Journal of Gandhara Medical and Dental Science
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Frequency of Malpresentation in Patients Presenting with Polyhydramnios during Pregnancy at Tertiary Care Hospital
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To determine the frequency of malpresentation in pregnant women with polyhydramnios.
METHODOLOGY
This Cross-Sectional Study was conducted at the Department of Obstetrics and Gynecology of Lady Reading Hospital, Peshawar, from March 2021 to September 2021. A total of 175 pregnant women with polyhydramnios were included in the study. Ultrasound was done to make a diagnosis of malpresentation.
RESULTSThe age range of pregnant women in this study was from 18-40 years with a mean age of 31.137±3.67 years, mean gestational age of 34.022±2.78 weeks, mean parity of 2.537±1.69 and mean AFI level was 29.017±2.32 cm. A previous history of malpresentation was seen in 25.7% of patients. Malpresentation was observed in 10.3% of patients. The previous history of malpresentation and polyhydramnios had strong statistical significance with current malpresentation (p<0.01).
CONCLUSION
With the timely diagnosis of polyhydramnios with documentation on ultrasound by an expert radiologist and clinical examination by a gynaecologist, malpresentation can be reduced significantly by prompt treatment.
Functional Outcome of Open Latarjet Procedure for Recurrent Anterior Shoulder Dislocation
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To find the functional outcome of the open Latarjet method for recurrent anterior shoulder dislocation.
METHODOLOGY
The current retrospective study was conducted at the Orthopedic and Trauma Department of the Khyber Teaching Hospital in Peshawar from September 2020 to August 2021. A total of 31 patients were included in the study, of which 29 were males and 2 were females. A detailed medical history was obtained through physical examination, and all necessary laboratory tests were requested. AP and axillary views of plain X-ray radiographs were taken. We used a CT scan on all the patients to calculate the humeral and glenoid bone loss. We had all patients undergo an MRI to rule out soft tissue pathology. Six months after surgery, the outcome was graded using the Constant Murley Score on a good, good, fair, and poor scale.
RESULTS
In this study open Latarjet procedure was done in 31 patients with 29 males (93.4%) and two females (6.45%). The right-sided shoulder was involved in 24 (77.14 %) patients, while the left shoulder was involved in 7 patients (22.58%). A bipolar lesion in the shoulder with bone loss was seen on the glenoid side at 17.5% (range 10-25%), and the humeral side was 22.5%.
Follow-up was done for six months in which 22 patients had a very good outcome (70.96%), six patients had a good outcome(19.35%), two patients had a fair outcome(6.45%), and one patient had a poor outcome(3.22%). There were no major complications seen like graft fractures, graft malposition, neurovascular compromise, and hardware breakage
CONCLUSION
Recurrent anterior shoulder instability can be effectively treated with open Latarjet with excellent functional outcomes and a very low complication rate and recurrence
Lower Lip Paresthesia in a Patient With Carious Mandibular Premolar: A Case Report
Get PDFSeveral dental operations, including local anaesthetic administrations, wisdom teeth procedures, orthognathic surgical treatments, ablative operations, implantation, and root canal therapy, can cause numbness and tingling of the inferior alveolar nerve. The present case report explains a case report of lower lip paresthesia arising due to carious mandibular premolar
Hearing Loss Due to Cyclosporine In Children
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A 13-year-old boy known for steroid-resistant nephrotic syndrome taking cyclosporine for the last four years was referred from one private hospital for non-response to treatment and decreased hearing. On detailed history, it was revealed that hearing loss started after initiation of treatment with cyclosporine during the first year, and the patient was not properly followed for hearing issues. Rather cyclosporine was continued despite no response to treatment. The patient raised alanine transaminase (ALT) and uric acid levels. The drug was discontinued, and ALT and uric acid were normalized on follow-up. Hearing on follow-up improved clinically. It was concluded that children taking calcineurin inhibitors should be screened for hearing when taking them long
Decision-Making of Patients Towards Treatment Modalities of Failed Root Canal Therapy
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To determine the awareness and perception of patients towards treatment modalities of failed root canal therapy.
METHODOLOGY
A cross-sectional study was conducted at the department of Operative Dentistry and Endodontics, Altamash Institute of Dental Medicine, Karachi, from 15 August’2021 to 14 October’2021. A total of 292 participants, 155(63%) female and 104(37%) males, were selected for the study. All the participants included had at least one root canal-treated tooth. A well-constructed and validated performa was used to evaluate the patient’s decision for different treatment modalities against a tooth with failed root canal treatment.
RESULTS
Among the subjects, most patients opted for endodontic re-treatment (60%) in case of root canal treatment failure, whereas the remaining opted for extraction (40%). Out of this, 40% (8%) choose removal of partial denture, (12%) bridge, and implant (20%).
