Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University

Correlation of Balance and Functional Ankle Instability in Elderly Women

Tue, 21 Mar 2023 00:00:00 +0200

Objectives: To evaluate and find the correlation of balance and functional ankle instability in elderly women. Methodology: A cross-sectional correlation study was conducted from June 2020 to December 2020, in which 61 participants (i.e., elderly women) were included. In the selected old age homes the self-reported questionnaire (Identification of Functional Ankle Instability [IdFAI]) had been distributed to the participants fulfilling the inclusion criteria as hand-outs and the performance-based questionnaire (Performance Oriented Mobility Assessment [POMA]) have been assessed and filled by the researcher. Chi square was used for associations and Pearson correlation for balance score and functional instability score.

Results: The mean age of the participants was 64.89±4.30 years. According to the result of Tinetti Balance score, 31.1% elderly women with low risk of fall, medium risk of fall was 32.8% whereas with high risk of fall was 36.1%. The IdFAI showed, elderly women with Ankle Instability 62.3% while elderly women with No Ankle Instability were 37.7%. There was negative (inverse) Pearson linear correlation (r = -0.550) between age and balance (p ≤ 0.05) which means when the age increases, the balance decreases and also a weak association between age and functional ankle instability (p ≥ 0.05).

Conclusion: This study concluded that there was not adequate evidence to propose an association between Balance and self-reported functional ankle instability.

Comparison of Early Outcome of the Close and Open Technique for the Treatment of Distal Femur Fractures

Tue, 21 Mar 2023 00:00:00 +0200

Objective: To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations.

Methodology: This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures.

Results: The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p<0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups.

Conclusion: This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique.

Keywords: Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications

In Hospital Outcome Among Smoker and Nonsmoker Patients Presented with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Tue, 21 Mar 2023 00:00:00 +0200

Objective: To determine the association between smoking and in-hospital outcomes in patients presented with ST-Elevation Myocardial Infarction undergoing primary percutaneous coronary intervention (PCI).

Methodology: This prospective cohort study was conducted at Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, from November 9, 2020 to May 8, 2021. All the patients (current smoker, ex-smoker and non-smoker) with age 18 years to 85 years, both gender, patients diagnosed with STEMI in accordance with operational definition and underwent primary PCI were included. Patients diagnosed with ST-Elevation Myocardial Infarction were divided into two groups, expose (smoker) and unexposed (nonsmoker). Before PPCI demographic detail were noted and body mass index was calculated after management of STEMI then PCI was performed. In hospital outcome i.e. heart failure, in-hospital mortality and transient ischemic attack were assessed within 30 days of hospital stay after PCI. All the collected data were entered into the proforma.

Results: Mean ±SD of age in exposed group was 56.5±11.8 and non-exposed group was 57.7±12.1 years. In group wise distribution of gender, 82 (70.7%) males and 34 (29.3%) females were enrolled in exposed group and 80 (68.9%) males and 36 (31.1%) females were included in non-exposed group. Risk of heart failure and transient ischemic attack were 1.4 and 5.0 times more likely in exposed as compared to unexposed with [Relative Risk 1.444 and 5.0 respectively. While risk of mortality was 0.2 times less likely in exposed as compared to unexposed with [Relative Risk 0.222] and P value was found to be as significant i.e. (P=0.030).

Conclusion: It is to be concluded that significant risk of heart failure and transient ischemic attack were noted in exposed as compared to unexposed and vice versa in case of mortality, but we cannot rule out residual confounders.

Early Outcome of Coronary Artery Bypass Grafting in Obese and Non Obese Patients

Ajwad Farogh, Noman Izhar, Iqra Niaz, Omar Iqbal — Tue, 21 Mar 2023 00:00:00 +0200

Objective: To determine the impact of body mass index (BMI) on short-term outcomes like; renal failure, prolonged ventilation and mortality after CABG surgery.

Methodology: This prospective comparative study was conducted at the Cardiac Surgery Department, Pervaiz Elahi Institute of Cardiology, Bahawalpur from February to December 2021. A total of 148 patients were enrolled after taking written consent and data was collected through predesign proforma sheets, including; clinical history, investigation and early outcomes in term of (renal failure, prolonged ventilation, and mortality). SPSS 23 was used to analyze data with statistically significant p-value < 0.05.

Results: The findings showed that average age of research participants were 57.14 ± 3.07 (age range 30-73 years) and 121 (81.76%) male compared with 27(18.24%) female patients were enrolled with insignificant p-value of 0.730. In this study prolonged ventilation was found in 5(6.76%) obese and 8(10.81%) non-obese patients with insignificant p-value of 0.070. Renal Failure was found in 2 (2.70%) obese and 8 (10.81%) non-obese patients with significant p-value of 0.02 and mortality in 4(5.41%) obese and 2 (2.70%) non-obese patients with significant p-value of 0.0482.

