The Outcome Of Pedicled Medial Sural Artery Perforating Flap For Proximal Leg Reconstruction.

BACKGROUND: Reconstruction of defects around the knee and proximal leg are difficult to reconstruct. Out of the multiple flaps described for reconstruction, the pedicled Medial Sural Artery Perforating Flap (MSAP) has recently gained popularity. We conducted this study to assess the clinical outcomes of pedicled MSAP for this purpose at our hospital. METHODS: A descriptive case series was conducted from April 2022 to March 2023. All patients above 18 years with defects around the knee and proximal leg were included. Patients with tissue loss in the calf area were excluded. RESULTS: A total of 14 patients were included. Twelve (86%) were males, while only 2 were females (14%). The mean age was 33.5 years (±8.76). The most common cause of the defect was trauma (n=11, 85%). The Mean distance of the distal-most perforator from the popliteal crease was 12.714 (±1.990) cm (range 9-16 cm). It was observed that the most distal perforator is usually present in a 2 cm radius of the medial musculo-tendinous junction of the gastrocnemius. Complications were seen in 2 (14%) patients. The mean duration of hospital stay was 4.2 (±0.96) days. Patients were followed up weekly for the first two weeks and then at 1, 3 and 6 months. CONCLUSIONS: MSAP Flap is a reliable thin, long pedicled fasciocutaneous flap with low donor site morbidity and aesthetically good results for reconstruction around the knee and proximal leg.

Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019.

AIMS AND METHOD: We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan. RESULTS: DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25). CLINICAL IMPLICATIONS: A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

How to eradicate polio in Pakistan: Insights from community health workers.

Pakistan, along with Afghanistan, is one of two countries where wild poliovirus is still endemic. Frontline workers (FLWs) are the staff most intimately familiar with both implementation challenges and community context. Harnessing their expertise may be a way to improve the community-polio program interface, which has been a persistent and shifting challenge in polio-endemic areas of both countries. From 2020-2022, we engaged frontline workers in 18 Super High-Risk Union Councils (SHRUCs) in Pakistan through a Human-Centered Design ideas competition. In that competition, teams of polio FLWs identified the most significant barriers they faced in conducting their work, and suggested solutions to those problems-a window into the issues the program faces by the people who know it best. The suggestions of FLWs on how to eradicate polio fell into four main categories. First, there were suggestions to tackle community fatigue by reducing touchpoints, particularly visits solely for data collection. Second, there were calls to improve Primary Health Care in SHRUCs, as a way of addressing community frustrations over an intense focus on just one disease in the context of numerous acute needs. Third, there were suggested ways to increase community engagement through locally relevant channels. Finally, many workers suggested improvements to Human Resources processes and workplace dynamics. Across these ideas, one repeated concept is the need for balance between the intensity of polio activities required for eradication and the provision of other government services, including health services. FLWs engaged the process deeply, providing well thought out problem statements and ideas for change. It is our view that there is no one more qualified to speak to the issues on the ground than FLWs. There are critical insights available if we listen to people who are instrumental to the success of health programs, but not commonly involved with creating policy.

"Walking on eggshells": experiences of underrepresented women in medical training.

INTRODUCTION: Medicine remains an inequitable profession for women. Challenges are compounded for underrepresented women in medicine (UWiM), yet the complex features of underrepresentation and how they influence women's career paths remain underexplored. This qualitative study examined the experiences of trainees self-identifying as UWiM, including how navigating underrepresentation influenced their envisioned career paths. METHODS: Ten UWiM family medicine trainees from one Canadian institution participated in semi-structured group interviews. Thematic analysis of the data was informed by feminist epistemology and unfolded during an iterative process of data familiarization, coding, and theme generation. RESULTS: Participants identified as UWiM based on visible and invisible identity markers. All participants experienced discrimination and "otherness", but experiences differed based on how identities intersected. Participants spent considerable energy anticipating discrimination, navigating otherness, and assuming protective behaviours against real and perceived threats. Both altruism and a desire for personal safety and inclusion influenced their envisioned careers serving marginalized populations and mentoring underrepresented trainees. DISCUSSION: Equity, diversity, and inclusion initiatives in medical education risk being of little value without a comprehensive and intersectional understanding of the visible and invisible identities of underrepresented trainees. UWiM trainees' accounts suggest that they experience significant identity dissonance that may result in unintended consequences if left unaddressed. Our study generated the critical awareness required for medical educators and institutions to examine their biases and meet their obligation of creating a safer and more equitable environment for UWiM trainees.

Audiovisual Distraction: A Pricking Pain Reduction Modality among Ladies Receiving Intraoral Injections.

OBJECTIVE: To determine the effect of audiovisual distraction (AVD) using virtual reality device (bobo VRZ4-VRBOX) on intensity of pricking pain at the intraoral injection site among different age groups in ladies. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, during September 2018 to March 2019. METHODOLOGY: An in-vivo interventional study, using split-mouth technique was conducted in 50 lady patients of sample size of 50, to investigate pricking pain perception during needle insertion. Topical anesthesia (benzocaine gel) was applied on left side (control) for 1 minute without audiovisual distraction (AVD); whereas, on the experimental side (right), similar methodology was followed after topical anesthesia but with AVD via VR-Z4 video eyeglasses after the local anesthesia was administered. Patients' pain perception ratings were measured through visual analog scale (VAS). After profound anesthesia was achieved, restorative treatment was performed under rubber dam isolation. RESULTS: Audiovisual (AV) device was effective in decreasing the pricking pain sensed by the patients during infiltrate anesthesia; but the score remained within the same pain category. The effect of audiovisual distraction (AVD) using virtual reality device (VRZ4-VRBOX) was statistically insignificant on intensity of pricking pain at the intraoral injection site among different age groups in ladies. CONCLUSION: AV device is not dependent on age (21-50 years) in reducing the pricking pain. Pain is effectively reduced after the use of AV device, but this reduction is not statistically significant.