CONCLUSION
Re-treatment is the first-line treatment option for the previously failed root canal. Our study concluded that most patients would opt for an endodontic re-treatment. The patient's education and awareness level affected the treatment options
Propofol Versus Dexmedetomidine Sedation Reduces Delirium
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Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine infusion to prevent delirium is controversial. We hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD.METHODOLOGY
After the approval from institutional ethics review board and informed consent, a comparative cross sectional study was conducted in 100 patients scheduled for cardiac surgery. Patients suffering from consequential psychological issues, delirium, and grievous dementia were excluded. Delirium was evaluated by confusion assessment method for ICU (CAM-ICU). Normality and homogenity of data were analyzed using Kolmogorov-Sminorv and saphiro wilk. The factors related to delirum status were analyzed using Logistic Regression.RESULTSThe mean age among propofol group was 55.14+9.6 while among Dexmedetomidine was 55.96+12.1. POD was present in 24 of 50 (48%) and 4 of 50 (8.%) patients in propofol and dexmedetomidine groups, respectively. variables which had significance values <0.05 were patient age (0.000), associated disease (p<-0.003). In regards to other variables like patient gender (p value: 0.660), pre-operative medication (p value: -0.090), different type of surgery (p value: -0.239), had no correlation with POD.CONCLUSIONIn comparison with propofol, dexmedetomidine postoperative sedation minimized the occurrence and abbreviated the time span of POD in patients who had to undergo cardiac surgery
Treatment of Neurological Diseases in Pakistan and Medicinal Plants - Letter to Editor
No full textIn developing and developed countries, neurological diseases contribute to the major reason for morbidity and mortality. The overall burden is 6.5% globally, of which advanced countries contribute 10 to 11%, whereas progressive countries constitute 4 to 5%. The higher ratio in technologically advanced countries might be due to their advanced system providing complete patient data. Some neurological diseases are common and wellestablished, whereas others occur rarely or are poorly ordered. Schizophrenia affects 45 million people, whereas depression affects 340 million globally. The people living with Alzheimer’s constitute 11 to 45 million people, accounting for 1% of the total disease load. 10% Pakistani community suffer from mental disorders, with 1% Alzheimer’s, 5% depression, 2% epilepsy and 1.5% schizophrenia. Medicinal plants play a vital role in treating several neurological disorders. Due to the upsurge in the cost of the available drugs, the local population is dependent on the use of medicinal plants to treat these neurological disorders.
Medicinal plants possess a great therapeutic potential and fewer side effects than synthetic drugs. In Pakistan, research on medicinal plants is increasing day by day. The Pakistani population traditionally depends on herbal medications to treat several neurological disorders. The use is more in rural areas due to easy access and costeffectiveness. In Pakistan, there is a stern gap between the availability of neurological care and a trained neurologist. In this scenario, the use of traditional medicinal plants for aiming to treat neurological disorders is obvious
Prevalence and Factors of Non-Vaccination Of Covid-19 in District Peshawar,Khyber Pakhtunkhwa, Pakistan
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The study aimed to compare the clinical outcome of transverse versus longitudinal incision for surgical release of the first dorsal compartment of the wrist to treat de Quervain’s disease.
METHODOLOGY
In this quasi-experimental study, all the patients with resistant de Quervain’s tenosynovitis who had the surgical release of the first dorsal compartment between January 2008 and December 2020 were included. The surgeries were performed under local anaesthesia. The first dorsal compartment of the wrist was approached through either a longitudinal or transverse incision, and the tendons of the abductor pollicis longus and extensor pollicis brevis were released. Patients were followed for a minimum of three months, and the primary outcome measure was the Visual analogue score (VAS) for relief of pain and secondary outcome measures were any immediate or delayed complications.
RESULTS98 patients were included in the study with a female-to-male ratio of 7:1. The cohort’s mean age was 44 years (Range 25-75). Most patients were housewives exposed to manual work with the involvement of the dominant hand. There were no major complications besides wound issues and transient paresthesia in few patients. The longitudinal incision was associated with less transient nerve palsies, less duration of surgery and easier identification of structure and anomalies. The only advantage of transverse incision was less scar formation. The clinical outcome was similar in both groups: 94% of patients had complete pain relief (VAS 0).