Conclusion: The results of the current investigation demonstrated that an obese BMI was a reliable indicator of morbidity or mortality following CABG.

Umbilical Cord Blood Bilirubin and Determination of Neonatal Hyperbilirubinemia

Sat, 11 Mar 2023 00:00:00 +0200

Objective: To determine accuracy of cord blood bilirubin in identifying significant neonatal hyperbilirubinemia.

Methodology: A Cross sectional study was conducted in Pediatric department of Fauji Foundation Hospital Rawalpindi from Jan.2019 to June 2019. Cord blood samples were sent for the blood group and bilirubin levels. Neonates with cord bilirubin level > 2mg/dl and < 5 mg/dl were enrolled and admitted for 3 days and serum bilirubin level were done on 3rd day. Those developing significant hyperbilirubinemia were further investigated for hemoglobin, reticulocyte count, Coomb’s test and other causes.

Results: Total 74 newborns at >35 weeks of gestation were included in the study of which 35 (47.3%) were male and 39 (52.7%) were female (male: female: 1:1.1). The data was analyzed using SPSS 17. At 3rd day of life mean ± SD cord blood bilirubin was 8.4 ± 2.7 mg/dl, mean direct bilirubin was 1.6 ± 0.9 mg/dl and mean indirect bilirubin was 6.8 ± 2.3mg/dl. Significant hyperbilirubinemia developed in 16 (21.6%) newborns at >35 weeks of gestation, who had a cord blood bilirubin level of > 2 mg/dl, so that the accuracy of cord blood bilirubin level (true positives) in determining significant hyperbilirubinemia was 21.6%.

Conclusion: Cord blood bilirubin level >2mg/dl in all healthy term newborns predicts significant hyperbilirubinemia.

Categorization of Glucose 6 Phosphate Dehydrogenase (G6PD) Deficiency on the Basis of Enzyme Activity and its Clinico Haematological Correlation

Tue, 21 Mar 2023 00:00:00 +0200

Objective: To categorize glucose-6-phosphate dehydrogenase (G6PD) deficiency based on enzyme activity and its clinical haematological correlation.

Methodology: This Cross-sectional study was conducted at the Department of Haematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from February 2022 to August 2022. Sampling was done using the nonprobability consecutive sampling technique. Test analysis included a complete blood picture, RBC morphology and reticulocyte count, G6PD quantitative test, and serum bilirubin. Thus, to categorize G6PDD based on its enzyme and clinic-haematological correlation, study included patients of both gender with an age ranging from 0-76 years. Descriptive statistics were expressed as mean ± standard deviation (SD) and categorical data were presented as frequency and percentage.

Results: Out of 120 study participants, 30 (25%) were females and 90 (75%) were males. The mean age of study participants was 10.83±12.75. G6PD PCR was detected among participants having G6PD deficiency level <1 U/g Hb and between 2-3 U/gm Hb. Hb levels below 8g/dL were found only in individuals with G6PD deficiency levels <1 U/gm Hb.

Conclusion: GDPD deficiency can be diagnosed by blood analysis comprising of complete blood count and RBC morphology aided by clinical correlation. The signs and symptoms increase in severity with a decline in GDPD enzyme function along with blood haemoglobin levels.

Diagnostic Accuracy of Magnetic Resonance Arthrography and its Correlation with Arthroscopy in the Detection of Lesions Triangular Fibrocartilaginous Complex and Intrinsic Ligaments in the Wrist

Naushaba Malik, Tehmina Sajjad Khan, Shah Bakht Aftab, Minnal Ahmed Malik — Tue, 21 Mar 2023 00:00:00 +0200

Objectives: To assess the diagnostic validity and reliability of magnetic resonance arthrography in identifying the lesion of triangular intrinsic wrist ligaments and fibrocartilaginous complex based on arthroscopy as reference standard and preferred modality of imaging.

Methodology: This was a retrospective validation study that was carried out at the Radiology department of PESSI (Punjab Employees Social Security) Hospital, Islamabad, between April 2019 and September 2022. A total of 11 patients with an age range 21-58 years, lesions of the triangular fibrocartilaginous complex (TFCC), and MR arthrography were included. MR arthrography images of the wrist were evaluated to assess the integrity of the intrinsic wrist ligaments, including those of the TFCC, scapholunate, and lunotriquetral ligament. MR arthrography injection was performed into the wrist joint, likely to help visualize the ligaments and other structures within the joint. The injection was performed under fluoroscopic guidance, and the size of the needle used for the injection was 20-24G. The data collected from the MR arthrograms and arthroscopy was analyzed using SPSS v 23.

Results: The patient’s mean age was 40.0±12.31 years. Out of 11 patients, there were 6 (55.5%) males and 5 (45.5%) females. Sensitivity of MR arthrography is 71.4% and specificity that of 75% for detecting TFCC defects, and a 100% sensitivity and 85.7% specificity for diagnosing intrinsic ligament defects. MR arthrography had an overall accuracy of 73% for detecting TFCC, while the overall accuracy for detecting intrinsic ligament defects was 90.9%.

