Impact of Drain Placement on Postoperative Complications after Thyroidectomy for Substernal Goiter.

Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m 2 , score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3.

Determining the psychometric properties of a written test to assess safe dental practice.

INTRODUCTION: Safe practice in medicine and dentistry has been a global priority area in which large knowledge gaps are present.Patient safety strategies aim at preventing unintended damage to patients that can be caused by healthcare practitioners. One of the components of patient safety is safe clinical practice. Patient safety efforts will help in ensuring safe dental practice for early detection and limiting non-preventable errors.A valid and reliable instrument is required to assess the knowledge of dental students regarding patient safety. OBJECTIVE: To determine the psychometric properties of a written test to assess safe dental practice in undergraduate dental students. MATERIAL AND METHODS: A test comprising 42 multiple-choice questions of one-best type was administered to final year students (52) of a private dental college. Items were developed according to National Board of Medical Examiners item writing guidelines. The content of the test was determined in consultation with dental experts (either professor or associate professor). These experts had to assess each item on the test for language clarity as A: clear, B: ambiguous and relevance as 1: essential, 2: useful, not necessary, 3: not essential. Ethical approval was taken from the concerned dental college. Statistical analysis was done in SPSS V.25 in which descriptive analysis, item analysis and Cronbach's alpha were measured. RESULT: The test scores had a reliability (calculated by Cronbach's alpha) of 0.722 before and 0.855 after removing 15 items. CONCLUSION: A reliable and valid test was developed which will help to assess the knowledge of dental students regarding safe dental practice. This can guide medical educationist to develop or improve patient safety curriculum to ensure safe dental practice.

Sepsis and Septic Shock in Patients Undergoing Thyroidectomy: Incidence, Risk Factors, and Outcomes.

INTRODUCTION: Postoperative sepsis represents a rare complication following thyroidectomy. We aimed to explore the incidence, risk factors, sources, and outcomes of postoperative sepsis and septic shock among adult patients undergoing thyroidectomy. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program were used in this retrospective cohort study. Patients aged ≥18 y who underwent elective thyroidectomy between 2005 and 2019 were included. Multivariable binary logistic regression models were computed to explore risk factors and outcomes of 30-d sepsis and septic shock. RESULTS: Among the 180,373 included patients, 0.1% developed sepsis or septic shock. Male gender, low body mass index, American Society of Anesthesiologists classes 3-5, functional dependence, smoking, diabetes mellitus, pulmonary disease, inpatient surgery, malignant indication, clean-contaminated wound classification, and operation time ≥150 min were significant risk factors for development of sepsis or septic shock. Common infectious sources of sepsis included surgical site infections (29.6%), pneumonia (18.6%), urinary tract infections (16.2%), and multiple infections (6.9%). Patients with postoperative sepsis or septic shock were significantly more likely to develop complications, including wound disruption, stroke, cardiac and renal complications, thromboembolism, prolonged length of stay, unplanned reoperation, and mortality. CONCLUSIONS: Sepsis is rare following thyroidectomy. Our study provides insight into risk factors and procedural characteristics which may contribute to the development of postoperative sepsis or septic shock in this population.

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review.

