Evaluation of Clinical & Functional Outcomes Bristow Latarjet Procedure in the Management of Recurrent Anterior Shoulder Dislocation

Background: Glenohumeral joint is highly susceptible to dislocation due to its wide range of movements. Recurrent anterior shoulder dislocations are common in young adults. The Bristow Latarjet procedure is one of the effective techniques for the treatment of recurrent anterior shoulder dislocation. This study aimed to assess the clinical and functional outcome of the Bristow Latarjet procedure in the management of recurrent anterior shoulder dislocation. Material & Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU, from October 2017 to September 2019. Within this period, a total of 40 cases of recurrent anterior shoulder dislocation that meet inclusion criteria were taken as a sample. Patients were evaluated both pre and postoperatively for functional outcomes according to Rowe’s score for instability. A purposive non-randomized sampling technique was used in this study. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Paired Student’s‘t’ test was performed to compare pre and final postoperative follow-up. The level of significance was calculated at a confidence interval of 95% and p-value <0.05. Results: : In this study age of the patient ranged from 18-40 years and the mean age was 28.2±6.3. 29(72.5). Surgery was done within 4-6 months of the first dislocation in 5 patients, within 6-12 months in 21 patients and after 12 months in 14 patients. The mean (±SD) Rowe score for instability was significantly (p<0.001) higher 6 months after the Bristow Latarjet procedure at 91.87(±9.00) in comparison to preoperative periods 52.62(±18.40). Results were excellent in 32(80%), good in 4(10%), fair in 3(7.5%) and poor in 1(2.5%) patients. 36(90%) patients were in the satisfactory group and only 4(10%) in the unsatisfactory group. Only 1(2.5%) patient developed screw migration, 2(5%) patients developed subluxation, and 1(2.5%) patient developed postoperative arthritis. Conclusion: It can be concluded that the Bristow-Latarjet procedure is a very effective and safe procedure with reduced complications, presenting very satisfactory functional results in the treatment of recurrent anterior shoulder dislocation.

Resident involvement in the prostatic urethral lift: implementing innovative technology in an academic setting / 亚洲男科学杂志(英文版)

Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1-3 are considered junior residents, while those in PGY 4-6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement (P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.

Effect of six-month use of oral contraceptive pills on plasminogen activator inhibitor-1 & factor VIII among women with polycystic ovary syndrome: An observational pilot study

Background & objectives: Polycystic ovary syndrome (PCOS) is an endocrinopathy warranting lifelong individualized management by lifestyle and pharmacological agents mainly oral contraceptive pills (OCPs). This study was aimed to report the impact of six-month OCP use on plasminogen activator inhibitor-1 (PAI-1) and factor VIII (FVIII) in women with PCOS. Methods: PCOS women diagnosed on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinyl estradiol-0.03 mg, levonorgestrel-0.15 mg) for a period of six months (n=40) or drug-naïve (n=42), were enrolled in this study. Blood was drawn to estimate glucose, insulin levels and lipid profile. Chemiluminescence immunoassays were used to measure hormones (LH, FSH, PRL, T4). Plasma levels of PAI-I and FVIII were measured by commercially available kits. Results: Menstrual regularity, Ferriman-Gallwey score and serum total testosterone significantly improved in the OCP group compared to drug-naïve group (P<0.01). No significant difference was observed in PAI-1 levels of the two groups; however, significant decrease in FVIII levels was observed in OCP group as compared to drug-naïve group. PAI-1 levels of OCP group correlated positively with blood glucose two hours, triglycerides and insulin two hours, while FVIII levels of OCP group correlated negatively with fasting insulin and homoeostatic model assessment-insulin resistance. Interpretation & conclusions: OCPs use has differential effect on pro-coagulant markers among women with PCOS. Well-designed, long-term, prospective, large-scale studies are prerequisite to elucidate the efficacy and safety of OCP in the treatment of PCOS.

effect of adding dexmedetomidine or fentanyl to levobupivacaine for ultrasound-guided supraclavicular brachial plexus block in upper extremity sugeries

Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. It has gained importance as regional anesthetic technique for surgical, diagnostic and therapeutic purpose in interventional pain management

Aim: We aimed to study the effect of adding dexamedetomidine or fentanyl to levobupivacaine in ultrasound guided supraclavicular brachial plexus block in upper extremity surgeries as regard to onset and duration of sensory and motor block and postoperative pain

Methods and Material: The study was carried out in Tanta University Hospital on 90 patients of 18-60 years old with ASA physical status I/II scheduled for elective surgery of upper hand. Patients were divided into three equal groups. Group A: was given 30 ml of 0.5% levobupivacaine with fentanyl 100 Mug. Group B: was given 30 ml of 0.5% levobupivacaine with dexamedetomidine 100 Mug. Group C: was given 30 ml of 0.5% levobupivacaine with 1ml normal saline. The following data were measured for each patient: hemodynamic status [HR, MAP], onset of sensory and motor block, and duration of sensory and motor block, visual analogue score [VAS] and incidence of complications

Results: Our results showed that no significant difference between three groups according to hemodynamic changes, while there was significant prolongation in duration of sensory and motor block, significant decrease in VAS score in group B compared to group A and C

Conclusions: We concluded that the addition of dexmedetomidine was better than fentanyl when both used as adjuvants to levobupivacaine in ultrasound guided brachial plexus block as demonstrated by prolongation of duration of sensory block, improved quality of postoperative analgesia and provide of desirable sedation

Implementing standard setting into the Conjoint MAFP/FRACGP Part 1 examination – Process and issues

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent.

