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An Assessment of Risk Factors Associated with Osteoarthritis: A Study in a Tertiary Care Hospital of Bangladesh
Shamsul Alam,
Erfanul Huq Siddiqui,
Sheikh Forhad,
Anjumun Ara,
Jannat Sultana
Issue:
Volume 9, Issue 3, June 2021
Pages:
98-102
Received:
20 March 2021
Accepted:
2 April 2021
Published:
29 April 2021
Abstract: Introduction: Osteoarthritis (OA) is a common musculoskeletal disorder which occur in different patterns. It is the most common form of arthritis, affecting millions of people worldwide year after year. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. OA can damage any joint that affects joints in one’s hands, knees, hips and spine. As there had been very few studies in Bangladesh we have not enough data regarding the risk factors of osteoarthritis. Objective: The aim of this prospective observational study was to evaluate the risk factors associated with osteoarthritis (OA). Methodology: This was a retrospective study which was conducted at the Department of Orthopedics Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from January 2018 to December 2018. Data were collected by a pre-designed questioner and analyzed by computer program, SPSS Version 20. Incomplete data-sheets were rejected before analysis and finally total study population was fixed to 146 with Osteoarthritis (OA). Result: Risk factor, family history was associated with 29 (19.86%) patients. It was the highest engagement and it was followed by Diabetes Mellitus: 27 (18.49%), history of injury: 14 (9.59%), Hypertension: 12 (8.22%) and previously operated: 7 (4.79%). In This study the comparison of sample data regarding risk factors have been displayed. Here against ACR, LEFS, K and L and VAS score P values were 0.876, 0.893, 0.067 and 0.436 respectively. So there was not any significant correlation. Conclusion: In this study ‘family history of osteoarthritis’ and ‘Diabetes Mellitus (DM)’ were two most frequent risk factors which was associated with osteoarthritis. But we did not find any significant correlation regarding any risk factor. More studies regarding OA are necessary to get the clear concepts about this issue.
Abstract: Introduction: Osteoarthritis (OA) is a common musculoskeletal disorder which occur in different patterns. It is the most common form of arthritis, affecting millions of people worldwide year after year. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. OA can damage any joint that affects joints in o...
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Combination Between Surgical Excision and Pressure Therapy for Ear Keloids in a Pediatric Population: Clinical Results
Ibrahim Cherry,
Tamara Sadighi,
Diane Franck
Issue:
Volume 9, Issue 3, June 2021
Pages:
103-108
Received:
11 April 2021
Accepted:
22 April 2021
Published:
8 May 2021
Abstract: Introduction: A single effective therapeutic option for ear keloids has yet to be discovered. Many treatments have been studied with variable effectiveness, side effects and complications. Pressure therapy using custom molded clip is a non-invasive treatment with minimal side effects. In the present study, the recurrence rate of a treatment protocol combining excisional surgery and pressure therapy on ear keloids is being studied in a pediatric population. Materials and Methods: The charts of 22 consecutive patients treated between January 2008 and January 2019 were reviewed. All patients were under 18 years of age and clinically diagnosed with, at least, one keloid of the ear. They all underwent complete surgical excision with primary closure followed by early postoperative pressure therapy using custom molded clips. The collected data included patient age at time of diagnosis and surgery, sex, skin type, familial and personal history, etiology and anatomical location of the keloid, and recurrence. Patients or parents were interviewed by phone call and reviewed by an independent examiner to evaluate the current evolution of their scar (s). Results: 22 patients were included in the study, representing a total of 26 keloids of the ear. The male to female ratio was of 3:4. The mean age at diagnosis was 9.7 years old. The mean follow-up time was 5.2 years. Four ears needed a single corticoid injection in addition to the initial protocol. Follow-up observations showed a recurrence rate of 15.4%. Conclusion: Excisional surgery combined with pressure therapy is an effective and well-tolerated treatment for ear keloids in a pediatric population. Although residual symptoms are sometimes observed, it seems to be better tolerated than other, more invasive, therapies.