BACKGROUND: Postoperative nausea and vomiting (PONV) affects patient satisfaction, health care costs, and hospital stay by complicating the postoperative recovery period after adolescent idiopathic scoliosis (AIS) spinal fusion surgery. Our goal was to identify recommendations for optimal management of PONV in AIS patients undergoing posterior spinal fusion (PSF). METHODS: We performed a systematic review in June 2022, searching the PubMed and Embase electronic databases using search terms "(Adolescent idiopathic scoliosis) AND (Postoperative) AND (Nausea) AND (Vomiting)." Three authors reviewed the 402 abstracts identified from January 1991 to June 2022. Studies that included adolescents or young adults (<21 years) with AIS undergoing PSF were selected for full-text review by consensus. We identified 34 studies reporting on incidence of PONV. Only 6 studies examined PONV as the primary outcome, whereas remaining were reported PONV as a secondary outcome. Journal of Bone and Joint Surgery Grades of recommendation were assigned to potential interventions or clinical practice influencing incidence of PONV with respect to operative period (preoperative, intraoperative, and postoperative period) on the basis that potential guidelines/interventions for PONV can be targeted at those periods. RESULTS: A total of 11 factors were graded, 5 of which were related to intervention and 6 were clinical practice-related. Eight factors could be classified into the operative period-1 in the intraoperative period and 7 in the postoperative period, whereas the remaining 3 recommendations had overlapping periods. The majority of grades of recommendations given were inconclusive or conflicting. The statement that neuraxial and postoperative systemic-only opioid therapy have a similar incidence of PONV was supported by good (Grade A) evidence. There was fair (Grade B) and poor evidence (Grade C) to avoid opioid antagonists and nonopioid local analgesia using wound catheters as PONV-reducing measures. CONCLUSION: Although outcomes after spinal fusion for AIS have been studied extensively, the literature on PONV outcomes is scarce and incomplete. PONV is most commonly included as a secondary outcome in studies related to pain management. This study is the first to specifically identify evidence and recommendations for interventions or clinical practice that influence PONV in AIS patients undergoing PSF. Most interventions and clinical practices have conflicting or limited data to support them, whereas others have low-level evidence as to whether the intervention/clinical practice influences the incidence of PONV. We have identified the need for expanded research using PONV as a primary outcome in patients with AIS undergoing spinal fusion surgery.

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan.

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N - 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46-28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Rotation and Asymmetry of the Axial Plane Pelvis in Cerebral Palsy: A CT-Based Study.

Spinopelvic malignment is commonly seen with non-ambulatory cerebral palsy (CP). Axial plane deformation is not well described in the literature. The purpose of this study was to describe and quantify the axial plane deformity in CP using CT scans and compare it to normal controls. We retrospectively collected data using CT scans of the abdomen and pelvis of 40 patients with GMFCS IV/V CP and neuromuscular scoliosis (CPP) and normal controls (NP) matched by age and sex. Pre-operative Cobb angle was recorded for the CP patients. Pelvic anatomy was evaluated at the supra-acetabular region of bone using two angles-iliac wing angle and sacral ala angle, measured for each hemipelvis. The larger of each hemipelvis angle was considered externally rotated while the smaller angle was considered internally rotated, termed as follows-iliac wing external (IWE) and internal (IWI); sacral ala external (SAE), and internal (SAI). Differences were noted using an independent t-test while correlations with Cobb angle were performed using Pearson's correlation. Iliac wing measurements showed the externally rotated hemipelvis showed a significantly greater magnitude compared with normal controls at 47.3 ± 18.1 degrees vs. 26.4 ± 3.7 degrees in NP (p < 0.001) while no internal rotation was observed (p > 0.05). Sacral ala measurements showed greater magnitude in both external and internal rotation. SAE was 119.5 ± 9.5 degrees in CPP vs. 111.2 ± 7.7 degrees in NP (p < 0.001) while SAI was 114.1 ± 8.5 degrees in CPP vs. 107.9 ± 7.5 degrees in NP (p = 0.001). In the CP cohort, the mean Cobb angle was 61.54 degrees (n = 37/40). Cobb angle correlated with the degree of external iliac wing rotation-IWE (r = 0.457, p = 0.004) and degree of absolute difference in the rotation of the iliac wing (r = 0.506, p = 0.001). The pelvis in a patient with CP scoliosis is asymmetrically oriented exhibiting a greater external rotation of one hemipelvis relative to normal controls. The severity of neuromuscular scoliosis is related to the pelvic axial rotation in CP patients. Axial plane deformity exists in the CP pelvis and this deformity warrants consideration when considering spinopelvic instrumentation strategies and outcomes of supra-pelvic and infra-pelvic pathologies.

Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures.

