Cochlear duct length in Pakistani cochlear implant recipients gender, age and side association: A Radiological Measure.

Objectives: To analyze the gender, age and side association of cochlear duct length in Pakistani-Asian cochlear implant recipient population based on computed tomography imaging study. Methods: Current study retrospectively studied charts of cases who underwent cochlear implantation at the Department of Otolaryngology & Auditory Implant Centre, Capital Hospital Islamabad, over a period of two years from 1st May 2017 to 30th April 2019. These included 200 cases of both genders and of any age. In addition to basic demographic data, computed tomography findings of the temporal bone were utilized to measure the cochlear duct length. Data was analyzed using SPSS Version 23. Results: Study revealed a mean Cochlear duct length of 29.935±2.173mm (range: 25.12 to 37.60) with significant (p<0.001) association with gender with longer cochlear duct in males compared to females on right (30.50±2.384 vs. 29.36±1.887) and on left side (30.50±2.236 vs.29.32±1.935). However, no significant difference was noted for side with slightly longer cochlear duct on the right side compared to left (29.95±2.224 vs.29.92±2.171). Also, no significant association with age was noted with p=0.578 & p=0.824 for right and left side respectively. Conclusion: Pakistani population is characterized by a short mean CDL of 29.935±2.173 mm with significant association (p<0.001) with gender with longer cochlear duct length in males; and side with larger CDL on right side. However, no significant association with age was noted.

Duodenal ulcer perforation and its consequences.

Duodenal ulcer perforation, a frequent surgical emergency, needs simple closure with indirect Graham's Omentopexy which is effective with excellent results in majority of cases despite patients' late presentation. The objective of the study was to determine the frequency of postoperative complications of perforated duodenal ulcer, conducted in the Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, from March 20, 2018 to September 20, 2018. The study was a descriptive case series of 108 patients of both genders with perforated duodenal ulcer > 1 week old with ASA score I & II. Patients with trauma and comorbidities were excluded. The patients underwent laparotomy and peritoneal toilet, and after noting the site of perforation indirect Graham's Omentopexy was performed. Complications like duodenal fistula, peritonitis, and paralytic ileus, and patient's death within 10 days of surgery were noted. Age ranged from 18 to 50 years with mean age of 35.027±5.13 years, mean weight 71.120±12.77 kg, mean height 1.541 ±0.09 metres, mean BMI 29.975±4.99 kg/m2, and the mean duration of complaint was 4.194±1.30 weeks. Male predominance in 75 (69.4%) patients. Duodenal fistula was seen in 10 (9.3%) patients, peritonitis 12 (11.1%), paralytic ileus 14 (13%) and mortality was in 11 (10.2%) patients.

Complications of Cochlear Implant Surgery: A Public Implant Centre Experience.

OBJECTIVES: To determine the prevalence of complications of cochlear implant surgery in children with congenital profound sensorineural hearing loss. METHODS: This study retrospectively & consecutively reviewed charts of children who underwent cochlear implantation from July 2015 to July 2019 at Cochlear Implant Centre of Otolaryngology Department of Capital Hospital, Islamabad Pakistan. These included cases of both genders aged one to 12 years operated at least one year before the time of data collection. Basic demographic data, complications including major and minor complications and treatment received was noted and statistically analyzed using SPSS-23. Results were presented using descriptive statistics. RESULTS: Current study included a sample of N=251 having a mean age of 4.05±2.15 years including 154(61.4%) males and 97(38.6%) females revealed a prevalence of complications of 16(6.4%) with 4(1.6%) major and 12(4.8%) minor complications. Wound infection and acute otitis media with frequency of 3(1.2%) each were the commonest complications, followed by , facial nerve twitching, tinnitus and vertigo, infection and extrusion; and device failure in 2(0.8%) each. However, there was no significant association of complications with age group and gender with P=0.344 and P=0.519 respectively. CONCLUSION: Present public sector implant program is characterized with a very low prevalence of complications of 16(6.4%) with 4(1.6%) major and 12(4.8%) minor complications. Wound infection and acute otitis media were the commonest complications.

Prevalence & features of inner ear malformations among children with congenital sensorineural hearing loss: A Public Cochlear Implant Centre Experience.

