bluuebunny/crossref_metadata_2025 huggingface dataset:
Occult periprosthetic fractures of the acetabulum in THA using an elliptic cup design have no adverse impact on outcome
Authors: Häller Thomas Vincent , Dora Claudio , Schenk Pascal , Zingg Patrick Oliver
Published: September 2021

Occult periprosthetic fractures have been defined as a fracture only visible on postoperative CT scans but not on postoperative plain radiography after an uneventful surgery without intraoperative fracture. The fracture rate for hemispherical and peripheral self-locking cups has been described as 8.4%. We retrospectively analyzed postoperative CT scans after primary THA to clear the question whether such occult periprosthetic fractures of the acetabulum require particular treatment strategy.

Between 2014 and 2018 we identified 115 CT scans of 114 patients after primary cementless THA with elliptical cups using a direct anterior approach. The CT scans were obtained as part of other investigations. Localization of the fracture, patients demographics, clinical (WOMAC, Harris Hip Score) and radiological outcome were analyzed.

Fracture and non-Fracture group were compared with regard to demographics and short-term outcome after 1 year.

Four occult fractures (3.5%) were identified. Three fractures involved the posterior wall. All patients had an uneventful routine postoperative rehabilitation. Patients with occult fractures showed similar post- operative HHS and WOMAC scores at 3 (HHS p = 0.576, WOMAC p = 0.128) and 12 (HHS p = 0.479, WOMAC p = 0.588) months. There were no cup loosening nor radiolucent lines at latest follow-up (mean FU 22 months, range 12-34 months).

Clinical and radiological short-term outcome was not impaired by the occurrence of an occult periprosthetic fracture of the acetabulum. The incidental detection of an occult periprosthetic fracture of the acetabulum does not seem to oblige the surgeon to adapt the postoperative regime.
Outpatient total hip arthroplasty : the future?
Authors: De Wouters Solange , Petronilia Steven , Paulet Daniel , De Baere Tom , Willemart Etienne , Cornu Olivier
Published: September 2021

With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety.

Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered.

Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience.

With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied.
Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation
Authors: Mohan Kunal , Hintze Justin Matthias , Morrissey David , Molony Diarmuid
Published: September 2021

Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN.

61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity.

40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature.

In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.
Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique
Authors: Yazdi Hamidreza , Kwon John Y. , Ghorbanhoseini Mohammad , Gomrokchi Alireza Yousof , Motaghi Paniz
Published: September 2021

Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised.

Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded.

Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity.

In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion.
TỬ VONG SƠ SINH VÀ MỘT SỐ CAN THIỆP HIỆU QUẢ GIẢM TỬ VONG TRONG LỘ TRÌNH HƯỚNG TỚI MỤC TIÊU CẢI THIỆN SỨC KHỎE SƠ SINH VÀO NĂM 2030
Authors: Hòa Đinh Thị Phương
Published: September 2021

Số trẻ sơ sinh tử vong trên toàn cầu đã giảm từ 2,7 triệu năm 2015 xuống 2,4 triệu năm 2020. Tuy nhiên, tốc độ giảm tử vong sơ sinh chậm và hiện nay chiếm tới 44% trong số tử vong trẻ dưới 5 tuổi. Vì thế, giảm tử vong sơ sinh được đưa vào trong mục tiêu 3 của mục tiêu phát triển bền vững hậu thiên niên kỷ (SDGs) với chỉ tiêu là chấm dứt các trường hợp tử vong sơ sinh do cácnguyên nhân có thể phòng tránh được vào năm 2030. Ở Việt Nam, cũng tương tự như thực trạng ở các nước thu nhập và trung bình khác, tử vong sơ sinh tuy có giảm trong những năm gần đây nhưng vẫn chậm so với những thành tựu nổi bật trong giảm tử vong trẻ em. Một số khó khăn chính trong cải thiện sức khoẻ sơ sinh là sự khác biệt giữa các vùng, miền; chất lượng chăm sóc chưa đáp ứng được nhu cầu và các chương trình chăm sóc sơ sinh chưa đến được hết những đối tượng cần nhất. Nhà nước cũng đã xác định được sự cần thiết phải giảm tử vong sơ sinh và hiện đang nỗ lực đẩy nhanh các hoạt động can thiệp hiệu quả hơn. Các can thiệp và phương pháp tiếp cận dựa trên bằng chứng có thể ngăn chặn được tử vong sơ sinh bao gồm chăm sóc bà mẹ trong thời gian mang thai, cuộc đẻ và sau đẻ. Gói can thiệp có hiệu quả nhất để có thể chấm dứt những tử vong do các nguyên nhân có thể phòng được là chăm sóc trong thời gian chuyển dạ, tại cuộc đẻ và trong vòng 1 tuần sau đẻ; chăm sóccác trẻ đẻ non/nhẹ cân và sơ sinh bệnh lý. Mở rộng độ bao phủ, cải thiện chất lượng chăm sóc theo tiếp cận chăm sóc liên tục, bảo đảm công bằng cho mọi bà mẹ và trẻ sơ sinh bao gồm cả vấn đề tài chính. Đó là những can thiệp chính mà mỗi quốc gia cần đầu tư mới có thể giảm tử vong sơ sinh thành công.
ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG CỦA NHIỄM CYTOMEGALOVIRUS BẨM SINH TẠI TRUNG TÂM SƠ SINH BỆNH VIỆN NHI TRUNG ƯƠNG
Authors: Nga Nguyễn Thị Quỳnh , Lê Cao Thị Mai
Published: September 2021

