Journal of Gandhara Medical and Dental Science
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Quality of Hypospadias Surgery in a High Volume Hospital: Review of Short to Medium-Term Outcomes after Snodgrass Hypospadias Repair
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The study aimed to review short-term and medium-term outcomes of Snodgrass repair from one-year to two-year follow-up.
METHODOLOGY
It’s a retrospective review of 114 patients (secondary data) with distal penile hypospadias without curvature who underwent Snodgrass repair performed by a single surgeon in the department of Urology, Lady Reading Hospital Peshawar from March 2021 to March 2022. Hypospadias objective score Evaluation (HOSE) was used for functional and cosmetic outcomes.
RESULTSThe mean age at the time of presentation for surgery was 3 years. The mean documented follow-up was 13 months (2-23 months). 51% (58) of patients presented with coronal hypospadias, followed by sub-coronal, distal and glanular hypospadias. Overall complication rate was 10%. Three patients developed a total breakdown of their wounds that needed further staged procedures. Meatal stenosis was noted in three patients requiring meatal dilatation, and another two came back with non-obliterative strictures. One had gentle dilatation, and the other underwent an optical urethrotomy. The rest of the four patients developed urethrocutanoeus fistulae (UCF), ultimately getting repaired 6 months postoperatively. Good cosmetic and functional results were achieved in 93% of cases (HOSE score of 14 or above).
CONCLUSION
This study shows that Snodgrass repair is the best option for mainly correcting distal penile and midshaft hypospadias and has an acceptably low complication rate with better short to medium-term outcomes
Proximally Based Medial Hemi-Soleus Muscle Flap Employed For Moderate-Sized Pretibial Defects of the Middle Third of the Leg
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This study was undertaken to document the clinical indications and outcome of proximally based medial Hemi-soleus muscle flap for coverage of moderate-sized complex pretibial defects of the middle third of the leg.
METHODOLOGY
This descriptive case series was conducted at the Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Burn & Trauma Center, Hayatabad, Peshawar, over five years. (i.e., from November 01, 2016, to December 31, 2021). It included all adult patients of either gender whose complex pretibial wounds of the middle third leg were managed with proximally based medial Hemi-soleus muscle flaps.
RESULTS
The mean age was 31.40±9.83 years, ranging between 19-47 years. All the patients had complex post-traumatic defects secondary to road traffic accidents. There were 9(33.3%) patients with minor defects (i.e., measuring ≤2×2 cm2), whereas 18(66.6%) patients had medium-sized defects (i.e., ≥2×2 cm2 and ≤7×5 cm2). Their hospital stay ranged between 9-15 days with a mean stay of 11.92±3.1 days. All the flaps (100%) survived. Partial skin graft loss was encountered among three patients (n=3;11.1%).
CONCLUSION
The study provides a good evidence base regarding the usefulness of the flap in managing complex defects of the leg. It is recommended to carry out similar studies internationally. These should help improve our findings and come up with further refinements
Impact of Personality Trait of Emotional Stability on Oral Parafunctional Habits
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To find the impact of emotional stability on oral parafunctional habits.
METHODOLOGY
A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over five months, from July to November 2021. Data was collected using a medical questionnaire and a ten-item personality inventory scale (TIPI). The medical questionnaire comprised two sections with 11 items. The first section had six demographic statements, including age, gender, marital status, occupation, educational level and medical condition. The second section consisted of a pre-validated parafunctional habits questionnaire.
RESULTSThere was a non-significant difference in the scores of the personality trait of emotional stability across categories of oral parafunctional habits of nail-biting (p=0.093), tooth grinding (p=0.192), tooth clenching (p=0.055), biting on hard objects (p=0.17) and chewing gum (p=0.116).
CONCLUSION
Emotional stability was most prevalent in individuals who denied having the habit of nail-biting, teeth grinding, tooth clenching and biting hard objects but neither agreed nor disagreed with having the habit of chewing gum
Blending Old and New Teaching Methods and Tools in Medical Education
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To identify a preference for current teaching methods and use new teaching aids through feedback by medical students and teachers of first and second-year MBBS.