OBJECTIVE: To determine the prevalence and features of inner ear anomalies in children with congenital profound hearing loss who presented at our cochlear implant center based on imaging studies. METHODS: This retrospective study reviewed charts of children with congenital SNHL, who presented to Department of Otolaryngology & Auditory Implant Centre, Capital Hospital Islamabad over a period of 2 years from 1st May 2017 to 30th April 2019. These included 481 cases of both genders aged between 1 to 12 years. After gathering demographic data, audiological data, computed tomography findings of the temporal bone were analyzed. Data was analyzed using SPSS 22. RESULTS: The Inner Ear Malformations were identified in 48(10%) children including 28 (58.33%) males and 20 (41.67%) female. Most 20(41.67%) presented at >3-5 years of age followed by 19(39.58%) at 2-3 years. However, no significant association of gender (p=0.57, p=0.076) and age of presentation (p=0.344, p=0.697) for right and left ears was noted with inner ear malformations. The most common anomaly noted were CLA, CH-III and CH-II in decreasing order of frequency in both ears. CONCLUSION: The prevalence of IEM's was found to be 48(10%). Commonest anomalies noted were CLA, CH-III and CH-II. No significant association of gender and age of presentation was noted with type of anomaly in both ears.

Workplace Based Learning (WBL): An Effective Learning Modality during Orthopaedics Surgical Clerkship: Students' Perspective.

OBJECTIVE: To evaluate the student's perspective about educational and training efficacy of workplace based learning (WBL) during surgical clerkship in Orthopaedics amongst 4th and 5th year medical students. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa Tameer-e-Millat University, Islamabad, from September 2020 to December 2021. METHODOLOGY: The inclusion criteria was fourth and final year MBBS students who had completed their orthopaedic surgery mini-clerkship. The exclusion criteria was medical students who did not attend the orthopaedics clerkship in the study period. The research instrument was a questionnaire based on the principles of experiential based learning. The participants were sent an online questionnaire as well as a consent form through e-mail. The responses were recorded and analysed for descriptive statistics. RESULTS: From the target group, 140 responses were received, 94 students (67%) expressed that workplace environment was conducive to learning and 98 (70%) agreed that their diagnostic and management skills further developed following exposure to the orthopaedic workplace. A short duration of 2 weeks served as a hindrance with 53 (38%) of students expressing that they were not able to effectively inculcate all concepts within that limited time-frame. Moreover, 52 (37.5%) students described limited patient's clerking time. CONCLUSION: Though majority of students were satisfied with teaching and learning strategies, design and implementation of the curriculum at the orthopaedics department; yet, there were significant limitations requiring further evaluation and cooperation by both students and faculty in order to establish ecosystem focusing on experiential learning. KEY WORDS: Orthopaedics, Workplace based learning (WBL), Student, Clerkship, Learning environment.

Choledochorraphy (primary repair) versus t-tube drainage after open choledochotomy.

BACKGROUND: T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. METHODS: This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 T-tube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. RESULTS: The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 (5%), jaundice in 1 (5%), wound infection in 1 (5%). No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 (2%), jaundice in 1 (5%), dislodgement of T-tube in 1 (5%), wound infection in 1 (5%), and sepsis in 1 (5%) patients. Re-exploration was done in one patient. CONCLUSION: Primary closure of Common Bile Duct (CBD) is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy.

Impact of the COVID-19 lockdown on routine vaccination in Pakistan: a hospital-based study.