Mục tiêu: Mô tả đặc điểm lâm sàng, cận lâm sàng của trẻ sơ sinh mắc CMV bẩm sinh tại Bệnhviện Nhi Trung ương. Phương pháp: Nghiên cứu trên 30 trẻ sơ sinh được chẩn đoán nhiễm CMVbẩm sinh nhập viện tại Trung tâm Sơ sinh, Bệnh viện Nhi Trung ương từ 1/2018 đến 4/2021. Trẻđược đánh giá lâm sàng, cận lâm sàng về bệnh trong thời kỳ sơ sinh. Kết quả: Trẻ nhiễm CMV bẩmsinh có các đặc điểm: 50,0% sinh non; cân nặng lúc sinh trung bình là 2270±540gr; 63,3% cânnặng nhỏ hơn so với tuổi thai. Triệu chứng lâm sàng phổ biến của CMV bẩm sinh là vàng da, ganto, lách to gặp ở 43,3% số trẻ. Giảm tiểu cầu, tăng bilirubin trực tiếp và tăng transaminase có tỷ lệtương ứng là 63,3%; 56,7%; 52,4%.18/28 (64,3%) trẻ CMV bẩm sinh có ít nhất một bất thường vềhình ảnh thần kinh. 8/15 (53,3%) trẻ có mất hoặc giảm thính lực trong lần kiểm tra AABR đầu tiênvà 14,3% trẻ có bất thường về mắt. Tỷ lệ CMV-IgM dương tính là 88,5%. Kết luận: CMV bẩm sinhvẫn là một căn bệnh có tác động gây sinh non, nhẹ cân và các di chứng nặng nề khác trên trẻ sơsinh. Biểu hiện lâm sàng đa dạng và thường ảnh hưởng lên nhiều cơ quan hệ thống.
ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG CỦA VIÊM MÀNG NÃO NHIỄM KHUẨN Ở TRẺ SƠ SINH
Authors: Nga Nguyễn Thị Quỳnh
Published: September 2021

Mục tiêu: Mô tả đặc điểm lâm sàng và cận lâm sàng của viêm màng não nhiễm khuẩn (VMNNK) ở trẻ sơ sinh. Đối tượng nghiên cứu: 133 trẻ sơ sinh được chẩn đoán và điều trị VMNNK tại khoa Hồi sức Sơ sinh Bệnh viện Nhi Trung ương từ 01/07/2019 đến 30/06/2020. Phương pháp nghiên cứu: Nghiên cứu mô tả tiến cứu. Kết quả: Trong số 133 bệnh nhân, 32 trẻ sơ sinh đượcchẩn đoán VMNNK sớm chiếm tỷ lệ 24%. Trẻ đẻ non mắc VMNNK sớm nhiều hơn trẻ đủ tháng. Các triệu chứng lâm sàng bao gồm: thay đổi nhệt độ (63,1%), vàng da (53,3%) hay gặp ở trẻ đủ tháng; suy hô hấp (60,2%), thay đổi nhịp tim (60,2%), bú kém (95,5%), bỏ bú (61,7%), li bì (42,8%) hay gặp ở trẻ non tháng. Giá trị CRP tăng với trung vị là 31,4(81,6) mg/l. Đặc điểm dịchnão tủy với số lượng tế bào có trung vị là 78 (49-415) tế bào/mm3 , protein là 1,37 (0,97-2,27) g/l, glucose là 2,55 (1,75-3,18) mmol/l. 6/133 (4,5%). Bệnh nhân có kết quả cấy dịch não tủy dương tính. Kết luận: Triệu chứng lâm sàng của VMNNK sơ sinh thường không đặc hiệu và giống bệnh cảnh nhiễm khuẩn huyết. Trẻ sơ sinh có biểu hiện nhiễm trùng cần được nghĩ tới nguyên nhân VMNNK và nên được chọc DNT sớm. Kết quả nuôi cấy DNT đóng vai trò quan trọng trong chẩn đoán bệnh nhưng tỷ lệ dương tính còn thấp.
Oral Disintegrating Films – A Novel Approach for Patient Compliance
Authors: Barot Tularam , Prajapati Bhupendra , Joshi Chaitanya , Barot Shruti , Dalvadi Hitesh , Parmar Komal
Published: September 2021

Oral disintegrating films (ODF) are recently being explored overcome the problem faced by pediatric and geriatric populations of swallowing the tablets. Oral disintegrating films disintegrate in the mouth cavity infraction of time and then they are to be swallowed. Remarkably, after getting swallowed by the patient, they should dissolve and release the drug in the GI track. The ODF is simply placed on the tongue or any oral mucosal tissue which makes the film wet, rapidly disintegrate and dissolve to immediate release of medication for oral absorption. It is the advance form of solid dosage form due to their flexibility and enhances the release rate of API within the seconds. There are various polymers used in ODF as an individual or in combination to obtain desirable properties such as Mechanical strength, Drug loading capacity, Drug release and Disintegration time. Depending on the content and type of polymer selected for the preparation of optimized formulation of ODF, which has to be disintegrate within a seconds after make in contact with mouth. ODFs are characterized for the quality parameters like Physical strength, Appearance, Drug release profile, Residual water content, Dose uniformity, Organoleptic characteristics and Stability. Thus, the oral disintegrating films can be a novel promising approach for patient compliance with faster onset of action.
The Next Generation of Capital and County Government Offices Developments in Hungarian Middle-Level State Administration Since 2011
Authors: Barta Attila
Published: September 2021