Abstract: Introduction: A single effective therapeutic option for ear keloids has yet to be discovered. Many treatments have been studied with variable effectiveness, side effects and complications. Pressure therapy using custom molded clip is a non-invasive treatment with minimal side effects. In the present study, the recurrence rate of a treatment protoco...
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Usefulness and Cost-effectiveness of Interval Appendectomy for Complicated Appendicitis
Ryosuke Kita,
Hiroki Hashida,
Daisuke Yamashita,
Hiromitsu Kinoshita,
Masato Kondo,
Satoshi Kaihara
Issue:
Volume 9, Issue 3, June 2021
Pages:
109-113
Received:
7 April 2021
Accepted:
28 April 2021
Published:
14 May 2021
Abstract: Background: The management for abscess-forming appendicitis, including interval appendectomy, is controversial. Emergency surgery for abscess-forming appendicitis may lead to expanded surgery, which is associated with many perioperative complications. To prevent complications, we introduced the Interval Appendectomy protocol (IA protocol), and examined its efficacy compared to emergency appendectomy. Methods: Patients treated for complicated appendicitis at our hospital from January 2010 to January 2018 were consecutively enrolled into this study. They were classified into two groups based on enrollment before and after April 2014: emergency appendectomy group (EA group, before April 2014) and interval appendectomy group (IA group, after April 2014). We compared the perioperative treatment outcomes and examined the necessity for elective surgery, focusing on the postoperative pathological results of the IA group. Results: We enrolled 49 consecutive patients with complicated appendicitis who were treated during this study period. The IA protocol was applied to 38 patients; 32 patients completed this protocol and were assigned to the IA group. Patient characteristics were not significantly different between the IA and EA group. The IA group had significantly less postoperative complications (p=0.002) and medical costs (p=0.01). Residual inflammation in the appendix was observed in 16 cases (50%) pathologically. Conclusions: Interval appendectomy for complicated appendicitis was associated with a low incidence of perioperative complications and was effective in terms of cost. Interval appendectomy seems necessary to prevent recurrent appendicitis, given that inflammation remains on pathological examination.
Abstract: Background: The management for abscess-forming appendicitis, including interval appendectomy, is controversial. Emergency surgery for abscess-forming appendicitis may lead to expanded surgery, which is associated with many perioperative complications. To prevent complications, we introduced the Interval Appendectomy protocol (IA protocol), and exam...
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The Management of Positive Axillary Nodes in Early Stage Breast Cancer: Analysis of Practice Pattern Concordance with Landmark Trials
Danushka Seneviratne,
Laura Vallow,
Jinny Gunn,
Tammeza Gibson,
Emmanuel Gabriel,
Sanjay Bagaria,
Sarah McLaughlin
Issue:
Volume 9, Issue 3, June 2021
Pages:
114-120
Received:
9 March 2021
Accepted:
5 May 2021
Published:
26 May 2021
Abstract: Axillary nodal dissections (ALND) were historically performed in the management of early stage, node-positive breast cancer. Since the ACOSOG Z0011 landmark study demonstrated that patients with clinically negative axillae and 1-2 positive sentinel lymph nodes could be spared the morbidity of an axillary dissection, surgeons have widely adopted the omission of ALND. However, the practice patterns in the adjuvant setting remain less clear, and our current work wishes to address this gap by assessing the management of early stage breast cancer at our institution. We performed a retrospective analysis of 504 women with cT1/T2 N0 breast cancer undergoing breast conserving therapy (BCT) between 5/2011-6/2016 and collected data regarding the clinico-pathological characteristics of the tumors and the adjuvant therapies received. Overall, 97% patients completed a SLNB, while 3% underwent upfront ALND. None of SLNB positive patients had further axillary surgery. In the SLNB positive cohort however, adjuvant therapies consisted of 61.5% patients receiving regional nodal irradiation. Further analysis revealed that factors such as tumor type, T and N stage, hormone receptor status, tumor grade, the presence of LVSI, patient age, and patient race, did not correlate with clinician decisions to deviate from ACOSOG protocol recommendations regarding adjuvant therapy. Our work suggests that although ACOSOG Z0011 recommendations for minimizing axillary surgery in patients with limited nodal disease has largely been adopted at our institution, node directed radiation therapy continues to be relatively commonplace. Interestingly, the delivery of nodal irradiation was not associated with common clinic-pathological factors.
