Journal of Gandhara Medical and Dental Science
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Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures
Full text linkOBJECTIVES
This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form.
METHODS:
This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at <0.05.
RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury.
CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales
Impact of Personality Trait of Agreeableness on Oral Parafunctional Habits
Full text linkOBJECTIVES
To find the impact of agreeable personality trait on oral parafunctional habits.METHODOLOGY
A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over 5 months, from July to November 2021. Data was collected using medical questionnaire and ten item personality inventory scale (TIPI). Kruskal Wallis test was to find the difference in the scores of agreeable personality trait across groups of oral parafunctional habits.RESULTSThere was a statistically significant difference in the agreeable personality trait across the parafunctional habits of tooth grinding (p=0.023) and biting on hard objects (p=0.013). A non-significant difference was seen in the personality trait across the habits of nail biting (p=0.495), tooth clenching (p=0.097) and habit of chewing gum (p=0.371).
CONCLUSION
The individuals who disagreed to having the habit of tooth grinding had the highest score for agreeableness and the least was seen in those who neither agreed nor disagreed to having the habit. The personality trait was the most prevalent in individuals who strongly agreed to having the habit of biting on hard objects and the least in those who agreed to having the habit
Perception of Neurosurgical Residents about Learning in Operation Theatre in Tertiary Care Hospitals
Full text linkOBJECTIVES
To explore Neurosurgical postgraduate residents perceptions of their learning environment in operating rooms.METHODOLOGY
From March 2022 to August 2022, this cross-sectional study will be carried out in the Department of Neurosurgery Hayatabad Medical Complex, Peshawar, Lady Reading Hospital Peshawar, and Ayub Teaching Hospital Abbottabad. The STEEM survey examined how surgical theatres were perceived as educational environments. After receiving informed consent, a printed questionnaire was provided to 32 surgical residents. SPSS 24 was used to conduct descriptive and inferential data analyses.
RESULTS
Thirty-one (31) of the 32 surgical residents that were surveyed (or 98.3%) answered. Residents' average age was 29.27 years (2.37); 27 were male, and 05 were female. Most residents were in their third (34.4%) and fourth (21.3%) years of residency. 147.66 (18.57) was the overall mean score. Participants' age and gender did not affect the mean scores; nevertheless, responses were statistically more favorable for residents in their first or fifth year of residency. Fifty-three locals responded favorably or positively overall.
CONCLUSION
Overall, residents had positive opinions of their training, their supervisors, the opportunities for learning in the operating room, the environment, and the monitoring they received
Minor Oral Surgery with Out Stopping the Daily Low Dose of Aspirin Therapy
Full text linkOBJECTIVES
Patients with the low-dose long-term aspirin regime have a severe risk of excessive bleeding during surgery, placing them at risk of "adverse thrombotic events". This study aims to evaluate the bleeding in patients undergoing minor oral surgery procedures without stopping daily low-dose aspirin therapy.
METHODOLOGY
A descriptive cross-sectional hospital-based investigation involved the patient with minor oral surgery at "Altamash Institute of Dental Medicine, Karachi, Pakistan" from mid-April 2021 to mid-June 2021, who were between the age group 30 to 75 with a low-dose aspirin regime. The data was collected via a questionnaire to record the variables, i.e. duration of aspirin, postoperative medications, platelets count, clotting time, normal bleeding time, and intraoperative bleeding time.
RESULTS
51 patients, of which 32 were males while 19, were females. The normal bleeding time was comparatively analyzed with the intraoperative bleeding time using SPSS statistical software version 22. The results revealed that the mean bleeding time for the patients with a low-dose aspirin regime during minor oral surgery was 5.49 ± 1.07, while for the patients with a stopped aspirin dose was 4.57 ± 1.07. The comparative analysis using a t-test doesn't reveal significant statistical differences of p<0.05 between both groups.
CONCLUSION
We concluded that minor oral surgical procedures could safely be done without altering or stopping the low-dose, long-term aspirin regime.