INTRODUCTION: Both bone forearm fractures are common injuries in children. Most can be treated with reduction and casting. Those that fail nonoperative management can be treated with a plate or intramedullary fixation; however, refracture remains a problem. The goal of this study is to evaluate the refracture rate in both bone forearm fractures based on the mode of fixation. METHODS: Institutional board review approval was obtained. A retrospective chart review from 2010 to 2021 at a single tertiary care institution was conducted for all operative patients <18 years who sustained a both bone forearm fracture. Groups were stratified based on initial operative fixation type: both bones fixated using nails, 1 bone fixated with a nail; both bones plated, and 1 bone plated. Further review was conducted to identify refractures following initial operative treatment. Statistical analyses were conducted using the χ 2 test of independence and Fisher's exact test. RESULTS: In all, 402 operatively treated both bone forearm fracture patients were identified. Two hundred fifty-six of these patients underwent intramedullary fixation (average age 10.3y/o), while 146 patients received plate fixation (average age 13.8y/o). Fracture location was similar across the nailing and plating cohorts, most often occurring in the mid-shaft region. Patients aged ≤10 years refractured at a significantly higher rate than patients aged >10 years across all operative fixation cohorts (12.5% vs. 2.5%, P <0.001). Among the 256 patients who underwent intramedullary fixation, 61.3% had both bones treated (n=157/256), whereas 38.7% received single bone fixation (n=99/256). Of the 146 plate fixations, 84.4% had both bones fixed (n=123/146), and only 15.8% were treated with single bone fixation (n=23/146). In the intramedullary group, 15 patients sustained refractures, 11 of whom were treated with single bone fixation (11.1%, n=11/99) versus 4 with both both fixation (2.5%, n=4/157). Among the plating group, 7 patients sustained refractures, 6 with both bone fixation (4.9%, n=6/123) and 1 in single bone fixation (4.3%, n=1/23). Refractures were found to be significantly more prevalent among patients treated with single bone compared with both bone intramedullary nail fixation (11.1% vs. 2.5%, P =0.006). By fixated bone, single bone ulna fixations had a higher refracture rate compared with both bone fixations (12.1% vs. 3.6%, P =0.003). CONCLUSION: The overall refracture rate following operative treatment of both bone fractures is 5.5% and is similar between intramedullary and plate fixations. Overall, patients ≤10 years of age had a higher rate of refracture. Among single bone fixations, higher refracture was seen with intramedullary fixations, and when the radius was treated nonoperatively. Surgeons may be able to reduce the refracture rate by performing intramedullary fixation of both bones instead of only one bone. Effective postoperative counseling among younger patients may also decrease refracture rates.

Traumatic hip dislocations in a pediatric cohort: The importance of advanced imaging.

Purpose: Given that pediatric traumatic hip dislocations are relatively rare, the purpose of the current study is twofold: first, to contribute a significant cohort to the existing corpus, and second, to provide evidence toward the role that computed tomography and magnetic resonance imaging could play in identification and management of this type of injury. Methods: A retrospective review was conducted of all patients with traumatic hip dislocation who presented from 2012 to 2022 at a tertiary-level pediatric trauma center. Data regarding demographics, mechanism of injury, imaging, and treatment were tabulated. Outcomes of interest included immobilization length, concomitant injuries, imaging performed and findings, and rates of avascular necrosis, pain, and stiffness. Concomitant injuries were identified using imaging, clinical, and operative notes. Differences between categorical variables were compared using chi-square analysis or Fischer-exact testing, while continuous variables were compared using Student t tests or Wilcoxon rank sum tests when appropriate. Results: Thirty-four patients were identified. Postreduction, 28 patients had a cumulative 17 magnetic resonance imaging, 19 computed tomographies, and 1 intraoperative arthrogram. Of these, 16 patients had 19 injuries identified on advanced imaging that were missed on initial radiographs. Eleven of these patients went on to operative treatment. In eight of these, postreduction advanced imaging helped guide the decision for surgery. In four patients, magnetic resonance imaging was necessary to fully characterize injury to the posterior acetabular rim after initial identification on computed tomography. Magnetic resonance imaging was also used to rule out one computed tomography-diagnosed acetabular fracture. Conclusion: Magnetic resonance imaging is valuable to fully define associated rim and intra-articular injuries following initial treatment of pediatric traumatic hip dislocations. Level of evidence: Level IV diagnostic study.

Comparative Effects of Azithromycin and Probiotics for Treatment of Acne Vulgaris.