The effect of the coronavirus disease (COVID-19) pandemic on routine vaccination in low- and middle-income countries are scarce. The current pandemic has disrupted routine immunization globally. We aimed to analyze the effect of COVID-19 pandemic on routine immunizations practice in Pakistan. A retrospective study was conducted. The data were extracted from the immunization registry in order to assess the disruption in routine immunization coverage during 5 months of the lockdown period. We compared 5 months post lockdown against the baseline period of 5 months preceding lockdown. To broaden the horizon of our research we also collected data of vaccination from rural areas within the country. The results of the current study showed that on average, there was a disruption in routine immunization by 36% during lockdown when compared with the prepandemic period. The largest decline was observed for measles vaccination with a decline of 48%. In rural areas there was a lower decline in vaccination coverage with the highest decline noted for rotavirus vaccination of 15%. This monthly decrease in routine vaccination continued to be at a decline for several months during lockdown; however, it slightly increased post lockdown. In conclusion, on average, there was more than 30% declined in routine vaccination during the lockdown period, while somewhat improved post lockdown, i.e. 12%. Thus, this ongoing pandemic is a reminder for the national immunization programs to consider to tackle the disruption in routine immunization, otherwise, this continued disruption may lead to secondary outbreaks of vaccine preventable diseases amongst the public.

Role of Urgent Thoracotomy in improving the survival of patients with severe chest trauma.

OBJECTIVE: To determine the frequency of survival in patients with thoracic trauma, undergoing Urgent Thoracotomy (UT). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: The study was carried out in the Department of Thoracic Surgery, JPMC, Karachi, from January 2005 to June 2007 (30 months). METHODOLOGY: Fifty two patients, who presented with chest trauma and underwent UT within 48 hours of sustaining thoracic trauma, were included in the study. All patients were assessed by history, physical examination and relevant investigations. RESULTS: A total of 475 patients with acute thoracic trauma needing admission during the study period presented to the Accidents and Emergency Department. Fifty-two (52/475; 10.9%) patients were indicated for UT. The most common indication for UT was massive hemothorax (43/52; 82.6%). The mean age of the patients was 34.36 +/- 11.02 years. There were 22 (42.2%) blunt injuries and 30 (57.8%) penetrating injuries. Road Traffic Accidents (RTA) were the most frequent cause of blunt chest injuries (15 patients; 75%), while firearm injury was the commonest (21 patients; 70%) cause of penetrating chest trauma. Post thoracotomy mortality was 13.3 % (4 out of 30) in patients with penetrating injuries and 18.2% (4 out of 22) in patients with blunt injuries (p < 0.01). Mortality of UT was 15.3 % with survival of 84.7%. Overall survival in 475 patients was 95.58%. CONCLUSION: Early recognition of treatable injuries and an aggressive approach in management with Urgent Thoracotomy can increase chances of survival of patients suffering from severe chest trauma.

Outcome Of Use Of 1% Silver Nitrate In Patients With Low Lying Perianal Fistula.

BACKGROUND: Anorectal fistula is a common illness which is seen among the middle-aged male patients. Various surgical procedures have been proposed and are associated with the recurrence of the fistula, repeated surgery and in some cases incontinence which may reach up to 43% in complicated fistulas. The purpose of this study was to assess and formulate a non-surgical procedure for fistula in ano through irrigation of the fistula tract with 1% of silver nitrate solution in healing the low perianal fistula. METHODS: Seventy-nine patients presenting to the outpatient department of Ward 3, Surgical unit 1 in Jinnah Postgraduate Medical Centre during a period of 8 months from April to November 2017 with complain of perianal pain and pussy discharge were included in the study. Three patients of the total 79 patients lost to follow up. Outcome measure were cessation of the symptoms for consecutive 10 weeks. RESULTS: Seventy-six patients were assessed and underwent irrigation using this 1% of silver nitrate solution. Out of 76 patients, 58 (76.3%) patients showed complete clinical healing while 18 (23.68%) of patients showed failure to clinical healing. Patients with continuous discharge had a significantly higher rate of complete clinical healing than those with intermittent discharge. CONCLUSIONS: From this study it can be concluded that cauterizing and corrosive properties of silver nitrate are effective in treating the patients with low lying perianal fistula. We suggest that this method should be used as a first line treatment option for all the patients presenting with low lying anal fistula since it is simple, can be easily performed on an OPD basis is minimally invasive and avoids any complication.

Hypoglycemic potential of herbal product dolabi compared with pioglitazone in streptozotocin-induced diabetic rats.