The last financial crisis and the rhapsodic developments of Hungarian public administration resulted in a political aspiration that aimed (and still aims) to revitalize the State of Hungary and increase its administrative competitiveness. The territorial representation of the government has been strengthened by the reorganization of the middle level of public administration and the establishment of the new institution of capital and county government offices. The goal of this study is to summarize and evaluate the major steps of the aforesaid process, and to consider the expected further developments in this field.
Impact of the Principle of Proportionality in Tax Law on the Jurisprudence of the Court of Justice of the European Union and the Supreme Administrative Court in Poland
Authors: Mudrecki Artur
Published: September 2021

The principle of proportionality in tax law as an EU and constitutional standard may play an important role in the interpretation of tax law. The principle of proportionality is associated with moderation of the activities of public authorities and minimization of their interference in the sphere of rights and freedoms. The principle of proportionality is also called the principle of commensurability, moderation, and adequacy. The article analyses the impact of the proportionality principle in tax law on the case law of the Court of Justice of the European Union. The case law of the Polish Supreme Administrative Court uses the principle of proportionality when interpreting tax law, and the judgments of the Court of Justice of the European Union and the Polish Constitutional Tribunal have a significant impact on the jurisprudence of administrative courts in Poland.
Tax Administration of Large Taxpayers in Some CEE and CIS Countries
Authors: Bogovac Jasna , Soloveva Natalia , Radvan Michal , Marczak Jarosław , Uvarova-Patenko Natalia
Published: September 2021

We compare tax administration of large taxpayers in Croatia, the Czech Republic, Russia, Poland and Kazakhstan. Our hypothesis is that these units of tax administrations play an important role in collecting public revenue as well as preventing tax evasion in a dynamic global economy. We provide evidences about the most important characteristics of large taxpayer offices, their normative definitions, scope of work and positive as well as negative aspects of their practice. Some data are compared between countries and some for each country separately, due to the fact that differences in the above-mentioned countries, in size, economic and political aspects, vary substantially. Moreover, we were confronted with the limited scope of available information what made our comparison even more challengeable. Therefore, this work is, in a way, a “pioneer” attempt to compare specific national LTOs in one place. Our findings support the discussion that prove the hypothesis and enable recommendations.
The Amendment of the Religious Registration Law and Its Impact on Freedom of Religion in the Slovak Republic
Authors: Havelková Mária
Published: September 2021

Church registration represents a legitimate instrument of surveillance over religious groups. In the Slovak Republic, registered churches are funded directly out of the State budget and dispose of a wide range of other financial, as well as non-financial benefits. Slovakia has recently tightened up the already strict registration criterion of a number of supporters. According to the currently effective legislation, a church or religious society applying for registration must provide evidence of having over 50,000 members. The main aim of this article is to analyse the impact of the new Slovak legislation on the freedom of religion with a focus on assessment of whether the rang of rights and duties for registered churches are the same as for not registered ones and whether this measure is in conformity with human rights standards applied in the European Union, as well as the Council of Europe.
European Investigation Order and the “Brussels” Bureaucracy
Authors: Kordík Marek , Kurilovská Lucia
Published: September 2021

The contribution deals with the insight on the European investigation order, as a tool of mutual judicial assistance in criminal matters. With the purpose to show that the criticised, so called Brussels bureaucracy very often just reacts on the propositions of the member states. A good example of this is given in the presented article. It shows the result of a conducted CEPOL survey and connects it with the short presentation of this tool.
Ethanolic Artichoke Extract improves outcome in a rodent model of 5- Fluorouracil Induced Cardio toxicity
Authors: Saeed Usman , Aziz Rao Salman , Ashraf Muhammad Imran , Rana Shazana , Fatima Javaria , Salman Ali
Published: September 2021