Abstract: Axillary nodal dissections (ALND) were historically performed in the management of early stage, node-positive breast cancer. Since the ACOSOG Z0011 landmark study demonstrated that patients with clinically negative axillae and 1-2 positive sentinel lymph nodes could be spared the morbidity of an axillary dissection, surgeons have widely adopted the...
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Episiotomy Closure After Vaginal Delivery – A Prospective, Single Centre Study Assessing a Novel Fast-Absorbable, Monofilament Suture in Daily Practice
Petra Baumann,
Michael Weigel
Issue:
Volume 9, Issue 3, June 2021
Pages:
121-127
Received:
8 April 2021
Accepted:
29 April 2021
Published:
26 May 2021
Abstract: This is the first assessment on the performance of a new fast-absorbable monofilament suture for episiotomy closure under daily clinical routine. The study was designed as a prospective, single centre, observational study including 50 women. Satisfaction and pain using the visual analogue scale was rated at discharge and eight weeks post-partum. Handling characteristics of the suture were assessed intrasurgically by the obstretricians using a 5-point Likert scale. Adverse events and wound healing outcome was monitored for eight weeks after delivery. Perineal pain rate as well as the pain level in different categories strongly decreased from discharge to eight weeks post-partum. Patient satisfaction was high, 84.4±18.97 and 91.2±16.86 at discharge and eight weeks after delivery, respectively. In total, 50% of the women had sexual intercourse 10 weeks post-partum. Suture handling was rated good to excellent by the obstretricians. Wound healing assessment indicated an excellent outcome. No wound dehiscence, wound infection, tissue reaction, allergic or inflammatory reaction occurred. Neither need for resuturing of the wound nor intrasurgical suture rupture were reported. Findings indicate that the clinical performance of novel, fast-absorbable, monofilament suture is equivalent to current sutures used for episiotomy closure and can be regarded as a viable alternative to rapid, absorbable multifilaments.
Abstract: This is the first assessment on the performance of a new fast-absorbable monofilament suture for episiotomy closure under daily clinical routine. The study was designed as a prospective, single centre, observational study including 50 women. Satisfaction and pain using the visual analogue scale was rated at discharge and eight weeks post-partum. Ha...
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Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics
Peter Deptula,
Dung Nguyen
Issue:
Volume 9, Issue 3, June 2021
Pages:
128-133
Received:
25 April 2021
Accepted:
7 May 2021
Published:
27 May 2021
Abstract: Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.
Abstract: Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal do...