OBJECTIVES: To investigate and compare the hypoglycemic potential of commonly used polyherbal formulation dolabi with pioglitazone in streptozotocin-induced diabetic rats. METHODS: A total of 24 adult male Wistar rats were randomized into diabetic control group, diabetic group receiving dolabi (17.6 mg kg-1 day-1), diabetic group receiving dolabi (35.2 mg kg-1 day-1) and diabetic group receiving pioglitazone (2.7 mg kg-1 day-1), with 6 rats in each group. The study was conducted for 4 weeks. Blood samples were collected for fructosamine estimation, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) were measured at different time points. RESULTS: Compared with baseline, the groups receiving dolabi (35.2 mg kg-1 day-1) and pioglitazone showed signififi cant reductions (P<0.05) in fructosamine levels at the end point and same was the case for FPG and OGTT with pioglitazone showing greater hypoglycemic potential. However, the group receiving dolabi (17.6 mg kg-1 day-1) showed significant reduction (P<0.05) only in FPG level and failed to achieve significant changes either in fructosamine level or OGTT. Moreover, signififi cant differences (P<0.05) in FPG and fructosamine levels were observed between groups receiving dolabi (17.6 mg kg-1 day-1) and pioglitazone at the end point. CONCLUSIONS: These results showed sluggish hypoglycemic effects of dolabi at manufacturer's recommended doses. At a higher dose however, good glycemic control was achieved with dolabi and the results were comparable to pioglitazone. The shorter duration of study (4 weeks) might be the reason of poor glycemic control associated with dolabi at a normal dose.

Benefits of Zubex beyond glycemic control: Evidence of the antiatherogenic effect.

OBJECTIVE: To determine the effect of Zubex (aqueous extract of Curcuma longa linn, Iron murakab, Eugenia jambolana, Lin seed or flflax seed, processed egg shell calcium and Asphaltum) on plasma sialic acid (PSA) along with cardiovascular (CV) risk factors in streptozotocin-induced diabetic rats. METHODS: Thirty male albino rats were divided into groups (1-6) with 5 rats in each group. Group 1 and 2 served as normal control (NC) and diabetic control (DC), respectively, and were given normal saline only. Groups 3-5 were given Zubex in different doses 100-400 mg/(kg day). Group 6 received glibenclamide 600 µg/(kg day) orally as a reference drug. Fasting plasma glucose (FPG) and PSA levels were determined at baseline after every 2 weeks for 10 weeks. The other parameters including blood lipids and hepatic enzymes were determined at baseline and at the end of the study. Finally, the liver was subjected to histological examination. RESULTS: Compared with DC group, Zubex treated groups showed signifificant decline in FPG levels (P<0.05). At the endpoint, the decrease in PSA concentration was significant (P<0.05) from baseline at the doses of 200 and 400 mg/(kg day) only and insignifificant at the dose of 100 mg/ (kg day). Statistically signifificant improvements were observed in blood lipids at the doses of 200 and 400 mg/kg (P<0.05) compared with DC; but, the improvement was insignifificant in low density lipoprotein-cholesterol and high density lipoprotein-cholesterol at the dose of 100 mg/ (kg day). Signifificant decreases were also found in hepatic enzyme levels at all the doses of Zubex (P<0.05). Histological examination showed marked improvement in streptozotocin induced liver injury after treatment of all the 3 doses of Zubex. CONCLUSION: Zubex could ameliorate PSA and other diabetic complications effectively and may be a useful alternative/adjuvant in diabetes treatment.

Gastric carcinoma: 5 years survival after gastric surgery.

OBJECTIVE: To study the five years survival rate after resection for gastric carcinoma. METHODS: Fifty six patients with gastric carcinoma in different stages were followed up for 5 years after gastric surgery to see recurrence, complications and survival rate. RESULTS: Of the 56 patients, 6 underwent total gastrectomy, 50 partial gastrectomy, 7 Billroth I and 43 modified DI resection with Billroth II reconstruction. Six patients were alive at the end of 5th year, 3 with early gastric carcinoma and 3 with locally advanced carcinoma. Mortality was 17 patients in the first year, 10 in second year, 8 in third year, 3 in fourth year and 1 in the fifth year. CONCLUSION: Gastric carcinoma carries a bad prognosis. The 5-year survival rate in our series was 13.3% [corrected] Efforts should be made to diagnose and treat these patients at an early stage.