OBJECTIVES: To measure the efficacy of oral probiotics when combined with a topical agent, and to compare the efficacy of Azithromycin, Probiotics, and their combination for the treatment of acne vulgaris. STUDY DESIGN: A quasi-experimental study. Place and Duration of the Study: Pharmacology Department, IIMC in mutual collaboration with the Dermatology Department, Pak Emirates Military Hospital (PEMH), Rawalpindi, from September 2021 to August 2022. METHODOLOGY: Seventy-five patients were enrolled in the study and were divided into 3 groups. Group A received Azithromycin (250mg oral on alternate days), Group B received probiotics i.e. Hi-Flora sachet (1 sachet oral daily), and Group C received both azithromycin (250mg oral on alternate days) and probiotics (Hi-Flora 1 sachet oral daily). The efficacy of three treatment regimens was measured by checking the difference in mean lesion count at the baseline and after 3 months of treatment and the percentage was calculated. RESULTS: All patients demonstrated significant improvement in total lesion count after treatment. In group A, the mean lesion count was reduced by 83.3%, in group B by 84.4%, and in group C, the reduction in mean lesion count was 90.3%. CONCLUSION: Probiotics have equal efficacy to azithromycin, and their combination has shown synergistic effects for the treatment of acne vulgaris. Probiotics should be used in combination with azithromycin for the best results for the management of acne vulgaris. KEY WORDS: Acne vulgaris, Azithromycin, Probiotics, Efficacy.

Does Skeletal Maturity Predict the Pattern of Tibial Tubercle Avulsion Fracture?

BACKGROUND: Proximal tibial physeal development and closure is thought to relate to tibial tubercle avulsion fracture (TTAF) patterns. Prior work has yet to formally evaluate the relationship between skeletal maturity and fracture pattern.  Using 2 knee radiograph-derived skeletal maturity assessments [growth remaining percentage (GRP) and epiphyseal union stage], we examined their association with TTAF injury patterns using the Ogden and Pandya fracture classifications. We hypothesized that different TTAF injuries would occur during unique periods of skeletal development. METHODS: Pediatric patients sustaining TTAFs treated at a single institution (2008-2022) were identified using diagnostic and procedural coding. Demographics and injury characteristics were collected. Radiographs were reviewed to assign epiphyseal union stage, Ogden and Pandya classifications and for measurements to calculate GRP. Univariate analyses examined the relationship between injury subgroups, patient demographics, and skeletal maturity assessments. RESULTS: Inclusion criteria identified 173 patients with a mean age of 14.76 (SD: 1.78) and 2.95% (SD: 4.46%) of growth remaining. The majority of injuries were classified Ogden III/Pandya C. Most (54.9%) were the result of the axial loading mechanism. Ogden groups showed no significant differences across all patient characteristics studied including age and GRP. With the exception of Pandya A fractures, we did not identify a direct relationship between GRP, age, and Pandya groups. Epiphyseal union stage differed for Pandya A and D groups. CONCLUSIONS: A predictable pattern in TTAF characteristics across skeletal (GRP), epiphyseal union, or chronologic age was not identified in this study. Distal apophyseal avulsions (Ogden I/II and Pandya A/D) occurred across a broad chronologic and skeletal age range. No differences were identified in epiphyseal or posterior extension (Ogden III/IV and Pandya B/C) injuries. Although differences in age and GRP were identified among Pandya As, this is thought to be due to the degree of skeletal immaturity that is a prerequisite for differentiation from Pandya Ds. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Head and neck cancer recurrence with limited mouth opening, radiation fibrosis and confirmed COVID-19 infection: Approach to airway management.

We present a case that describes the airway management of a patient with recurrent head and neck cancer and confirmed COVID-19 infection. Securing airway of these patients with anticipated difficulty and at the same time limiting virus exposure to providers can be challenging. The risk of aerosolization during awake tracheal intubation is extreme as it carries a high risk of transmitting respiratory infections. A multidisciplinary team discussion before the procedure highlighted aspects of both airway management and the urgency of surgical procedure where particular care and modifications are required. Successful flexible bronchoscopy and intubation was done under inhalational anaesthetics with spontaneous breathing. Although fiberoptic intubation during sleep,in anticipated difficult airways, have led to enhanced intubation time, this technique was opted to minimize the risk of aerosol generation associated with topicalisation, coughing and hence reduced incidence of cross infection to health care workers.

Knowledge & Attitude regarding Stem Cells research and its applications among Residents of a Tertiary Care Hospital in Karachi, Pakistan.

