Anthropometric Assessment Of Paediatric Flat Foot: A Diagnostic Accuracy Study.

BACKGROUND: Flat-foot involves total collapse of medial longitudinal arch, which becomes distressful when children begin to stand on their feet. Flat foot is usually diagnosed on clinical examination, however due to lack of a standardized protocol, there are conflicting views regarding its management. The objective of this study is to determine the accuracy of radiographic and podometric measurements in diagnosing paediatric flat foot. METHODS: It was a cross sectional diagnostic accuracy study. Eighty-four children of preschool and school going age were recruited equally into control and flat foot groups. Each child was examined clinically and was further classified into having flexible or rigid flat foot. For radiographic assessment, lateral and anteroposterior foot radiographs were taken while footprints were captured using podoscope and analysed with FREESTEP software. The diagnostic accuracy and correlation among different parameters were also computed. RESULTS: Clinically, of the 42 children in the flat foot group, 26 had flexible while 16 had rigid flat foot. Of these, 40 children were flat footed on one or more radiographic parameters, while 36 had podometric measurements within the flat foot range. Radiography had the sensitivity and specificity of 95% and 69%, respectively, while podometry was 86% sensitive and 47% specific. Clark's angle had highest sensitivity of 90%, with AUC of 0.952. A strong positive correlation was found between arch index and talocalcaneal angle (r=.805). CONCLUSIONS: The diagnostic accuracy of radiography was more than podometry. More specific and sensitive parameters in combination with clinical assessment may prove to be useful in the management of paediatric flat foot.

Role Of Papanicolaou Smear In Mapping Out Cervical Epithelial Morphology In Women With Infertility: Modified Bethesda Classification.

BACKGROUND: Papinocolaou smear (PAP) smear has a specificity of 98% in detecting early changes in cervical epithelium in women above 21 years, thus its avocation as a screening tool for cervical cancers worldwide. In Pakistan with a lack of awareness in our population as well as socioeconomic conditions there is no such screening program. Infertility on the other hand affects 22% of women in Pakistan and thus one of the most common cause of physician visits. Both cervical cancers and infertility have sexually transmitted diseases (STD's) as common causes with studies reporting ~75% of women have an STD at-least once during their life, presenting with cervical epithelial cell lesions. Thus, the present study was carried out to identify patterns of cervical cell morphology in women with infertility using PAP smear. METHODS: Cervical smears were taken from infertile women and fertile women (n=150), stained with H&E and PAP stains, and graded according to Bethesda Classification 2001. Analysis of data was done by using SPSS version 20 and MS Excel. RESULTS: The mean age of participants was ~29 years. Epithelial cell morphology of these smears showed significant difference among three groups (p value 0.037) with severity in infertile women. Further in the subgroup of secondary infertile women, there were more abnormal smears as compared to primary as well as a higher grade of severity by Pap smear. CONCLUSIONS: Thus, it is concluded that women presenting with some level of infertility are at a higher risk of having cervical epithelial abnormalities.