Background: During treatment, many drugs may become cause of cardiac system toxicity, cytotoxic drugs therapy cause cardiac toxicity, including 5- Fluorouracil (5- FU). It is regarded as antimetabolite which cause its toxic effects during S phase of the cell cycle and got its activation by conversion of thymidine phosphorylase into fluorodeoxyuridylate (5 fluoro 2'deoxyuridine 5'monophosphate, 5-FdUMP) which cause inhibition of thymidylate synthase, which ultimately cause prevention of synthesis of DNA. Aim: To focus on evaluation of ethanolic artichoke extract (Cynara scolymus L) with respect to its cardio protective properties against 5-fluorouracil (5-FU) induced cardio-toxicity in rabbits by estimation of Alanine aminotransferase, creatine kinase and aspartate aminotransferase enzymes in serum. Methods: 4 groups consisting of 8 rabbits each were made for collected 32 rabbits who were albinos. Group I: (negative control) administered dimethyl sulfoxide (DMSO) (2 ml/kg /day) orally on daily basis for duration of 10 days. Group II: (positive control) administered DMSO (2 ml/kg /day) daily via oral route for duration of 10 days and subsequently received dose of 5-FU (150 mg/kg) (single) by intraperitoneal injection, on day 8th day in connection with DMSO. Groups III: administered ethanolic artichoke extract (200 mg/kg/day) orally on daily basis for duration of 10 days. Groups IV: administered ethanolic artichoke extract (200 mg/kg/day) daily on oral basis for 10 days with subsequently single intraperitoneal dose of 5-FU (150 mg/kg) on day 8th day. Results: Before intoxication via 5-FU, treatment of ethanolic artichoke extract note worthily reduces the increase serum levels of AST,CK & ALT enzymes due to cardio toxicity induced via 5-FU- in case of rabbits . Conclusions: With respect to present scenario, extracts of ethanolic artichoke serve as powerful modulator in reducing or masking cardiac toxicity cause by induction of 5-FU in case of rabbits. Keywords: Artichoke Extract, Fluorouracil Induced Cardio toxicity, Ethanolic
Post Tocilizumab Secondary Infections in Covid-19 patients”- Are we doing enough?
Authors: Rana M A. , Chachar A Z. K. , Zartash S. , Siddiqui M. H. , Naqvi S. M. A. , Javed M. , Pervaiz R. , Qayyum M. A. , Tabassum S. A , Hafeez M. M. , SHAHEEN H. JAVERIA
Published: September 2021

Aim: To focus on the frequency of ICU-acquired infections in Sars Co-V2 Corona Virus disease (COVID 19) patients. Method: A retrospective observational study carried out in two tertiary care hospitals treating COVID 19 cases, Services Institute of Medical Sciences and Bahria International Hospital, Lahore. Data was collected from the medical records of the COVID 19 ICUs of both hospitals from May 1, 2020 to April30, 2021. All charts were reviewed for the evidence of positive cultures. The treatment given prior to positive cultures, after the availability of culture results and outcomes were also recorded. Results: A total of 432 records were reviewed and 400 cases were included while 32 cases were excluded because of incomplete data. The frequency of infections per 1,000 days of ICU stay was calculated in 90 (22.5%) patients. Gram-negative bacteria accounted for 68 cases (75.5%) with Pseudomonas in 44 cases (48.8%), Acinetobacter in 23/90 (25.5%) while 17 cases (18.8%) had gram positive infection with Enterococcus in 14/18 (77.77%) or 14/90 (15.55%), MRSA in 4/18 (22.22%) 4/90 (4.44%), while 5/90 (5.5%) had more than 2 isolates at same time. Among these 3 had both pseudomonas and Acinetobacter while 2 patients had Pseudomonas and Stenotrophomonas Maltophilia. Conclusion: There seems to be an increase in the infection rate among critically sick COVID 19 patients admitted in ICU. Use of steroids and Tocilizumab seems to play a role through their immunomodulatory effects. Keywords: Tocilizumab, Secondary infections
Frequency of High Neutrophil and Lymphocyte Ratio (NLR) Among NSTEMI/USA patients
Authors: Shamim Afaq , Chachar Aijaz Zeeshan Khan , Haider Miqdad , Asif Mohsin , Ali Sajjad , Tahir Muhammad Mubashar , Ali Sajjad
Published: September 2021

Background: Neutrophil to lymphocyte ratio (NLR) is comparatively a new prognostic marker used in patients with chronic stable angina (CSA). NLR can help in predicting short and long term moralities in NSTEMI patients. Aim: To evaluate the frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients and to compare frequency of mortality in patients of NSTEMI/USA having high NLR with those without high NLR. Study design& duration: Descriptive, case series study from 25th November 2020 to 24th May 2021. Study settings: Department of Medicine and Cardiology, Fatima Memorial Hospital, Lahore. Methods: 185 patients having non ST elevation myocardial infarction (NSTEMI) and/or unstable angina (UA) having 30 to 70 years age and both males and females were included. Patients with sepsis having total Leucocyte count (TLC>11,000/<4000), history of surgery or on steroids in the past three months, history of hematological malignancy, late for fibrinolysis or those with contraindication to fibrinolysis were excluded were excluded. Demographic information (name, age, address, and education) was also noted. Results: Mean age of the participants was 57.99 ± 6.10 years while the age range was from 30 to 70 years. Most of patients 164 were included in the age group of 51 to 70 years. 110 (59.46%) patients were male and 75 (46.54%) of them were females. Frequency of neutrophil and lymphocyte ratio among NSTEMI/USA patients was found in 91 (49.19%) patients. My study has shown higher frequency of mortality in patients of NSTEMI/USA having high NLR 26 (28.57%) compared to normal NLR 06 (6.38%) with p value = 0.0001. Conclusion: Frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients is very high with higher mortality in high Neutrophil-to-lymphocyte ratio group as compared to low NLR group. Keywords: Myocardial infarction, Non ST elevation, Neutrophil-to-lymphocyte ratio
Role of Prophylactic Bolus Dose of Ephedrine to Prevent Hypotension after Spinal Anesthesia; A Single Center Experience
Authors: Lashari A. A. , Chachar A. Z. K. , Rana M. A. , Tayyab M. , Qayyum M. A. , Siddiqui M. H. , Shaheen H. J.
Published: September 2021

