Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review and meta-analysis of randomized controlled trials.

Purpose: Supracondylar humeral fractures (SCHFs) rank among the frequently observed fractures in children. Nonetheless, there exists a dearth of consensus regarding the optimal surgical approach. This meta-analysis aims to thoroughly evaluate and compare two distinct pinning techniques (cross pinning versus lateral pinning) for SCHFs, using data from Randomized controlled trials (RCTs). Methods: Literature review was done using PubMed, CINAHL, Scopus, and The Cochrane Library for RCTs comparing the two pinning methods and providing information on at least one of the following: Loss of Baumann's angle, loss of carrying angle, elbow function assessed based on Flynn criteria, pin tract infection, and iatrogenic ulnar nerve injury. Random effect model was used to calculate standardized mean difference or Odds Ratio (OR) for the outcomes. Review Manager 5.4.1. was used to perform quality assessment and statistical analysis. Results: A total of 22 RCTs were included. 20 studies reported data for iatrogenic ulnar nerve injury, the OR was calculated to be 3.76 (95% CI 1.75-8.06), showing a significantly lower risk of surgical ulnar nerve injury with the lateral technique. However, no significant difference was found between the pinning techniques in regard to the other outcomes. Conclusion: In comparison to lateral pinning, the utilization of cross pinning technique exposes the patient to a heightened susceptibility of iatrogenic nerve injury. Therefore, it is recommended that surgeons prioritize the implementation of the lateral pinning technique whenever feasible, as it offers greater protection against iatrogenic ulnar nerve injury. For the other intraoperative and postoperative outcomes, both surgical techniques yield comparable results.

Effect of Phacoemulsification on Sub Foveal Choroidal and Central Macular Thickness as measured by Swept Source Optical Coherence Tomography.

Objectives: To study the effect of Phacoemulsification on Sub Foveal Choroidal Thickness (SFCT) and Central Macular Thickness (CMT) as measured by Swept Source Optical Coherence Tomography (OCT). Methods: This experimental study was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from April 2021 to February 2022. One hundred eyes of 100 patients with age related cataract underwent uneventful phacoemulsification surgery. Pre-operative SFCT and CMT was measured and compared with SFCT and CMT at one week, one month and three months after surgery using swept source OCT. Results: Mean age of study population was 56.76±8.31 years. Out of 100 patients, 46 (46%) were males and 54 (54%) were females. Mean pre-operative CMT, one week, one month and three months post-operative CMT was 233.95±9.46 µm, 232.88±8.59 µm, 230.38±10.62 µm and 230.67±7.55 µm respectively. Mean pre-operative SFCT, one week, one month and three months post-operative SFCT was 337.14±8.41 µm, 339.14±9.63 µm, 339.39±11.96 µm and 351.39±9.19 µm respectively. The difference of mean change in CMT from baseline at one week, one month and three months post-operatively was not statistically significant. The difference of mean change in SFCT from baseline at one week and one month post-operatively was not statistically significant. However, the difference of mean change in SFCT from baseline at three months post-operatively was statistically significant (p<0.05). Conclusion: Uneventful phacoemulsification surgery does not have any effect on central macular thickness, however there is a significant increase in subfoveal choroidal thickness at three months after surgery.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan.

OBJECTIVE: Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity. SETTING: This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan. PARTICIPANTS: In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument. RESULTS: Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20). CONCLUSION: Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Exome sequencing identifies a novel frameshift variant causing hypomagnesemia with secondary hypocalcemia.

Hypomagnesemia with secondary hypocalcemia is a rare autosomal-recessive disorder characterized by intense hypomagnesemia associated with hypocalcemia (HSH). Mutations in the TRPM6 gene, encoding the epithelial Mg2+ channel TRPM6, have been proven to be the molecular cause of this disease. This study identified causal mutations in a 2-month-old male patient of hypomagnesemia from a consanguineous marriage. Biochemical analyses indicated the diagnosis of HSH due to primary gastrointestinal loss of magnesium. Whole exome sequencing of the trio (i.e. proband and both parents) was carried out with mean coverage of > 150×. ANNOVAR was used to annotate functional consequences of genetic variation from exome sequencing data. After variant filtering and annotation, a number of single nucleotide variants (SNVs) and 2 bp deletion at exon26:c.4402_4403delCT in TRPM6 gene were identified. This deletion which resulted in a novel frameshift mutation in exon 26 of this gene was confirmed by Sanger sequencing. With these investigations in hand, the patient was managed with magnesium sulphate. The patient remained asymptomatic and was developmentally and neurologically normal till his last follow up.

Oral health-related quality of life in patients with upper gastrointestinal and hepatic disorders in Pakistan: validation of the Oral Health Impact Profile-14 in the Urdu language.

INTRODUCTION: The Oral Health Impact Profile (OHIP-14) has been used extensively to measure the impact of oral disease on oral health-related quality of life (HRQoL) but has not been validated in the Urdu language or tested in gastroenterology. AIMS: To validate the OHIP-14 for use in Pakistan and its ability to assess oral health in patients with upper gastrointestinal (GI) and hepatic disorders. DESIGN: Multicentre, cross-sectional. SETTING: Four major tertiary care hospitals. METHODS: The OHIP-14 was tested for reliability and validity in 700 patients referred for oesophago-gastro-duodenoscopic (OGD) investigation of the symptoms of upper GI or hepatic disease. Socio-demographic details and oral examination findings (for oral lesions and DMFT) were recorded. RESULTS: The mean (±standard deviation) total OHIP-14 score (range 0-56) was estimated to be 23.38 ± 10.47, indicating a significant impact of upper gastrointestinal and hepatic disorders on oral health. The reliability coefficient of the OHIP-14 was above 0.7 threshold, and the tool had good internal consistency (α = 0.83). When associated with worsening DMFT (decayed, missed, and filled teeth) index value, the highest correlations (p < 0.01) were detected with functional limitation (rs = 0.234), physical disability (rs = 0.230), and psychological discomfort (rs = 0.221). CONCLUSION: The OHIP-14 is a precise and valid instrument for assessing oral-HRQoL in a gastroenterological setting amongst Pakistani population.