Journal of Ayub Medical College, Abbottabad : JAMC最新文献

Background: The objective of this study was to compare the clinical efficacy of Resin modified glass ionomer cement and Flowable composite in terms of retention, marginal adaptation and surface texture using United States Public Health Service criteria in non-carious cervical lesions measured over a period of one year.

Methods: A Randomized Clinical Trial is conducted with Informed consent on 60 patients who are randomly allocated into 2 groups with at least 2 Non Carious Cervical Lesions in each. Group 1 is used for Flowable Composite while group 2 is used for resin modified glass ionomer cement. A recall is maintained to draw conclusions between two materials in terms of occurrence of marginal adaptation, retention and surface texture, to show which material is superior to other.

Results: Out of 30 restorations in 12 months follow up, only 19 found to be present in flowable composite group while in resin modified glass ionomer cement group, 28 are retained. Regarding margin integrity, Group 1 showed 21 intact margins whereas 23 margins were intact in group 2, while 18 and 25 showed smooth surface in flowable composite and Resin modified glass ionomer cement group respectively, on exploration.

Conclusion: It can be concluded from our study that Resin modified glass ionomer cement is superior to Flowable composite in terms of retention (p=0.005) and surface texture (p=0.045) in restoration of non carious cervical lesion.

Background: Haemorrhoids are very common but their exact prevalence is not known as most of the people suffering from them do not seek medical or surgical advice. The literature states their prevalence to be about 39% and commonly affect people aged between 45-65 years of age. Objective of the study was to compare the outcomes of open haemorrhoidectomy Vs Trans anal Doppler ultrasound guided hemorrhoidal artery ligation with recto-anal repair in 3rd and 4th degree haemorrhoids. It was a Randomized control trial, conducted at the Department of Surgery, King Edward Medical University, Lahore; from October 2019 to March 2021.

Methods: This was a randomized control trial study where the results of 70 patients of haemorrhoids including 3rd and 4th degree disease fulfilling the selection criteria, who underwent open haemorrhoidectomy (OH) and Doppler guided haemorrhoidal artery ligation with rectoanal repair (HAL RAR) procedure on elective and emergency operating lists, were analyzed with regards to post-operative pain, bleeding and hospital stay.

Results: From our seventy patients the minimum age was 23 and maximum age limit was 55 years (mean: 35.09±7.47). There were 49 (70%) males and 21 (30%) females. Mean post-op pain on day 7 for OH was 1.12±0.72 and for HAL RAR it was 1.06±0.52. Post-op bleeding (POB) occurred in 4 (10%) patients in OH group and 2(6.66%) patients in HAL RAR group. Mean hospital stay for OH group was 2±0.45 and for HAL RAR it was 1.20±0.40, for POB, it was 1.9±0.30 in OH group and 1.86±0.34 in HAL-RAR group.

Conclusions: There was no significant difference in mean post-op pain on day seven, and post-op bleeding, but there was significant difference in terms of mean hospital stay between the two groups.

Background: Acute upper gastrointestinal bleeding is a serious complication in cirrhotic patients. Without recommended management, recurrent bleeding happensin 30-40% within the next 2-3 days, and up to 60% within 1 week. Aim was to determine predictors of re-bleeding after oesophageal variceal banding in cirrhotic patients for 4 weeks. It was a descriptive study, conducted at the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Six months from June 21 to December 21, 2021.

Methods: A total of 93patients with active oesophageal variceal bleeding were included in this study. Upper gastrointestinal (UGI) endoscopy was performed to look for bendable varices (grades 1-4) and band ligation was applied. Patients were followed for 4 weeks for the history of hematemesis or Malena, fall in haemoglobin of 2 grams per decilitre or more and endoscopic rebleeding findings.

Results: Out of 93 patients, 67(72.0%) were males, while 26(28.0%) were females. The Mean age of the patients was 45.66±16.61 years. According to Child Pugh Classification, the majority of the patients 45(48.4%) had Child-Pugh Class-A, while 33 (35.5%) were Child B and 15 (16.1%) patients belonged to Child-Pugh Class C. Red wale sign was noted in 22 patients (23.7%). Among 93 cirrhotic patients who presented with variceal bleeding, 9 (9.7%) had re-bleeding within 4 weeks. Amongst 9 patients, 8 patients (88.9%) had red wale sign, grade II or above oesophageal varices and belonged to severe liver disease with child class B or C.

Conclusions: Endoscopic variceal band Ligation is an effective treatment modality for the control of oesophageal variceal bleeding. Re-bleeding after band ligation was 9.7%. The major contributing factors to re-bleeding were the severity of cirrhosis, grades and columns of oesophageal varices, number of bands ligation and findings of red wale sign. Increasing age and duration of cirrhosis were contributing predictors of increased re-bleeding risk.