To Correlate the Expression of KRAS and BRAF V600e with Histological Grades and Variants in Tissue Samples of Colorectal Carcinoma
Full text linkOBJECTIVES
This study aimed to correlate the expression of KRAS and BRAF V600E with histological grades and variants in tissue samples of colorectal carcinoma.METHODOLOGY
In this cross-sectional study total of 51 cases of Colorectal cancer (CRC) were analyzed for immunohistochemical staining using KRAS and BRAF antibodies on representative tissue blocks. Clinical and pathological records were retrieved for the collection of data. The results of the immunohistochemical analysis were correlated with the recorded clinicopathological parameters.RESULTSFifty-one cases of CRC were analyzed for immunoexpression of KRAS and BRAF V600E. The age of the patients ranged from 14 to 85 years, with a mean age of 60.96 years. Among the 51 cases, 37(72.5%) cases were males and 14(27.4%) were females. 37(72.5%) were localized to left side colon and 14(27.4%) were found in the right colon. For KRAS immunostaining, 41(80.3%) out of 51 cases showed overexpression, while the remaining 10(19.6%) cases revealed negative expression. In the case of BRAF V600E, positive expression was seen in 20(39.2%) cases, whereas 31(60.7%) cases showed negative expression of BRAFV600E. A significant association was seen between KRAS overexpression and histological variants, i.e. glandular carcinomas. CONCLUSIONOver-expression of KRAS was observed in advanced tumors. The presence of BRAF V600E mutation in the present study signifies the importance of BRAF V600E inhibitors as a potential alternate therapeutic tool in EGFR inhibitors and chemotherapy-resistant tumors
Protection and Awareness Against Child Abuse
Full text linkIn Pakistan, child abuse has risen alarmingly, i.e., 30% of cases from 2020-2021 statistics.1 WHO comprehensively drafts the definition as, "Child abuse or maltreatment constitutes all forms of physical and or emotional ill-treatment, sexual abuse, neglect or negligent treatment, or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship or responsibilities, trust or power." There is an urgent need to address these issues in the prevention, psychotherapeutic treatment and rehabilitation of such victims and suffering. On the contrary, there will be a scary consequence. According to WHO, about 1 billion old children (2-17 years) across the globe are subjected to physical, sexual, or emotional harm by their caregivers or strangers Violence or abuse does not have boundaries of country, religion, class, or gender.2 At the same time, the related stigma keeps it underreported. Every year, around 500 million children suffer from abuse. In the USA, more than 3 million cases are reported, causing 2000 deaths and 18000 permanent disabilities, the victim results every year. The count for sexually molested girls is 1 in 4, and for boys, it is 1 in 7.3 In New Delhi, Child abuse is 8 in 10 kids, whereas boys (7 in 10 kids) are more vulnerable than girls (6.5 in 10 kids).4 The percentage of sexual abuse in India is 52% only admitted patients annually, whereas statistics for unreported and other molestation are unknown.5 In Sri Lanka, more than 40000 children were involved in prostitution, where children are used by paedophile sex tourists.6
In an unofficial report, every year, somewhat 15-20% of children are sexually abused in Pakistan. According to an NGO, there is a rise of 2 to 10 reported cases of Child Sexual Abuse (CSA) per day in the upcoming year, whereas the actual numbers would be much higher because CSA is culturally veiled. They documented that both genders were equally victimized, although 0-5 years of CSA victims were mostly boys. The perpetrators included close family ties and acquaintances, marking an increase in per year cases reported. Out of a total 3852 number of CSA cases, 2211 (51%) were from Punjab. A total number of 92 cases were reported murder after the assault.7
According to the latest study, the amygdala in the brain shrinks with repeated trauma, resulting in delayed learning abilities and deficient memory.8 Depression, isolation, and delinquency are a few more to enumerate. There are physical, behavioural and emotional indicators of abuse that a physician must be able to identify, address and refer to a psychologist for professional treatment. The prevention measures of awareness, training for parenting, character building of parents and psychological treatment can prevent and decrease a victim’s suffering. The only way to prevent CSA is to educate and spread awareness against this act on two levels. One is educating parents and teachers, and the other is making the child aware of the good and bad touch. In this regard, the PAAC group has worked. They have prepared useful brochures to protect the child from encountering the issue. The whole structure of society needs renovation, and the best renovation is building attributes based on the psychological training present in the seerah of the Prophet (SAW) and his companions
Assessing the Mental Health Status and Sleep Quality among House Officers in Peshawar
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The aim of this study was to assess the mental health status and quality of sleep among house officers in Peshawar and to determine the correlation between their mental health status and quality of sleep.METHODOLOGY
This was a cross-sectional study, conducted on house officers of four tertiary care hospitals in Peshawar. Data was collected through a self-administered questionnaire using convenience sampling technique. Pittsburgh sleep quality index (PSQI) scale was used for assessing the sleep quality and Warwick Edinburgh mental wellbeing scale (WEMWBS) was used for assessing the mental health status of the respondents.RESULTSAmong the 276 house officers, the mean mental health score was 48.13±9.17, and mean sleep quality score was 6.39±3.27. In comparison, female House officers had poor mental health status (female: 45.72±9.32, male: 49.83±8.70, p<0.05) and sleep quality (female: 6.91±3.77, male: 6.03±2.82, p<0.05. The hospital status showed no significant association between sleep quality (p value: 0.778) and mental health score (p value: 0.573). Furthermore, quality of sleep had a positive correlation with mental health status of house officers (p<0.01).CONCLUSIONMental health status and quality of sleep among house officers was poor. Female house officers had a poor mental well-being and a poor sleep quality compared to male house officers. There was no significant difference between the mental health status and quality of sleep, of house officers working in public hospitals and those working in private hospitals. House officers having a poor sleep quality also had a poor mental health status showing a positive correlation between the tw
Compliance with Standard Precautions and Associated Factors among Critical Care Nurses in Peshawar, Pakistan and Kunming, China: Comparative Cross-Sectional Study
Full text linkOBJECTIVES
To find the level of compliance and the associated factors of compliance with standard precautions among registered nurses.