Clinical and cyto-histopathological evaluation of skin lesions with special reference to bullous lesions.

Aim: Cytopathology of skin has been documented to be useful in the diagnosis of several skin lesions. This study aims to evaluate cytopathology as a quick non-invasive method for early diagnosis of bullous lesions, neoplastic and preneoplastic skin lesions and to correlate the clinical, cytological and histopathological findings of various skin lesions. Materials and Methods: Eighty five patients of skin lesions were included in the study. Skin scraping, Tzanck smears, slit smears and fine needle aspiration cytology (FNAC) were done to obtain material for cytological examination. Excisional biopsy, incisional biopsy and punch biopsy were done to obtain tissue for histopathological examination. The slides were stained with routine stains and special stains as and when required. Results: Of the 85 patients, 45 were males and 40 females. The most common non-neoplastic lesions observed were vesicobullous lesions which comprised of 41 cases followed by neoplastic lesions which consisted of 24 cases, of which six were benign and 18 malignant. Concordant results between cytology and histopathology was seen in majority (91.7%) of lesions studied. Conclusion: Cytology (scrape/imprint/slit smears and FNAC), performed skillfully and with perfection, leads to an early diagnosis in majority of the lesions, as the observed cytomorphological features of various skin lesions were fairly distinctive making cytology a fairly sensitive 'patient compliant' technique for rapid diagnosis of skin lesions.

Comparative study of radical neck dissection vs. modified radical neck dissection in metastatic neck gland.

Treatment of metastatic neck gland is an integral part of management of Head and Neck cancers, because this is the single most important prognostic determining factor. Although surgery and radio therapy with or without chemotherapy are the modalities available for treating neck gland, wide surgical excision of the whole regional lymphatic chain enblock is mostly favored. Radical Neck dissection is the operation for such disease, designed in the early part of twentieth century, still has got the validity, but a modification of that (modified radical neck dissection) is becoming popular for last few decades to reduce morbidity. In this study we compared 15 cases of radical neck dissection and equal number of modified radical neck dissection to observe the selection criteria of these two types of operations, their complications and therapeutic success. Neck deformity, shoulder pain and restricted shoulder movement are the major morbidities which are less in modified radical neck dissection. The oncologic efficacy appears as same in both procedures.

Frequency of helicobacter pylori infection in dyspeptic patients in Libya

Helicobacter pylori infection is a very common infection worldwide particularly in the developing countries. The organism plays an important role in peptic ulcer diseases. The aim of the study was to detect and correlate the prevalence of Helicobacter pylori with such diseases and to evaluate the histopathological grading of gastritis. One hundred thirty two patients of 15-83 years of age [average 38] attending the endoscopy unit at the El-Jamahiria Hospital, Binghazi, Libya, mainly complaining from epigastric pain were randomly selected. Three antral biopsies for rapid urease test, direct smear stain and histology together with serum samples were obtained from each patient. Grading of gastritis and the presence of Helicobacter pylori was scored according to the Sydney system. Patients were considered infected when 2 of the biopsy-based tests were positive. Helicobacter pylori was detected in 108 [82%] of 132 patients examined [86% by rapid urease test, 77% by direct smear stain, 95% by histology]. The endoscopic findings revealed that 77 [77%] of 100 patients with non-ulcer dyspepsia, 26 [96%] of 27 with duodenal ulcer, 4 [100%] of 4 with gastric ulcer and in one patient with gastric cancer were Helicobacter pylori positive. The enzyme-linked immunosorbent assay test showed 94% sensitivity and 88% specificity. Histopathological sections from the majority of duodenal ulcer and gastric ulcer patients revealed higher grade [II and III] of gastritis than non-ulcer dyspepsia patients. Helicobacter pylori infection is significantly correlated with peptic ulcer diseases than with non-ulcer dyspepsia. Patients with duodenal ulcer and gastric ulcer had a significantly higher grade of gastritis than patients with non-ulcer dyspepsia

Spherical soft contact lenses in managing keratoconus

Hoya soft contact lenses were used to fit 50 keratoconus patients. Only 30 patients [53 eyes] could be fitted successfully. prefitting vision varied between 1/60 and 6/18, post fitting vision reached 6/12 or better in 69% of the eyes. Complications are recorded and perld of follow up varied between 6 months and 5 years. This paper shows that contrary to the general believe soft spherical contact lanses have a definite role in managing keratoconus patients