Objectives: The importance and potential of the use of stem cells as therapeutic tools is enormous and therefore, health professionals should be expected to have thorough knowledge and a positive attitude towards their utilization in medical practice. Hence this study was carried out to report and assess the knowledge and attitude regarding stem cell in our region. Methodology: The study was conducted amongst the residents employed at the Aga Khan University hospital, Karachi Pakistan from September-October 2022 with a sample size of 57. RESULTS: Amongst our survey participants, 33 (54.2%) responded with a score of 48 and above (i.e., 60% or above); 25 (40.9%) of the study participants scored between 50-60% only 3 (4.9%) had a score 40-50. CONCLUSIONS: Our survey shows a reasonable level of knowledge of the generic principles and implications Stem cell therapy amongst the residents.

Benign and Malignant Skin Lesions: Dielectric Characterization, Modelling and Analysis in Frequency Band 1 to 14 GHz.

OBJECTIVE: This paper aims to characterize Non-Melanoma malignancies and their corresponding benign conditions in ex-vivo/in-vivo tissue environments to study the feasibility of microwave techniques for skin cancer detection. METHODS: The dielectric dataset is developed across the frequency band 1 to 14 GHz using Keysight slim-form and RG405 probe characterization systems. The acquired reflection data captured by the systems is converted to dielectric values using the Open-Water-Short and Open-Water-Liquid calibration methods, respectively. Furthermore, the impact of anaesthesia application during skin excision procedure on ex-vivo dielectric data is investigated. RESULTS: The observations suggest that the dielectric properties (DPs) of excised skin lesions may not accurately represent actual tissue properties as they vary significantly (Dielectric Constant Contrast = 30.7%, Loss-Factor Contrast = 66.6%) compared to pre-excision conditions. In-vivo dielectric data analysis indicates that when compared to healthy skin, malignant Basal Cell Carcinoma presents increased DPs (dielectric constant & loss factor) of (24.8 & 38.6 %), respectively. On the other hand, for malignant Squamous Cell Carcinoma and pre-malignant Actinic Keratosis, the measured results show decreased DPs (dielectric constant & loss factor) accordingly by (19.4 & 18.2 %) and (19.2 & 27.9 %). The corresponding benign lesions have less than 13 % dielectric contrast compared to healthy skin across the tested band. CONCLUSION: The significant contrasts between in-vivo healthy and cancerous skin DPs strongly suggest the viability of the microwave band for skin cancer detection. SIGNIFICANCE: The research finding of this study would be critical in developing a portable electromagnetic system for skin cancer detection.

Evaluation of pharmaceutically compounded oral caffeine on the impact of medication adherence and risk of readmission among preterm neonates: A single-center quasi-experimental study.

BACKGROUND: Caffeine is available in an ampoule, used via parenteral and enteral routes in preterm neonates to treat apnea of prematurity (AOP) in neonates of gestational age ≥ 35-40 weeks. A longer duration of therapy has a higher risk of medication non-adherence due to higher costs and inappropriate dosage forms. Pharmaceutically compounded oral caffeine (PCC) could be an appropriate alternate dosage form. The researchers aimed to determine the impact of PCC on medication-related factors influencing medication adherence (MA) and the frequency of hospital readmission with apnea (HRA) in preterm neonates. METHODS: We conducted a single-center quasi-experimental study for this quality improvement project using PCC among the preterm neonates admitted in a tertiary care level-III NICU at the Aga Khan University Hospital Karachi, Pakistan, received caffeine therapy, and survived at discharge. The researchers compared pre-PCC data (April-December 2017) with post-PCC data (April-Dec 2018) each for nine months, with three months intervals (January-March 2018) of PCC formulation and implementation phase. The study was conducted according to the SQUIRE2.0 guidelines. The Data were collated on factors influencing MA, including the cost of therapy, medication refill rates, and parental complaints as primary outcome measures. The Risk factors of HRA were included as secondary outcomes. RESULTS: After PCC implementation cost of therapy was reduced significantly from Rs. 97000.0 (729.0 USD) to Rs. 24500.0 (185.0 USD) (p<0.001), significantly higher (p<0.001) number of patients completed remaining refills (77.6% pre-phase vs 97.5% post-phase). The number of parental complaints about cost, ampoule usage, medication drawing issue, wastage, inappropriate dosage form, and longer duration of therapy reduced significantly in post-phase. HRA reduced from 25% to 6.6% (p<0.001). Post-implementation of PCC (RR 0.14; 95% CI: 0.07-0.27) was a significant independent risk factor for reducing HRA using a multivariate analysis model. Longer duration of caffeine therapy after discharge (RR 1.05; 95% CI: 1.04-1.04), those who were born in multiple births (RR 1.15; 95% CI: 1.15-1.15), and those who had higher number of siblings were other significant independent risk factors for HRA. CONCLUSIONS: PCC dispensation in the appropriate dosage form at discharge effectively reduced cost, non-adherence to therapy, and risk of hospital readmissions. This neonatal clinical and compounding pharmacist-led model can be replicated in other resource-limiting setting.