Aim: To compare the efficacy of prophylactic bolus dose of ephedrine 10mg to prevent hypotension after spinal anesthesia for elective caesarean section. Methods: The study was conducted in Gynecological operation theatre suite of Bahria international teaching Hospital Lahore, from 15th September 2020 to 14th January 2021. It was quasi experimental study. It was conducted on ninety women admitted in gynecology department of Bahria international teaching Hospital Lahore, for caesarean delivery. These women were divided randomly into 2 groups: a) Patients in group E10 received ephedrine 1ml from 5ml syringe containing ephedrine 10mg/mland b)’ Results: Patients in group R acted as a control group and received normal saline 1ml from 5ml syringe.Blood pressure was recorded every minute for first 3 minutes, every 2 minutes for next 6 minutes, and then every 3 minutes till the procedure was completed. The sampling technique used was purposive sampling. Conclusion: It was concluded that prophylactic intravenous ephedrine bolus 10mg is more effective in preventing hypotension than fluid preload alone. It is simple and effective means of reducing the incidence of hypotension undergoing C- section in spinal anaesthesia. Keywords: Ephedrine, Hypotension, Spinal anesthesia.
Outcome of Partial Nail Avulsion Followed by Matricectomy Either With Phenol (80-88%) or With Electro Cautery for Toenails
Authors: Hamid Tahir , Qadir Muhammad Rizwan , Nsar Ahmad Raza , Saleem Rizwan , Rehman Abdur , Ali Mansab
Published: September 2021

Aim: To compare partial nail avulsion followed by matricectomy either with phenol (80-88%) or with electro cautery for Stage 2 & 3 ingrown toenails for early and late postoperative complications. Methods: This study was conducted at department of surgery Nawaz Sharif social security teaching hospital Lahore for one year from 01-01-2018 to 31-12-2018. One hundred patients full filling inclusion criteria were included in the study and divided into two equal groups A and B. Partial nail avulsion done in both groups followed by chemical matricectomy with phenol (80-88%) in group A and patients in group B matricectomy done with electrocautry. Results: The mean age in group A is 19.7± 8.08 years and in group B is 20.20± 6.9 years, both groups comparable p-value (0.74).In early post-operative complications in group A 17(34%) patients and 14(28%) patients in group B experienced mild pain p-value is (0.66). 6(12%) of group A patients and 6(12%) of group B patients experienced moderate pain p-value (01). 1(2%) of group A patient and 2(4%) of group B patients experienced severe pain p-value (01). 02(4%) patients of group A and 02(4%) patients of group B had serous discharge p-value(01). 1(2%) of group B patients have purulent discharge, however, no patients in group A patients have purulent discharge p-value (01). 1(2%) patients of group A and 2(4%) patients of group B had recurrence at three months follow up p-value (01). 2(4%) patients of group A and 4(8%) patients of group B had recurrence at six months follow up p-value (0.68). Conclusion: Partial nail avulsion followed by matricectomy either with Phenol 80-88% or with electrocautry are comparable in early and late complications. Keywords: Ingrown toenails, partial matricectomy
Accuracy of MRI in the Differential Diagnosis of Wilms Tumor
Authors: Ashraf Maham , Anjum Aysha , Tahir Eisha , Goraya Amber , Aqeel Rabia
Published: September 2021

Background & Objective: Renal tumors are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The current study aims at to determine the diagnostic accuracy of magnetic resonance imaging for the diagnosis of Wilms tumor taking histopathology as gold standard. Methodology: This cross-sectional study was carried at the Department of Radiology, The Children’s Hospital & Institute of Child Health Lahore over 6 months from March 2019 to September 2019. The study involved 125 children of both genders aged between 2 years to 14 years presenting with a neoplastic mass in the retroperitoneum on ultrasound abdomen during initial workup. These children were assessed on MRI for the diagnosis of Wilms tumor. Later the diagnosis was confirmed on histopathology which was taken as gold standard and the diagnosis of MRI was judged accordingly as true/false and positive/negative. A written informed consent was obtained from every patient. Results: The mean age of the children was 5.8±3.9 years having a male predominance with male to female ratio of 1.8:1. Wilms tumor was suspected in 13 (10.4%) children on MRI. The diagnosis of Wilms tumor was confirmed in 13 (10.4%) children on histopathology. MRI was found to be 76.9% sensitive, 97.3% specific and 95.2% accurate with positive and negative predictive values of 76.9% and 97.3% respectively. Conclusion: In the present study, MRI was found to be 95.2% accurate in the differential diagnosis of Wilms tumor in children presenting with retroperitoneal mass which along with its non-invasive and radiation free nature advocates the preferred use of MRI in the diagnostic evaluation of such children in future oncologic practice. Keywords: Retroperitoneal Tumor, Wilms Tumor, MRI, Diagnostic Accuracy
Mercury Kushta Induced Histopathological Changes in Liver of Wister Rats
Authors: Jamil Sakina , Lail Raees , Qayyum Zunaira , Riaz Zahra , Sattar Arooj , Rana Hadia
Published: September 2021