METHODOLOGY
This cross-sectional study was conducted on 91 MBBS students and teachers of Nowshera Medical College (NMC), Nowshera. Both male and female students and teachers of NMC of class first and second-year MBBS participated in the study. A feedback proforma-based questionnaire was filled out by all the participants online using Google forms. Participants were given the option to select more than one option in the case of the mode of teaching and tool of teaching. The data was collected, analyzed and presented in tabular and graphical forms using SPSS version 23.
RESULTS
Out of the 91 participants who responded to our research, 45 (49.5%) were males, and 46(50.5%) were female. The majority, 74 (81.3%), were MBBS students, while 17(18.7%) were MBBS teachers. Most of the participants selected more than one option. Most 48(52.7%) of the participants preferred lectures as the mode of delivery while 35(38.4%) opted for SGD, for demonstrations 14(15.3%), PBL 33(36.2%), assignments 13(14.2%0 and notes opted by 4(4.39%). 60.4% (55) were selected to use whiteboards and markers. Only 15.3% (14) were in favour of Powerpoint use, dissection 25(27.4%), models 29(31.86%), and figures 11(12%).
CONCLUSION
Lectures remain the most preferred teaching method in basic medical sciences among teachers and students, along with other teaching methods. Multiple teaching tools must be used during the class instead of solely depending on Powerpoint presentations
Knowledge of Safe Swaddling Practices among Mothers of Neonates Visiting a Tertiary-Care Hospital in a Developing Country
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Swaddling of new-borne and infants remains common in the developing world, but little is known about maternal knowledge of swaddling. Therefore, this study aimed to determine the level of knowledge of safe swaddling practices among mothers of neonates visiting a Tertiary-Care Hospital.METHODOLOGY
This cross-sectional study was conducted in the paediatric unit of tertiary care hospital in Peshawar city, Pakistan, between July and December 2018. A total number of 370 mothers of neonates who volunteered their participation were selected using a non-probability consecutive sampling technique. The study was based on a questionnaire comprised of socio-demographic and other questions related to the knowledge of safe swaddling practices.RESULTSA total number of 370 mothers of neonates knowledge were assessed. The study participants ranged between 17 - 49 years, with a mean age of 27.14 (SD ± 5.46). Of the total, 365 (98.6%) mothers were swaddling their babies, while only 5 (1.3%) reported not practising swaddling. Most mothers (51.1%) had good knowledge, while 44.3% had adequate knowledge, and only 4.6% had insufficient knowledge regarding safe swaddling. Knowledge of safe swaddling increased with age and parity. Most mothers (90%) correctly identified that "cotton cloth or light blanket should be used to swaddle baby".CONCLUSIONIt is concluded from this study that most mothers have adequate knowledge about safe swaddling, and the level of knowledge increases with age and parity. Safe swaddling techniques and information should be given to mothers at the beginning of antenatal care to benefit from its positive outcomes and, at the same time to avoid its drawbacks
The Effect of Epidural Steroids on Postoperative Pain and Hospital Stay in Patients Having a Single-Level Lumbar Discectomy
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To determine the effect of Epidural steroids on postoperative pain and hospital stay in patients having a single-level lumbar discectomy.
METHODOLOGY
A quasi-experimental study was conducted at the Neurosurgery department, Qazi Hussain Ahmad Medical Complex, Nowshera. Sixty patients with a mean age of 40.3±9.21 years were enrolled. The enrolled patients were divided into two groups: Group A patients were given intraoperative epidural methylprednisolone 80 mg, while Group B patients were given only normal saline. Pre- and post-operative pain was assessed after 6 hours, 12 hours and at the discharge time from the hospital. The duration of hospital stay was also noted.
RESULTSOut of 60 patients, 55.0% were male, and 45.0% were female, with an overall mean age of 40.3±9.21 years. The VAS score in Group A was 0.82±0.26 compared to 2.30±0.71 in group B (P <0.000). And at first follow-up, the VAS score was 0.13±0.05 and 1.25±0.33 in groups A and B, respectively. The length of hospital stay was 1.39±0.44 and 1.98±2.50 in groups A and B, respectively.
CONCLUSION
Intra-operative epidural steroid is beneficial in reducing post-operative pain and hospital stay
The Effect of Pyeloplasty on Renal Cortical Thickness in the Pediatric Population with Ureteropelvic Junction Obstruction
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To determine the effect of pyeloplasty on renal cortical thickness in the pediatric population with ureteropelvic junction obstruction (UPJO).