Budding Medical Professionals And Covid-19: The Impact Of Covid-19 On Mental Health And Medical Students.

BACKGROUND: Due to the Novel Coronavirus Disease, medical education has transformed from a physical to an online-medium. The importance of physical education in low-and-middle-income countries (LMICs), where online education can be challenging there is a need to explore the factors that affect online education. This study assesses the perspective and mental health of students whose medical education has been impacted by the pandemic. Methods: An online-questionnaire was distributed through social media platforms from October-to-December 2020 through Google-Forms among medical students across Pakistan. Two grading-scales were used to score anxiety and depression. Descriptive statistics and a logistic regression analysis were used to identify factors associated with anxiety and depression among medical students. p<0.05 was considered as significant. Data was analyzed using STATA v.15. RESULTS: Total of 433 medical students participated in the study where 68.1% had some form of depression and 10.9% had anxiety. Around 65%-participants disagreed with the preference for online-classes. Seventy percent agreed on "Has the thought of the pandemic made you worry about your academic future" being associated with COVID-19 related-depression (OR: 2.03, 95%CI: 1.32-3.11). Multivariate analysis showed agreeing to "COVID affected my educational performance" was associated with anxiety (OR:1.45, 95%CI: 1.03-2.06) and depression (OR: 1.27, 95%CI: 1.03-1.56). CONCLUSIONS: Being part of the Low- and-Middle-Income Countries (LMIC), online-education itself becomes a challenge. Given the continued shutdown of universities across the country and the growing anxiety and depression amongst the students, adequate measures should be taken to help in coping up with the current challenge.

Quantifying the Soil Arthropod Diversity in Urban Forest in Dera Ghazi Khan.

Arthropods can be either large or too small to be seen from the microscope. Their legs are jointed and perform a specific function in the soil. Several arthropods have been identified to date. Therefore, it is essential to identify them in a different type of soil. An experiment to quantify the soil arthropods in the urban forests of D.G. Khan was conducted at the Zoology lab of Ghazi University on four tree plants, i.e., neem (Azadirachta indica), mango (Mangifera indica), guava (Psidium guajava), and phalsa (Grewia asiatica). Soil samples were taken from different areas and on different months. The diversity of arthropods was analyzed through the Shannon index. The results were all significant. The total number of arthropods found in the experiment was 5151, with the following distributions: millipedes were 132 in neem, 133 in guava, 113 in mango, and 121 in phalsa; centipedes were 136 in neem, 142 in guava, 118 in mango, and 132 in phalsa; springtails were 138 in neem, 130 in guava, 120 in mango, and 134 in phalsa. There were a total of 12 different species of arthropods found. Neem (Azadirachta indica) have mites, centipede, and ants; guava (Psidium guajava) have centipedes and ants. Mango (Mangifera indica) have millipedes, centipedes, mites, springtail, and ants, and phalsa (Grewia asiatica) have mites, ants, and centipedes. The study reveals that millipedes, centipedes, springtails, and ants were found abundantly in the urban forest area of D.G. Khan, resulting in increased organic matter decomposition and appropriate distribution of nutrients through the soil having beneficial effects on the terrestrial ecosystem.

Far-field ultrasonic imaging using hyperlenses.

Hyperlenses for ultrasonic imaging in nondestructive evaluation and non-invasive diagnostics have not been widely discussed, likely due to the lack of understanding on their performance, as well as challenges with reception of the elastic wavefield past fine features. This paper discusses the development and application of a cylindrical hyperlens that can magnify subwavelength features and achieve super-resolution in the far-field. A radially symmetric structure composed of alternating metal and water layers is used to demonstrate the hyperlens. Numerical simulations are used to study the performance of cylindrical hyperlenses with regard to their geometrical parameters in imaging defects separated by a subwavelength distance, gaining insight into their construction for the ultrasonic domain. An elegant extension of the concept of cylindrical hyperlens to flat face hyperlens is also discussed, paving the way for a wider practical implementation of the technique. The paper also presents a novel waveguide-based reception technique that uses a conventional ultrasonic transducer as receiver to capture waves exiting from each fin of the hyperlens discretely. A metallic hyperlens is then custom-fabricated, and used to demonstrate for the first time, a super-resolved image with 5X magnification in the ultrasonic domain. The proposed hyperlens and the reception technique are among the first demonstrations in the ultrasonic domain, and well-suited for practical inspections. The results have important implications for higher resolution ultrasonic imaging in industrial and biomedical applications.