Background: Heavy metals are the natural constituents of the earth's crust but the indiscriminate human activities have drastically effected their biochemical balance and geochemical cycles. Heavy metals and their compounds have pharmacological importance. These are being used in south Asian countries as component of different medicines. These medicines may have serious side effects on liver. Objectives: To see the histological changes of Kushta which contains mercury, on liver of wister rats. Material and Methods: It was an animal experimental study in which a total of 42 Wistar rats were included and divided into five exposed and one control groups. Morphological changes were observed in liver of rats by using indigenous as well as patent mercury preparations. Results: Morphological changes in liver of exposed rats included hepatocyte swelling, hepatocyte necrosis, hepatocyte apoptosis, disarray of hepatic architecture, development of portal tract inflammation, central vein congestion, sinusoidal congestion and dilatation, development of fatty change and damage to hepatic vascular and liver capsule were seen at the end of 8 weeks. Conclusions: Indigenous herbo-mineral preparation (Kushta) of mercury produces deleterious morphological effects on liver of wister rats. Keywords: Mercury Kushta, Liver, Histopathology
Role of Virtual Training Lab in Enhancing Laparoscopic Skills of Residents Versus Consultants
Authors: Javid Muhammad Shahzad , Murad Faisal , Ali Qasim , Nawaz Tariq , Zia Naeem , Malik Asif Zafar , Ronald C Marrel
Published: September 2021

Objective: To compare the role of virtual training lab in enhancing laparoscopic skills at training stage and at the level of qualified surgeons. Materials and Methods: In this comparative study, we included 70 participants of national and resident MIS workshops were included, 35 consultants and 35 residents were included. Participants were analyzed in the basic laparoscopic skills of instrument navigation on Lapsim. Data were collected on first day and on last day of workshop. Parameters included were left instrument time, right instrument time, tissue damage and maximum damage. Result: In 35 residents the left instrument time was improved mean of 27.99(Range 39.52-13.43) to 21.53 (Range 42.37-12.38) and right instrument time improved mean of 31.73(Range 52-48.19) to 23.365 (Range 48.19-11.46). The tissue damage decreased from mean of 3.2 to mean of 1.46. The maximum damage decreased from mean of 8.82 to mean of 3.408. Data of consultants showed that the left instrument time improved mean of 35.71 (Range 140.22-13.09) to 24.39 (Range 111.82-9.71) and right instrument time improved mean of 45.76 (Range 141.45-15.89) to 27.82 (Range 49.2-8.6). The tissue damage decreases from mean of 5.171 to mean of 2.228. The maximum damage decrease from mean of 13.67 to mean of 5.136. All the values at consultant level were greater than resident level. Conclusion: This study further confirmed that virtual lab has very important role in improving laparoscopic skills and in addition this study prove that enhancing of the laparoscopic skill at resident level is much better than the acquisition of laparoscopic skill at consultant level. Keywords: Virtual Training Lab, Laparoscopy, Simulation.
Patterns of Cleft Lip and Cleft Palate in Southern Pakistani Population
Authors: Anwar Muhammad , Mustafa Gulam , Haider Zishan
Published: September 2021

Objectives: To determine various types of cleft lip and palate, its geographical distribution and its association with cousin marriages, family history and other craniofacial syndromes in the Southern Pakistani population. Study design: Cross-sectional study Place and Duration of Study: Plastic Surgery Department of Sheikh Zayed Medical College / Hospital, Rahim Yar Khan and Hamza Medicare, Rahim Yar Khan from January 2020 to March 2021. Methodology: All patients who presented to the outpatients department with cleft deformities of lip and palate, irrespective of their age and gender were included in the study. Patients who were operated previously and those who were not agree with the study protocol were excluded from the study. The data were collected through a structured proforma as well as history and physical examination. The data were organized and analyzed through Statistical Package for Social Sciences version 23. Results: Total of 403 patients with cleft lip and palate deformities were included in this study, with an average age of 39±62 months. Out of total 239 59.3% were males with male to females ratio of 1.4:1. Cleft lip with cleft palate, cleft palate only and isolated cleft lip were found in 56.8%, 13.4% and 29.20% of cases respectively and 2 (0.5%) cases of median cleft. Out of total, 155 (38.5%) were from Southern Punjab, 50.6% from Sindh and 10.9% were from Baluchistan Province. In 386 (95.8%) cases parent had a History of cousin marriage, and family history of Cleft Lip & Cleft Palate was positive in 67 (16.6%) cases. Other congenital anomalies were found in 12.5% of cases. Conclusion: Cleft lip and palate deformities affected the male population more than females. Cleft lip in association with cleft palate is the commonest deformity. Isolated cleft palate mainly affected females. The high incidence of these anomalies in cousin marriages emphasizes educating the people to avoid cousin marriages. Key Words: Cleft Lip, Cleft Palate, Consanguinity, Family history. Congenital deformities
An assessment of depression in type-II diabetics presenting at tertiary care hospital
Authors: Adnan Mahwish , Hassan Ghulam , Raziq Muhammad Abdul
Published: September 2021

