Characteristics and clinical features of cauda equina syndrome: insights from a study on 256 patients.

OBJECTIVE: To determine the frequency, clinical presentation, and etiological factors of cauda equina syndrome (CES). MATERIALS AND METHOD: This retrospective study was done on 256 participants, and aimed to analyze the frequency and patterns of clinical presentation in suspected cases of CES. The inclusion criteria included participants aged 18 or older with medical records available for review and having red-flagged symptoms for CES. The study collected information on various factors such as age, gender, confirmation of CES on MRI, neurological deficits, etiological factors, duration of symptoms, and more. The data collected was analyzed using descriptive statistics and logistic regression to identify significant variables between MRI-proven CES and suspected CES. RESULTS: The mean age was 58.05 ± 19.26 years, with 151 females (58.98%) and 105 males (41.02%). The majority (50.78%) had a neurological deficit, while other symptoms included difficulty initiating micturition or impaired sensation of urinary flow (17.58%), loss of sensation of rectal fullness (3.12%), urinary or faecal incontinence (35.16%), bilateral sciatica (21.88%), neurological symptoms in the lower limbs (25.00%), anaesthesia or any leg weakness (24.22%), and bilateral sciatica as the predominant symptom (21.88%). Symptoms were chronic in 47.27% and acute in 21.88%. The odds of MRI-proven CES increase by 3% per year of age. Neurological deficit was strongly associated with MRI-proven CES (OR = 14.97), while loss of sensation of rectal fullness increased the odds by 10-fold (OR = 10.62). CONCLUSION: CES can present with various symptoms, including the bilateral neurological deficit, urinary and faecal incontinence, and bilateral sciatica, with age, severe bilateral neurological deficit, and loss of sensation of rectal fullness being associated with MRI-proven CES. Early diagnosis and treatment are crucial for better outcomes.

Comparison of Digital Versus Conventional Documentation of Ward Round in Terms of Staff Satisfaction, Effect on Education, and Adherence to British Orthopaedic Association Guidelines.

Objective To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methods Forty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paper-based and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical.  Results For all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). Conclusion Electronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.

Evaluating the Effect of Induction Chemotherapy on Bone Metabolizing Nutrients in Patients of Acute Lymphoblastic Leukemia.

OBJECTIVE: To determine the levels of bone metabolizing nutrients (vitamin D, calcium, magnesium, potassium) in patients with acute lymphoblastic leukemia (ALL) before and after induction chemotherapy, and to correlate the effect of induction chemotherapy on their bone mass (BM). MATERIALS AND METHODS: This quasi-experimental study was carried out at Hayatabad Medical Complex (HMC) and Khyber Medical University (KMU) in Peshawar, Pakistan, in one year. A total of 69 newly diagnosed patients with ALL were enrolled in the study. They were to begin the induction phase of chemotherapy at HMC oncology ward for about four weeks, following standard protocols. Data was collected using a predesigned questionnaire, and blood samples were obtained from all the patients by applying a non-probability consecutive sampling technique. The bone biomarkers levels were measured before therapy and after induction chemotherapy for comparison. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA), and a p-value of <0.05 was considered significant. RESULTS: The mean age was 13 ± 5.23 years. Out of the 69 patients enrolled in the study, 36 (52%) were male and 33 (48%) were female. After the four-week induction chemotherapy, there was a significant reduction in bone contents levels. Vitamin D, calcium, magnesium and potassium levels were below the levels documented prior to the treatment with a p-value < 0.05. The bone mass remained unchanged after the four weeks of chemotherapy. CONCLUSION: The induction phase of chemotherapy causes a significant reduction in the levels of bone bio contents and results in bone morbidities.

Arthralgia In A Young Patient: Presentation Of Lofgren Syndrome.

Lofgren syndrome an acute form of sarcoidosis constitutes erythema nodosum, bilateral hilar adenopathy and arthralgia or arthritis. Here we present a case of a 28 years old young male patient who is a shopkeeper and farmer by profession admitted to inpatient department with chief complaints of bilateral painful nodules on his shins, low grade fever and pain multiple joints on both sides of the body. Suspicion of the Lofgren syndrome was made upon initial evaluation and patient was admitted to inpatient care facility for necessary comprehensive workup. Radiological findings were consistent with bilateral hilar lymphadenopathy and patient was diagnosed with Lofgren syndrome. Patient was started on non-steroidal inflammatory drugs (NSAIDs) with close observation for improvement in response to treatment. After one weak of treatment in hospital, patient was discharged home when his symptoms started to resolve.

A Plum On Thumb: A Rare Presentation Of Synovial Sarcoma.

Synovial sarcoma (SS) is a rare and aggressive mesenchymal tumour accounting for around 5-10% soft tissue neoplasms usually found in joints of upper and lower extremities. A 35years old healthy looking male patient from Afghanistan presented with swelling on palmar side of base of thumb from last one year. Seven months back excisional biopsy was taken report of which showed neurofibroma/dermatofibroma with. No evidence of malignancy seen. From last 5months mass reappeared and gradually increased in size with itching sensation and mild pain. On local examination there was 5×4×5 cm reddish mass on palmar surface of base of thumb with extension into mid thenar eminence with diffuse margins. X-ray showed soft tissue density mass with spikes of calcification. Ultrasound showed 4.2×4×4.5 cm heterogeneous solid lesion on anteromedial surface of root of right thumb without any remarkable intralesional calcification and remarkable intralesional vasculature. MRI reported lobulated well defined soft tissue mass eliciting low to intermediate signal on T1 and WIs and bright signal on T2and STIR Vividly enhancing mass. Case was operated mass was excised and biopsy sent. Post op status was unremarkable. Biopsy reported poorly differentiated biphasic synovial sarcoma. No recurrence seen till 3months.