METHODOLOGY
This retrospective study examined the renal cortical thickness in 100 pediatric patients diagnosed with ureteropelvic junction obstruction (UPJO). The study employed a non-probability consecutive sampling technique to select participants. Inclusion criteria encompassed children below five years of age, of both genders, with Pakistani nationality, and availability of both pre-and post-operative ultrasound data. Cases presenting with ureterovesical junction obstruction or vesicoureteral reflux were excluded from the analysis. Data collection involved gathering information on age, gender, and cortical thickness, with renal cortical thickness assessed through ultrasonography. A paired t-test was employed to compare the renal cortical thickness between the preoperative assessment and the 3-month follow-up.
RESULTSThe females were 40(40%) and males were 60(60%). The mean age was 33.51±22.91months. The mean cortical thickness before pyeloplasty was 5.23±0.93mm and 8.25 ± 2.34mm after pyeloplasty. The renal cortical thickness in both genders significantly increased to 3mm (p<0.001). The cortical thickness before pyeloplasty was 5.23±0.93mm, and after was 8.25±2.34mm.
CONCLUSION
Renal cortical thickness can be improved after pyeloplasty in patients with ureteropelvic junction obstruction
20-Gauge vs. 23-Gauge Vitrectomy, in Terms of Surgically Induced Astigmatism
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To compare the post-operative (post-op) surgically induced mean astigmatism in patients undergoing 20-gauge- and 23-gauge vitrectomy.
METHODOLOGY
Sixty patients were enrolled. Relevant information was recorded in a Performa for each patient. Patients were randomly grouped into A (20-gauge) and B (23-gauge) groups. Astigmatism was recorded by a single technician using the same keratometer for all patients. A single surgeon operated on all patients. Post-operatively, all patients were re-examined after 1 week and 6 weeks, and their surgically induced astigmatism was recorded.
RESULTSOf 60 patients, 58.6% were males, and 41.4% were females, with a mean age of 53.77 ± 9.63 years. The post-operative astigmatism difference between the two vitrectomy procedures was investigated. In the 20-gauge group, with 30 patients, the mean post-operative astigmatism difference was 2.21 D (±0.66 SD), with a standard error mean of 0.12. In the 23-gauge group, with 30 patients, the mean post-operative astigmatism difference was 0.74 D (±0.44 SD), with a standard error mean of 0.08. The degrees of freedom (df) were 58, and the standard error of the difference was 0.145. The t-value was calculated at 10.1504, and the p-value was found to be 0.001, indicating a significant difference.
CONCLUSION
The observation that the 20-gauge group displayed a notably higher mean difference in astigmatism than the 23-gauge group suggests a potential association between the choice of vitrectomy procedure and the extent of astigmatism alteration in post-operative outcomes
Prevalence of Hepatitis C Virus Infection among Chronic Kidney Disease Patients on Regular Hemodialysis
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To determine the frequency of the Hepatitis C Virus in patients with chronic kidney disease receiving regular hemodialysis.
METHODOLOGY
At a tertiary care hospital in Peshawar, 211 patients were observed to ascertain the frequency of the Hepatitis C Virus in chronic kidney disease patients receiving regular hemodialysis. The technique of non-probability sequential sampling was employed to acquire samples. SPSS version 26.0 was used.
RESULTSAmong the CKD patients with Hepatitis C Virus (HCV) infection, a higher proportion of males (48.5%) tested positive compared to females (28.1%). Furthermore, the prevalence of HCV infection was significantly higher in CKD patients residing in urban areas (98.5%) compared to those in rural areas (1.5%). The statistical analysis indicated a significant association between the prevalence of Hepatitis and the factors of gender and residency (P value = 0.002). Out of 211, hepatitis C-positive patients 66.2% were diabetics and hypertensive were 77.9%.
CONCLUSION
Hospitalized CKD patients have a considerably higher frequency of hepatitis C infection. To stop the spread of the hepatitis C virus, nephrology wards should undertake strict universal infection control procedures
Efficacy of Uterovaginal Packing Versus Uterine Balloon Tamponade to Control Postpartum Hemorrhage Due to Uterine Atony
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To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment.
METHODOLOGY
This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS
Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION
All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group