Objective: To assess the frequency of depression in type-II diabetics presenting at tertiary care hospital. Materials & Methods: This cross sectional study was conducted at Department of Psychiatry & Behavioral Science, Sheikh Zayed Hospital, Rahim Yar Khan from April 2020 to October 2020 over the period of 6 months. Total 200 type-II diabetics having age 20-65 years either male or female were selected for this study. Depression was assessed in selected by using DSM-IV criteria for Depression. Results: Mean age was 54.37 ± 5.88 years. Out of 200 patients of diabetes, depression was noted in 46 (23%) patients. Most (98,49%) of the patients were between 51-65 years but difference of depression with age group was not statistically significant with p value 0.8958. Total 19 (20.88%) male patients and 27 (24.77%) female patients were found with depression. But depression was insignificantly associated with gender with p value 0.6315. Total 11 (14.29%) patients found with depression having duration of diabetes mellitus ≤3 years and 35 (28.46%) patients found with depression having duration of diabetes mellitus >3 years. Depression was significantly associated with duration of diabetes mellitus with p value 0.032. Conclusion: Our study concluded that prevalence of depression in type 2 diabetes mellitus patients was much higher and have shown positive association with extremes of ages and duration of disease. Keywords: Diabetes mellitus, depression, socioeconomic status, physical recovery
Role of Flash Glucose Monitoring System in Diabetic Patients with Chronic Liver Disease
Authors: Malik Sadiq Hussain , Reza Sara , Aslam Farheen , Zafar Saleha , Shafiq Sadaf
Published: September 2021

Background: Diabetic patients show serious complications of chronic liver disease. The monitoring of glucose in diabetic patients with chronic liver disease is very challenging. Generally, the glycaemic control monitoring in chronic liver disease patients is the same as in a person who does not have any liver disease. Flash glucose monitoring system is a way to measure glucose levels of body without pricking the body. It is an innovative method of measuring glucose levels. A flash glucose monitor is a small sensor. This sensor is a small sticky chip and is attached on the skin of the arm. One side of the chip has a small needle that goes inside the skin. It records glucose levels throughout day and night continuously. Levels of glucose can be assessed whenever wanted. Materials and Methods: The study was conducted in the Medical Ward 1, Bahawal Victoria Hospital, Bahawalpur and the Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur from 1st January 2018 to June 2020. Freestyle Libre Sensor flash glucose monitoring system (by CoolPlus Medical) was used to measure glucose of subcutaneous interstitial fluid. The disposable sensor was applied to the back of the arm for up to 14 days. Sensor is calibrated by the factory with no automatic alarms. Results: We noticed that the results of the patients who had co-existing disease of chronic hepatitis and diabetes mellitus had same results of glucose readings when measured by flash glucose monitoring system and by finger prick for glucose measurement by glucometer. Conclusion: Flash glucose monitoring system is way better than self monitoring blood glucose method by glucometer in diabetic patients with chronic liver disease. Keywords: Diabetes, glucose, monitoring, chronic liver disease, complications
Factors Affecting the Implementation of Specialized Skills of Therapist in Special Education Centers
Authors: Mumtaz Aqsa , Saeed Bareera , Ghayas Khan M. Sikander , Noreen Hafsa , H. M Rashid , MASOOD Fahad , Ruhamah Y. M., , Hassan Askri Syed M.
Published: September 2021

Background: The present study is about the factors affecting the professional skills implementation in special education centers. Speech-language pathologists (SLPs) are responsible for the evaluation and treatment of speech language impediments, however they offer multiple services, such as evaluation and treatment of swallowing problems, impaired cognition, and hearing problems. The failure to maintain an effective professional skills implementation in special education centers so many irreversible, fatal consequences among the speech-language pathologist (SLP). Objectives: To study the factors affecting the implementation of professional skills in special education centers. To conduct comparisons between female and male regarding the implementation of professional skills in special education centers. Method: This observational cross sectional study was conducted in special educational centers of district Lahore, Mandibahudin, Sahiwal, Okara and Shekhupura Punjab, Pakistan. The sample size of this research study was consisting of 73 speech therapists. Age range of participants are 21 to 50 years. There are 61 (81.3%) male participants and 14 (18.7%) female participants sample size as per topic need participate in survey. To draw the sample from population, purposive sampling technique was used. Instrument was developed with the help of the literature review and expert opinion about the topic. Content analysis was done to find out reliability and validity of the questionnaire. Duration of research was nine months from May 2020 to January 2021. Study is approved from the institutional review board of The University of Lahore, Ref No: IRB-UOL-FAHS/745-II/2020. Results: All the factor professional knowledge, Environmental factors affecting professional skills, workload and assessment tools are the positively corralled. The result depicted that significant difference in t (-1.424) p<.000) between the male and female speech-language pathologist. One way ANOVA was used for analysis result showed that there was significant difference (t(198)=-.434 ,sig=.00) among speech therapists responses on the above mentioned factor. Conclusion: Factors affecting the professional skills implementation in special education like availability, professional knowledge, workload, and assessment tools was significantly difference among male and females speech-language pathologist. In future such detailed studies are recommended to further enhance the factors affecting the professional skills implementation in special education centers. There is also need to improve the policies regarding vaccination and its implementations all over the country. Keywords: Professional Skills, Speech-language pathologists (SLPs), Special Education Centers, Gender
Effect of Basil Seed and Chia Seed Extracts on Blood Lipid Profile
Authors: Munir Sidra , Khurshid Sana , Iqbal Qamar Javed , Hussain Abrar , Iqbal Nasir , Masood Zainab
Published: September 2021