CONCLUSION
There was no difference in the outcome of de Quervain tenosynovitis when released with a transverse or longitudinal incision. The longitudinal incision had fewer complications as compared to the transverse incision
Unlocking Minds: The Promising Horizon of Cognitive Behavior Therapy in Pakistan
Get PDFCognitive Behavior Therapy (CBT) has come a long way since its inception in the 1960s. The approach has effectively treated various psychological disorders, from anxiety and depression to post-traumatic stress disorder and substance abuse. However, as we move further into the 21st century, the future of CBT is poised to undergo significant innovation. Cognitive Behavior Therapy (CBT) is evolving rapidly, and its future holds exciting new developments. Emerging trends in CBT include the use of digital and mobile applications to increase access to mental health services and the development of personalized treatment plans based on an individual’s unique needs. These transdiagnostic approaches treat underlying mechanisms that cut across different disorders, the integration of new technologies, and the emphasis on self-help strategies. These innovative approaches offer promising new ways to treat mental health disorders more effectively and efficiently and are likely to shape the future of CBT.1
Here briefly discuss the emerging trends that could shape the future of CBT: Digital and Mobile Applications; with the rise of telehealth and digital mental health platforms, CBT is being integrated into mobile and online applications. These platforms enable greater access to mental health services, reaching individuals who may not have access to traditional in-person therapy. Personalized Treatment; CBT is moving beyond a one-size-fits-all approach. Customized treatment plans can be developed using assessment data and digital monitoring tools. This approach considers an individual’s unique circumstances, symptoms, and treatment preferences to create a more effective and targeted treatment plan. Transdiagnostic Approaches: In the past, CBT has primarily focused on treating specific disorders. However, the transdiagnostic approach is gaining attraction, emphasizing treating underlying mechanisms that cut across different disorders. This approach may enable the treatment of comorbid conditions more efficiently and effectively.2 Incorporating New Technologies; The use of new technologies, such as virtual reality and brain stimulation techniques, has shown promise in treating a range of psychological disorders.3 Incorporating these tools into CBT may offer more effective treatment options for individuals who are unresponsive to traditional therapies. Emphasizing Self-Help Strategies; CBT’s future may rely on empowering individuals to control their mental health through self-help strategies. By utilizing mobile applications, online resources, and telehealth, individuals may gain access to resources that can help them manage their symptoms more effectively.
The future of Cognitive Behavior Therapy (CBT) in Pakistan is bright, as the country is experiencing a growing demand for mental health services. There is a need for effective, evidence-based treatments like CBT, which have demonstrated efficacy in treating various psychological disorders. However, several challenges need to be addressed to increase the availability and accessibility of CBT in Pakistan.4 One of the major challenges is the shortage of mental health professionals, particularly those trained in CBT. To address this issue, there is a need for increased investment in mental health education and training and initiatives to attract and retain mental health professionals. Another challenge is the cultural context in which CBT is delivered in Pakistan. Cultural sensitivity and adaptation of CBT are crucial to its success, and this can be achieved through collaboration with local experts and stakeholders to tailor the approach to the local context. To fill the gap in CBT training, a 6-month postgraduate certificate training program was started in 2017 at Khyber Medical College Peshawar, affiliated with Khyber medical university Peshawar. This training attracted mental health professionals from all over the country, and so far, about 100 mental health professionals (psychiatrists and psychologists) have been trained in CBT. CBT training has been further enhanced, and a one-year postgraduate diploma training program was started in 2022 at Bashir Psychiatric Hospital and Institute in collaboration with Gandhara University Peshawar. This training program covers the treatment of a broad range of psychiatric disorders, including depression, various anxiety states such as panic anxiety, social anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), conversion disorder, personality disorder, drug addiction and psychosis. In conclusion, using technology and telehealth can greatly enhance the availability and accessibility of CBT in Pakistan. With the increasing adoption of digital technologies in the country, mobile applications and online resources can expand the reach of mental health services to underserved populations
Metastatic Hepatic Epithelioid Hemangioendothelioma In 10 Years Old Boy; A Rare Case Report
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Epithelioid Hemangioendothelioma is an infrequent vascular neoplasm of intermediate malignant potential oddly affecting children. It is primarily noted in soft tissues, the stomach, breast, spleen, brain, and liver. No definite risk factor is identified in children. However, following WWTR1-CAMTA1 and YAP1-TFE3 gene fusions are frequently seen in these tumours. We present a case of very rare childhood Epithelioid Hemangioendothelioma of the liver in a ten-year-old boy. A 10-year-old boy presented with abdominal pain, mild weight loss, and abnormal liver function tests. Radiologically, hepatic, pulmonary, and bony lesions are noted. The biopsy report showed Epithelioid Hemangioendothelioma confirmed by an Immunohistochemical panel. Due to the lack of facilities in our centre, palliative treatment was given to the patient. Surgical resection, liver transplant, and radiofrequency ablation were impossible due to widespread hepatic and pulmonary disease. The patient was resistant to any medical treatment. The patient died at the seventh-month follow-up. HEHE is a scarcely seen tumour with no definite management protocol. Surgical resection is the preferred treatment for resectable tumours. In non-resectable extensive bifocal tumours, like in our case, the preferred treatment is radio-frequency ablation and hepatic transplant. The overall survival is trivial due to the non-compliant nature of the disease