Colorectal microbiota after removal of colorectal cancer.

The colonic microbiome has been implicated in the pathogenesis of colorectal cancer (CRC) and intestinal microbiome alterations are not confined to the tumour. Since data on whether the microbiome normalises or remains altered after resection of CRC are conflicting, we studied the colonic microbiota of patients after resection of CRC. We profiled the microbiota using 16S rRNA gene amplicon sequencing in colonic biopsies from patients after resection of CRC (n = 63) in comparison with controls (n = 52), subjects with newly diagnosed CRC (n = 93) and polyps (i = 28). The colonic microbiota after surgical resection remained significantly different from that of controls in 65% of patients. Genus-level profiling and beta-diversity confirmed two distinct groups of patients after resection of CRC: one with an abnormal microbiota similar to that of patients with newly diagnosed CRC and another similar to non-CRC controls. Consumption levels of several dietary ingredients and cardiovascular drugs co-varied with differences in microbiota composition suggesting lifestyle factors may modulate differential microbiome trajectories after surgical resection. This study supports investigation of the colonic microbiota as a marker of risk for development of CRC.

A Comprehensive Assessment of Blood Transfusions in Elective Thyroidectomy Based on 180,483 Patients.

OBJECTIVES: To assess the incidence, risk factors, and complications of blood transfusions (BTs) in elective thyroidectomy patients. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. Adult patients who underwent elective thyroidectomy from 2005 to 2019 were divided into two cohorts based on whether they received BT or not. Multivariable binary logistic regression models were used to identify risk factors of BT and its impact on postoperative complications. RESULTS: Of 180,483 patients, 0.13% received BT. Risk factors for BT included underweight body mass index (BMI) (adjusted odds ratio [OR] 3.179, 95% confidence interval [CI] 1.444-6.996), bleeding disorders (OR 2.121, 95% CI 1.149-3.913), anemia (OR 4.730, 95% CI 3.472-6.445), preoperative transfusion (OR 7.230, 95% CI 1.454-35.946), American Society of Anesthesiology physical statuses 3-5 (OR 3.103, 95% CI 2.143-4.492), operative time >150 min (OR 4.390, 95% CI 1.996-9.654), and inpatient thyroidectomy (OR 5.791, 95% CI 3.816-8.787). In addition, transfusion was independently associated with any postoperative complication, non-infectious, cardiac, pulmonary, renal, vascular, or infectious complications, surgical site infection, sepsis, septic shock, wound disruption, pneumonia, unplanned reoperation, prolonged length of stay, and mortality. CONCLUSION: Recognition of risk factors of BT is imperative to identify at-risk patients and reduce transfusions by controlling modifiable risk factors such as anemia, operative time, and BMI. In cases where transfusions are still indicated, surgeons should optimize care to prevent or adequately manage transfusion-associated complications. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2078-2084, 2022.

Rates of publication of FCPS dissertations in international and national peer-review journals among residents at AKUH; A cross sectional review of 15 years.

OBJECTIVE: To see the rate of publication of postgraduate residents' dissertation. METHODS: The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got published in national or international journal. Data was analysed using SPSS 21. RESULTS: Of the 103 subjects, 70(68%) were males and 33(32%) were females, while 73(70.8%) belonged to surgical specialties and 30(29.2%) were from non-surgical specialties. Of the 22(22.9%) who were able to convert, 12(54.5%) publications were carried by national peer-reviewed journals, while 10(45.4%) were carried by international journals; 9(40.9%) unpaid peer review journals and 13(59.1%) paid journals. Delay in exam due to incomplete dissertation was faced by only 16(16.6%) candidates. CONCLUSIONS: The rate of publication for resident dissertation was found to be low.