Comparison Between Uses Of Contraceptive Methods In LHW Covered And LHW Uncovered Areas.

BACKGROUND: Family planning is of great importance in population dynamics as unregulated fertility negatively affects the economic stabilization of the country. Family planning is considered an effective way for the improvement of child and maternal health and reduces the maternal and perinatal morality. Total contraceptive prevalence rate (CPR) in Pakistan is 29% even of the fact that 97% Pakistani women know only one method of contraception. This study compares the contraceptive usage among LHW covered and LHW uncovered areas. METHODS: This was a comparative cross-sectional study, which was conducted in LHW covered, and un covered areas in tehsil Takht Bai of district Mardan from August to December 2016. Samples of 102 families were selected randomly. All those females who were married, in reproductive ages (15-49 years) and were not pregnant were included in the study. RESULTS: Out of total 102 females 44 (43.1%) were from LHW covered areas while 58 (56.9%) were from LHW uncovered areas. Overall knowledge about various birth control methods was more in uncovered areas, i.e., 71.4% than the covered ones which was 28.6%, p=0.67 and most ladies knew only about the contraceptive pills as compared to other methods. No statistical difference p=0.86 was found in usage of contraceptive methods among couples living in LHW covered and uncovered areas. CONCLUSIONS: This study highlights contraceptive usage and role of national program for family planning and primary health care in promotion of contraception. A lot more has to be done for the improvement of family planning services in the community.

Comparison Between Uses Of Contraceptive Methods In LHW Covered And LHW Uncovered Areasxxx.

BACKGROUND: Family planning is of great importance in population dynamics as unregulated fertility negatively affects the economic stabilization of the country. Family planning is considered an effective way for the improvement of child and maternal health and reduces the maternal and perinatal morality. Total contraceptive prevalence rate (CPR) in Pakistan is 29% even of the fact that 97% Pakistani women know only one method of contraception. This study compares the contraceptive usage among LHW covered and LHW uncovered areas. METHODS: This was a comparative cross-sectional study which was conducted in LHW covered and un covered areas in tehsil Takht Bai of district Mardan from August to December 2016. A sample of 102 families were selected randomly. All those females who were married, in reproductive ages (15-49 years) and were not pregnant were included in the study. RESULTS: Out of total 102 females 44 (43.1%) were from LHW covered areas while 58 (56.9%) were from LHW uncovered areas. Overall knowledge about various birth control methods was more in uncovered areas, i.e., 71.4% than the covered ones which was 28.6%, p=0.67 and most ladies knew only about the contraceptive pills as compared to other methods. No statistical difference p=0.86 was found in usage of contraceptive methods among couples living in LHW covered and uncovered areas. CONCLUSIONS: This study highlights contraceptive usage and role of national program for family planning and primary health care in promotion of contraception. A lot more has to be done for the improvement of family planning services in the community.

Outcome Of 0.2% Glyceryltrinitrate Cream Versus 2% Diltiazem Cream In The Treatment Of Chronic Anal Fissure.

BACKGROUND: Anal fissure is a linear tear in the distal anal canal resulting from persistent hypertonia and spasm of the internal sphincter which results in mucosal ischemia. We have conducted a study in order to compare the outcome of 0.2% glyceryl trinitrate cream versus 2% diltiazem cream in the treatment of chronic anal fissure. METHODS: This randomized controlled trial (RCT) was carried out in the Department of Surgical "B" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 15th June 2012 to 15th May 2015. One hundred and eighty-four patients who visited the outpatient department for the treatment of chronic anal fissure were included in the study. They were divided into two groups with 92 patients in each group. Patients in group "A" included those patients receiving topical glyceryl trinitrate and group "B" patients were those receiving topical diltiazem cream. RESULTS: Out of 184 patients 66.3% were males, 33.7% were females. Mean age of the patients was 43.84±7.976 and mean duration of symptoms was 10.55±2.524. Overall outcome in terms of healing was 71.2%, among which 80.4% were from diltiazem group while 62% in glyceryl trinitrate group. Complete relief of pain was observed in 67.9%, 26.1% complained of mild pain and 5.4% complained of moderate pain. Only one patient in glyceryl trinitrate group complained with severe pain with no healing after one month of follow up. No statistical association was found between healing outcome and gender as well as age of the patients (p>0.05) although an association was found between healing outcome and duration of symptoms (p<0.05). CONCLUSIONS: This study shows that diltiazem has better outcome in terms of healing of chronic anal fissure and reductions in symptoms, i.e., pain compared with glyceryl trinitrate.

Cholecystectomy For Gall Stones In 26 Months Old Child.

Cholelithiasis is a major cause of morbidity worldwide. The incidence of gall stone in children in Pakistan has not been sufficiently studied and is increasingly being detected: the reason may be a true rise in the incidence or an improvement in diagnosis due to liberal use of diagnostic facilities and thus the increased opportunity to detect disease. A healthy 2 years and 2 months old male child presented to outpatient with history of recurrent attacks of pain abdomen and anorexia. Ultrasonography showed a 0.6 mm stone, inflammation and pericholecystic fluid. Open cholecystectomy was performed under general anaesthesia. A distended gall bladder with multiple very small calculi was removed. Post-operative stay was uneventful and patient was allowed oral feeds after 24 hours.