METHODOLOGY
Cross-sectional study was conducted during March and August 2020 in four hospitals, two from each country; Pakistan and China. Data was gathered through a modified version of the adopted questionnaire from 424 registered nurses, selected by a simple random sampling technique. Data were analyzed by SPSS version 26.
RESULTSThe overall compliance with SPs among registered nurses in Pakistan was 57.1%, and among the respondents from China was 75.2%. Gender, age and working area were associated with the compliance of SPs. Female nurses from China are 1.72 times less compliant, while the increasing age of Pakistani nurses increases the risk for non-compliance with SPs by 1.7 times. Participants working in Emergency Department in Pakistan were 2.07 times less compliant than those working in Intensive Care Unit/Coronary Care Unit (ICU/CCU). Lack of training increases the risk of being 2.9 times more non-compliant. For Chinese Nurses, less knowledge and a lack of resources were associated with non-compliance in both countries nurses.
CONCLUSION
Noteworthy numbers of nurses were found non-compliant with standard precaution practices in both study populations. Therefore, strategies like regular training on standard precautions, availability of Personal Protective Equipment and policymaking may improve compliance with SPs practice
Risk Factors for Hypertension in Patients with Stroke Presenting to Tertiary Care Hospital
Full text linkOBJECTIVES
To determine the risk factors for hypertension in stroke patients presenting to the tertiary care hospital of Peshawar, Pakistan.
METHODOLOGY
This cross-sectional descriptive study was conducted in the Department of Medicine at Khyber Teaching Hospital, Peshawar. This study spanned months and included 225 patients of either gender who had stroke symptoms within the preceding 72 hours. Detailed information was documented in age (in years), residence, gender, educational qualification, family history of hypertension, smoking, diabetes mellitus, obesity, dyslipidemia, hypertension, and duration. SPSS version 26.0 was used.RESULTSThe age range of the participants were from 41 to 80 years, with a mean age of 61.004±6.69. The mean duration of hypertension was 3.052±0.85 years. Hypertension was seen in 42.2% of patients. Factors leading to hypertension in stroke patients were age 40.8%, urban area 42%, illiteracy 36.2%, positive family history 61.9%, diabetes mellitus 65.2%, smoking 33.3%, obesity 85.3%, and dyslipidemia 71.8%.
CONCLUSION
Significant risk factors for stroke include hypertension, diabetes mellitus, hypercholesterolemia, smoking, obesity, and positive family history
Histopathological Assessment of Microvascular Invasion in Hepatocellular Carcinoma Resection Specimens and its Correlation with Tumor Size and Grade
Full text linkOBJECTIVES
To determine the histopathological assessment of microvascular invasion in Hepatocellular Carcinoma Resection Specimens and its correlation with tumour size and grade.
METHODOLOGY
This retrospective cross-sectional study included the biopsy-proven Hepatocellular (HCC) case with microvascular invasion (MVI) noted in the resected specimens evaluated by two independent consultants Histopathologists. The exclusion criteria were; all patients below 18 years, unfixed autolyzed samples, and incomplete requisition-filled forms. Numerical data, i.e., patient age and tumour size, are presented as mean with standard deviation. Categorical variables, i.e., tumour size, grade, and presence or absence of MVI, were submitted as numbers with percentages. Continuous variables, i.e., tumour size and differentiation grade, were assessed using the Chi-square test. A p-value of ≤ 0.05 was considered significant.
RESULTSMost patients, 34.4%, fall into the age group of 47-70. Most patients were males, 63.6%, and microvascular invasion was noted in 49.09% of cases. Most cases were of moderate to poorly differentiated tumours, 80.0%. MVI was statistically significant with the grade of the tumour.
CONCLUSION
Microvascular invasion is an important prognostic marker noted in a surgical resection specimen. Although the exact definition and risk stratification is unclear, survival studies have proven that MVI is associated with poor outcomes