Background: Basil and Chia seeds contain higher nutritive values like vitamin, carbohydrates, Omega-3 oil and other dietary fibers. With all these rich dietary benefits these seeds regulate necessary health conditions and maintain body weight. Ocimum basilicum (Basil) plant have been known to contain properties of weight loss, better digestion and other health benefits. Objective: The aim of this research was to check the Basil seed against hyperlipidemia in mice with Chia seeds. Methodology: In this research, the effect of both seeds extract on body weight and plasma lipid profile were estimated in Albino mice after raising their cholesterol levels by high fatty diet. The experiments were performed in different groups like normal control, standard control, hyperlipidemia group and four groups of diet supplemented chia or basil seeds with two different doses. Results: The biochemical analysis revealed that the supplementation of Basil seeds (400mg/kg/day) significantly lowered the levels of total plasma cholesterol, lipoproteins and triacylglycerol. Moreover, histopathological analysis of vital organs like kidneys, heart reported no toxicity. Conclusion: Extracts of Chia and Basil seeds have shown controlling effects over the given parameters in the blood and weights of the animals and these may have potential to control high fat diet-induced hyperlipidemia when taken as dietary supplements. Keywords: Cholesterol, Hyperlipidemia, Ocimum basilicum, Salvia hispanica
Comparison of Outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery
Authors: Rehman Waseem , Ahmed Aqeel , Bashir Husnain , Ullah Ubaid , Mohsin Muhammad , . Sindhu
Published: September 2021

Objective: To compare the outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery Methodology: A total of 102 cases between 25 to 60 years, of either gender, advised CABG procedure and suitable for beating heart surgery were included in the study. Whereas those with known bleeding diathesis, not suitable candidate for beating heart surgery and with concomitant valvular heart disease were excluded from the study. These cases were enrolled through wards of Cardiothoracic Surgery Department, Shaikh Zayed Hospital, Lahore. Three groups were formed A,B and C. Group-A was assigned to DAPT, Group-B was SAPT (single anti platelet therapy) and Group ”C” was on DAPT that is ASPRIN 75 mg and CLOPIDOGREL 75mg till the time of surgery. Control group A was compared with group B (SAPT) and group C (DAPT) for bleeding risk. The indications of blood products transfusion was assessed by baseline HCT platelet counts, PT and APTT. The CABG was carried out through a full sternotomy incision, under general anesthesia by using routine cardio protective measures and surgical techniques. Operating surgeon decided for on pump or off pump CABG. All patients were assessed and managed in ICU after Coronary artery bypass grafting. Duty doctor and anesthetist decided about transfusion of any allogenic blood product. Transfusion decision was made on the basis of routine laboratory values of APTT, ACT, and INR of PT, as well as on Hb. and HCT levels. Moreover, the need of non-self blood products was predicted. Results: In our study, mean age was calculated as 52.65+7.48 years, 50.32+5.68 years and 48.47+5.96 years respectively, 61.76%(n=21) in Group-A, 52.94%(n=18) in Group-B and 44.12%(n=15) in Group-C were male whereas 38.24%(n=13) in Group-A, 38.24%(n=16) in Group-B and 55.88%(n=19) in Group-C were females, comparison of Perioperative blood loss as 597.29+129.26 in Group-A, 643.18+65.42 in Group-B and 654.70+59.16 in Group-C, p value was 0.02. Conclusion: We concluded that Dual Antiplatelet Therapy have more chances of Peri-Operative bleeding as compare to heparin only or Single Antiplatelet Therapy in Coronary artery bypasses grafting on Beating heart. However, it has advantage of short pre procedure stay, reduced chances of ischemic events, less chance of canula related cellulitis and less chances of HIT. Whereas the cases administered with Heparin alone are having a greater chance of canula related cellulitis, expensive, prolonged pre procedure hospital stay with increased chances of HIT (Heparin induced thrombocytopenia. Keywords: CABG , Perioperative bleeding, Dual Antiplatelet Therapy, Single Antiplatelet Therapy
Comparison of Post-Operative Pain Between Nalbuphine and Tramadol in Total Intravenous Anesthesia for Dilation and Evacuation
Authors: Yunus Quratulain , Abdullah Saima , Riffaat Sana
Published: September 2021

Objective: Comparison of post-operative pain between nalbuphine and tramadol in total intravenous anesthesia for dilation and evacuation. Methodology: This randomized controlled trial was conducted at Fatima Memorial Medical and Dental College and Hospital, Lahore during June 2019 to September 2020. We randomly enrolled in Two Groups-A, who received intravenous injection tramadol 1.5 mg/kg after rapid sequence induction with propofol2mg/kg, succinylcholine 1-1.5mg/kg followed by LMA insertion and Group-B those receiving nalbuphine0.1mg/kg after rapid sequence induction with propofol2mg/kg, succinylcholine 1-1.5mg/kg followed by LMA insertion. Consultant anesthetist administered these drugs and evaluated pain score after 30 mins of surgery done with the help of VAS. Results: Comparison of mean pain score in both groups shows 2.28+1.13 pain on VAS in Group-A and 1.07+0.82 in Group-B, p value was 0.0001 showing a significant difference. (Table 1) Conclusion: Post-operative pain is significantly lower in nalbuphinewhen compared with tramadol in total intravenous anesthesia for dilation and evacuation. Keywords: Dilation and evacuation, postoperative pain, nalbuphine, tramadol