Background: The objective of the study to assess the workability and cosmetic outcome of endoscopic thyroidectomy vestibular approach (TOETVA) and share results of underdeveloped country with the world about their first clinical experience.

Methods: We performed TOETVA in 3 patients presenting with thyroid nodules in our hospital, between October 2020 and December 2020 at Liaquat National hospital. Three-port technique was used, one 10-mm port for camera and two 5-mm ports for working. All ports were passed through oral vestibule. The demographic data of the patients and surgical outcomes were retrospectively reviewed. The surgery was completed successfully in all 3 patients. The operative time was between 120-150 mins.

Results: No complications such as recurrent laryngeal nerve palsy, mental nerve injury or parathyroid gland injury damage occurred in patients postoperatively. No visible scarring occurred in the patients postoperatively. Patients remain stable after surgery and got discharged next day. No complications were noted in 6 months follow up.

Conclusions: TOETVA is safe, feasible, and effective and scar free option as compared to conventional thyroid surgery.

Background: Hepatitis C is a diverse illness that causes significant death and morbidity. The hepatitis C virus infects hundreds of millions of individuals globally (HCV). More than 80% of those infected develop chronic infection; the remaining 10-20% recovers spontaneously through natural immunity. Acute hepatitis is only icteric in 20% of individuals and is seldom severe.

Methods: A pilot study was conducted at INOR hospital Abbottabad. Eleven hepatitis C positive and 10 hepatitis C negative participants were included in the study.

Results: A significant difference correlation was found between viral load and SWE quantification for fibrosis stage in Kilo-Pascal, r=0.904 (p-value=0.000

Conclusions: Although a biopsy is considered to be gold standard for determining the degree of damage caused by chronic viral hepatitis, it is far from perfect. Liver elastography is intriguing techniques that can help physicians make difficult decisions while treating viral hepatitis. This study showed that fibrotic changes of liver are directly proportional to the presence of viral load in blood. The greater the viral load more severe fibrosis will be seen. Age also plays a role in severity of fibrosis, however, more studies on larger population is required to support this statement.

Background: The doctor-patient relationship is a central feature of the healthcare system. The recent developments in the delivery of health care have tended to focus on patient satisfaction. Therefore, this study was planned to find out the satisfaction of patients attending the outpatient department of teaching hospitals in Peshawar.

Methods: A cross-sectional study on Patients Satisfaction was conducted in outpatient departments of five different private and public teaching hospitals in Peshawar, Pakistan from March 2019 to March 2020. The questionnaire was translated into Pashto. All the patients consenting to participate were asked questions from Patient Satisfaction Questionnaire-18 (PSQ-18) by the principal investigator. The data was analyzed using SPSS Version 25.

Results: The mean age of the sample (n=1025) was 37.58±15.60 years. There were 725 (70.1%) females and the majority were attending public sector hospitals (n=596, 58.1%). More than half of the sample (n=589, 57.5%) reported higher than mean scores on the Patient Satisfaction Questionnaire (PSQ). The insignificant gender difference was observed in terms of PSQ, whereas patients of public sector hospitals were more satisfied than patients of private sector hospitals (p=0.000). The inter-scale correlation using Pearson Coefficient between patient satisfaction and its subtypes showed a significant moderate positive correlation with a p-value of p=0.000.

Conclusion: More than half of the patients showed satisfaction with the healthcare services. Patients attending public sector hospitals were more satisfied than the patients attending private sector hospitals.

Background: Vesical calculi refer to stones in the urinary bladder. The causes of bladder stones include bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Very rarely, these vesical calculi may reach very large sizes and the largest dimension can sometimes reach 13 centimetres.

Methods: This descriptive cross-sectional study was conducted from 1ST May 2019 to 31st October, 2019 at Institute of Kidney Diseases, Urology Department, Hayatabad Peshawar. 164 patients with vesical stone were included in study. Ultrasound-KUB was used for diagnosis of vesical stone and after informed consent, and they underwent transurethral nephroscopic lithotripsy via the pneumatic Swiss Lithoclast.

Results: Frequency of stone clearance was 96.34%. No statistically significant association of stone clearance was observed with age, gender, number of stones or max dimension of largest stone in the bladder (p>0.05).

Conclusions: Transurethral nephroscopic pneumatic lithotripsy via pneumatic Swiss Lithoclast is safe and effective procedure for treatment of large vesical stones. However, this being the first such study in adults, more data is needed to confirm these findings.

Background: Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius.

Methods: A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient's functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21.

Results: There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population.

Conclusions: Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.