Conclusion: MR arthrography was an adequate diagnostic tool for detecting defects of the intrinsic ligaments and the TFCC of the wrist when compared to diagnostic arthroscopy.

Does Providing Story Books to Children Lead to an Improvement in Oral Hygiene in School Children: A Quasi-Experimental Study

Tue, 21 Mar 2023 00:00:00 +0200

Objective: To assess the effect of giving tooth brushing storybooks along with verbal oral hygiene (OHI) instructions on plaque levels to schoolchildren.

Methodology: This quasi-experimental study was conducted in a private school in Islamabad from October to November 2022. Children in Class V were selected as the Experimental Group I (Storybooks + OHI), while Class IV children were placed in the Control Group II (OHI alone). There were 20 students in each group. Plaque levels were compared at the baseline (before intervention) and after seven days. Tooth brushing practices were recorded at the baseline. Quantitative variables, such as age and mean plaque score were reported as mean and standard deviation. Categorical variables such as gender and tooth brushing frequency were described as frequencies and percentages.

Results: The mean age of the children was 9.6 + 1.08 years. A total of 16 (40%) boys and 24 (60%) girls were included in the study. Children in Group II had significantly better self-reported tooth brushing practices with 16 (80%) children brushing twice a day, as compared to 10 (50%) children from Group I (p = 0.041). There was no difference in the reduction in plaque scores between group I (0.14 + 0.21) and group II (0.08 + 0.21; p = 0.382).

Conclusion: Giving story books to children is not an effective intervention to improve the oral hygiene status of children, as compared to oral hygiene instructions alone.

Single Stage Reconstructive Surgery to Treat Anorectal Malformations in Neonates; Ten Years Experience

Mumtaz Hussain Khan , Naila Yaqub — Tue, 21 Mar 2023 00:00:00 +0200

Objective: To present single surgeon’s ten years’ experience of Single stage reconstructive surgery in 26 neonates born with anorectal malformations (ARMs) and review of literature.

Methodology: This is a retrospective study of 26 neonates admitted in NICU with diagnosis of ARMs between period of June 2011 to Oct 2021 and managed by single stage reconstructive surgery with an average follow up of three years. All these patients were full term. The diagnosis was confirmed on clinical examination supported by cross table lateral film in prone position after 24 hours and ultrasound evaluation of level of rectal pouch. Single stage reconstructive surgery was done under general anesthesia within 24 to 48 hours after birth. The outcome of single stage reconstruction of neonates with anorectal malformations is evaluated post operatively during an average regular follow up of 3 years.

Results: All the 26 neonates are treated by single stage reconstructive surgery between 24 to 48 hours after birth during the period from June 2011 to Oct 2021 who were admitted with anorectal malformations in NICU after excluding associated congenital anomalies. All the patients had excellent cosmetic and functional outcome without significant problem of wound infection. Only 3 female patients with recto-vestibular fistula had mild superficial wound infection and were managed conservatively.

Conclusion: Single stage reconstructive surgery to treat ARMs in neonates I effective, safe and feasible with good continence. It avoids morbidity and higher cost associated with three stage surgeries and colostomy. This fact may further be confirmed through multi-institutional experience in large number of patients.

Comparison of Casein Phosphopeptide-Amorphous Calcium Phosphate and High-Fluoride Dentifrices in reducing White spot Lesions during Orthodontic Treatment

Tue, 21 Mar 2023 00:00:00 +0200

Objective: To compare the effectiveness of CPP-ACP paste and high-fluoride toothpaste (1400ppm) on the demineralized enamel surfaces that appear to develop white-spot lesions in patients seeking fixed orthodontic treatment.

Methodology: This randomized control trial was conducted at the OPD of Orthodontic Department, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from January 2020 - July 2020. After evaluating scores of lesions, participants are provided with their respective preventive measures according to their division in the randomized control trial. Group one is provided with high fluoridated toothpaste at 1400 ppm that is commercially available in markets under the name Colgate Total twice daily for a period of 56 days. The other group is asked to visit OPD for the application of a paste of CPP-ACP once a week for a period of 56 days. Both groups are supposed to make three follow-ups at days 15, 34, and 56.

Results: This study consists of 126 participants. Out of 126 participants, 48.0% were males and 57.94% were female. The mean age of the cases was 17.8 years. Out of total, 48% were males and 57.94% were females, with a mean age of 15.99±2.183. A comparison of high fluoridated toothpaste and CPP-ACP paste after three consecutive follow-ups shows that both of them are effective in reducing white spot lesions, but high-fluoridated toothpaste is observed to be more effective during this trial.

Conclusion: High-fluoridated toothpaste and CPP-ACP paste, observed to be effective after three consecutive follow-ups in reducing white spot lesions, while high-fluoridated toothpaste was observed to be more effective during the trial.