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Efficacy of Desarda's in Comparison to Lichenstien's Techniques for Primary Inguinal Hernia Repair Regarding to Operative and Post-operative Parameters
Abd-El-Aal Ali Saleem,
Islam Ahmed Amer,
Emad Gomaa
Issue:
Volume 9, Issue 3, June 2021
Pages:
134-144
Received:
20 April 2021
Accepted:
25 May 2021
Published:
31 May 2021
Abstract: Background: The aim was to assess the efficacy and safety of Desarda’s no-mesh repair in comparison to Lichtenstein’s tension -free mesh repair in treatment of primary inguinal hernia. Methods: a prospective study of 80 patients suffering from unilateral primary inguinal hernia who underwent elective operation for hernia repair. The patients were of both males and females their age ranged from 20 - 60 years. They were divided into two groups (A and B). Group A: 40 patients were subjected to Desarda’s no mesh repair. Group B: 40 patients were subjected to Lichtenstein’s tension free mesh repair. The data were collected within one year including sociodemograghic data, general and local examination, co-morbidities, type and duration of inguinal hernia, type of operation, intra- and post -operative parameters, hospital stay and recurrence. Results: Demographic parameters, general examination, duration, type of hernia and co-morbidities in the two intervention arms were similar and shows insignificant difference. 35.5 minutes was the operative time in Desarda’s group and 46 minutes in Lichtenstein’s group which was highly significant (p<0.0001). Post-operative pain, loss of sensation over groin, chronic inguinal pain (>1 month), hospital stay duration and return to normal activity were significantly decreased in Desarda’s group in comparison to Lichtenstein’s group (P<0.0001& P<0.01 & P<0.01 & P<0.0001, P<0.001, respectively). Foreign body sensation and reaction, abdominal wall stiffness and migration of mesh occurs only in Lichtenstein’s group. Hematoma, seroma, scrotal edema, surgical site infection and fever shows insignificant deference between the studied groups but more prevalent in Lichtenstein’s group than Desarda’s group (P=0.49 & P=0.26 & P=0.21 & P=0.09 and P=0.67, respectively). No recurrences of hernia in both studded groups through 1- year follow-up. Conclusion: This study has shown that Desarda’s repair for primary inguinal hernia gives better results when compared with the Lichtenstein’s repair. It is easy to learn and it is physiologically sound. It is associated with less operative duration and mesh related complications. It can be used in a contaminated surgical field, in young individuals and in cases of financial constraints.
Abstract: Background: The aim was to assess the efficacy and safety of Desarda’s no-mesh repair in comparison to Lichtenstein’s tension -free mesh repair in treatment of primary inguinal hernia. Methods: a prospective study of 80 patients suffering from unilateral primary inguinal hernia who underwent elective operation for hernia repair. The patients were o...
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Treatment of Open Book Pelvic Fractures: Comparison Between Internal and External Fixation
Md. Zulfiqur Ali,
Jibananda Halder,
Nahid Sultana,
Mohammad Rajib Mahmud
Issue:
Volume 9, Issue 3, June 2021
Pages:
145-148
Received:
1 March 2021
Accepted:
21 April 2021
Published:
4 June 2021
Abstract: Background: An open-book pelvic fracture is used to describe any fracture that significantly disrupts the pelvic ring of human body. Internal and external fixation in treating open book pelvic fractures are two broadly used treatment methods. But we have very few comparative data regarding this issue. The aim of this study was to compare both internal and external fixation methods in the treatment of open book pelvic fractures. Methods: This prospective comparative study was conducted at the Department of Orthopaedic Surgery in Shaheed Mansur Ali Medical College, Sirajganj, Bangladesh and The National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR) during the period from January 2016 to December 2018. In total 100 patients with open-book pelvic fracture were obeyed all the inclusion and exclusion criteria and completed the full tenure of the intervention were finalized as the study population. Total population were divided into two groups. In Group I there were 50 participants who were treated by internal fixation method and in Group II there were 50 participants who were treated by external fixation method. Data were analyzed by SPSS Version 20 and disseminated by MS Office programs. Result: In the final follow-up of this study among total participants, there were 34 excellent, 30 good, 16 fair and 20 poor results. But, In Group I, 56% got excellent and 38% got good result. Besides these, only 4% got fair and 2% got poor result. On the other hand, the highest 38% participants got poor result. Then 28%, 22% and 12% got fair, good and excellent results respectively. This difference was statistically highly significant, the p-value was 0.013. Conclusion: After completing this comparative study it was found that the internal regarding outcome and complications the internal fixation method is better than external fixation method in treating open-book pelvic fracture.
Abstract: Background: An open-book pelvic fracture is used to describe any fracture that significantly disrupts the pelvic ring of human body. Internal and external fixation in treating open book pelvic fractures are two broadly used treatment methods. But we have very few comparative data regarding this issue. The aim of this study was to compare both inter...
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