% and 13+10% respectively on day 1 and reduced to 2.2+2%, 11+14% and 11+14% on day 10. Of the 59 recipients, 38 [64%] had uneventful recovery [group A], 21[36%] had graft dysfunction [6 acute rejection [group B] and 15 either acute tubular necrosis or high CsA [group C]]. In group A, on dayl, FENa+, FEK+ and FEMg[2+] were 5+4%, 24+12% and 6.6+3% respectively and these declined to 1.2+0.6%, 4.6+0.7% and 6+3% respectively on day 10. Compared to group A, group C had significantly high values on day 1, FENa[+] 1 5+8%, FEK+ 36+24% and FEMg[2+] 21 + 10% [p<0.0001] and on day 10, FENa[+] 3.7+ 2.7%, FEK+ 20+15% and FEMg[2+] 15+8% [p<0.05]. In the group B, day 1 and day10 levels were FENa[+] 6+3%, FEK[+]26+13% and FEMg[2+] 7+2.8% and FENa[+] 1.2+0.7%, FEK+ 4.2+0.5%, FEMg[2+] 7+4% respectively. CsA levels and AUC did not correlate with CsA toxicity. FE of magnesium is a useful marker of CsA toxicity independent of CsA blood levels. FE studies can supplement renal biopsy findings