Journal of Gandhara Medical and Dental Science

Frequency of Maxillofacial Trauma in Patients Reporting to Oral and Maxillofacial Surgery Unit, Lady Reading Hospital, Peshawar

2025-01-07T01:06:38-06:00

OBJECTIVES

This study aimed to determine the epidemiology and primary etiology of maxillofacial fractures and to correlate these factors to identify the main patient categories affected by various traumatic etiologies.

METHODOLOGY

This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Lady Reading Hospital, Peshawar, Pakistan, from 21 July 2023 to 30 April 2024. Ethical approval was obtained from the Institutional Review Board, and informed consent was acquired from all participants. Patients of all ages and sexes who presented with maxillofacial trauma were included. The data were collected using a structured questionnaire and clinical examination, and the analyses were performed using R statistical software.

RESULTS
A total of 137 patients were included, with a greater prevalence of maxillofacial fractures among males (68.61%) and individuals aged 18-30 (67.88%). Road traffic accidents were the most common cause of injury (35.04%). Females were more likely to be involved in assaults (χ² = 18.614, p = 0.00033). The chi-square tests and one-way ANOVA showed no significant differences in BMI, duration of complaints, or age based on the laceration site or mechanism of injury.

CONCLUSION

This study highlights the high incidence of maxillofacial fractures among young adults, primarily due to road traffic accidents and interpersonal violence. The findings underscore the need for preventive strategies, better traffic regulations, and targeted education to reduce the incidence of these injuries.

The Comparison of Microbiologic Pattern in Chronic Osteomyelitis Over 5 Years Period, Hayatabad Medical Complex, Peshawar

2025-02-27T22:47:31-06:00

OBJECTIVES

This study aimed to quantify the changes in microbiological patterns associated with chronic osteomyelitis over five years. It specifically focused on infections caused by multi-drug resistant (MDR) bacteria and the susceptibility of antimicrobial treatments in the Department of Orthopedic and Spine at HMC, Peshawar.

METHODOLOGY

This cross-sectional study was conducted in the Department of Orthopedic & Spine Surgery Hayatabad Medical Complex Peshawar, Pakistan, from 1^st August 2023 to 31^st July 2024. The sample size was 133. A non-probability consecutive sampling technique was used for sampling. All patients fulfilling the inclusion criteria were included in our study. Patient’s age (< 45 years or > 45 years) & gender (men/women) were our demographic variables, while the presence of chronic osteomyelitis was our research variable. Data was analyzed using IBM-SPSS-V.25.

RESULTS
Out of 134 patients in the study, 70(52.2%) were males & 64(47.8%) were females. Among patients in Group A, i.e., from 11th Nov 2018 to 1st Nov 2019, the most prevalent microbe causing osteomyelitis was Pseudomonas aeruginosa, 29%, followed by MRSA found in 26.3%. Among patients in Group B, i.e., 1^st Nov 2023 to 1^st Nov 2024, the most prevalent microbe causing osteomyelitis was Methicillin Sensitive Staph aureus (MSSA) 40.2% followed by Pseudomonas aeruginosa 13.8%. MRSA was isolated from 2 cases. Among instances of various osteomyelitis, E-Coli & Pseudomonas aeruginosa were the most resistant microbes to multiple antibiotics.

CONCLUSION

The evolving antibiotic resistance to various microbes has made it mandatory to perform cultures of infected bone & to use antibiotics that are sensitive to specific organisms. Further, in our setup, there has been a decline in several MRSA cases in 5-year period causing osteomyelitis. Pseudomonas aeruginosa & E-Coli are associated with multi-drug-resistant Chronic Osteomyelitis.

Graceful Aging: A Cross-Sectional Study on The Frequency, Risk Factors, And Predictors of Falls Using The Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test

2025-02-11T23:26:09-06:00

OBJECTIVES

We aimed to determine the frequency, risk factors, and predictor of falls in the aged population using the Berg Balance Scale and the Timed up and test.

METHODOLOGY

A cross-sectional study was conducted for 1 year from 2023 to 2024 on 376 subjects selected from outpatient clinics of tertiary hospitals; those above 65 years of age, physically and mentally handicapped subjects were excluded. A thorough history of physical examinations was made, and they were assessed through timed up-and-go tests and the Berg balance scale to screen for fall risk. Non-probability serial sampling technique was used, and the sample size was determined through the openEpi.com sample size calculator by keeping a 95% confidence interval, 5% margin of error and 80 power of test; the calculated sample size was 376. Open epi calculator used following formula Sample size n = [DEFF*Np(1-p)]/ [(d2/Z21-α/2*(N-1) + p*(1-p)].

RESULTS
The frequency of falls in 65 plus older adults in the past 2 years was 20.7% (77) in the study. Fall was seen more in women, 38% (35). Of those who fell, 50 (22.4%) subjects belonged to a low socioeconomic class. The urban dwellers had a fall prevalence of 21.3% (76). Among various comorbidities, Diabetics (68.8%) were more prone to falls. Of all the diabetics who fell, neuropathy was found to be the most frequent complication, 48.9% (23). Visual impairment was a common finding among the fall subjects, 23.1% (74). Muscle relaxant use (81.3%) was the primary reason for falling among all medication-induced falls. The proportion of people who used assisted walking devices was 59.3% (16). Of the subjects who fell, 51.3 % had compromised BBS scores while 15.8% had compromised timed up and test, indicating that BBS score is a better marker of falls in age.

CONCLUSION

These results highlight the importance of targeted fall prevention strategies, particularly for high-risk populations, to mitigate the risk of injury and improve overall mobility and safety.

Postgraduate Students Perception of Using Chatgpt in Clinical Management and Research: A Qualitative Exploratory Study

2025-02-01T01:01:30-06:00

OBJECTIVES

This study investigated how postgraduate residents see ChatGPT's function in clinical and research settings.

METHODOLOGY

May 1, 2024, to September 30, 2024, was the time frame for this research. Twelve postgraduate residents from three tertiary care institutions in Peshawar participated in a qualitative exploratory study. Semi-structured interviews were used to gather the data, and a thematic analysis was performed to determine the main topics.
RESULTS
While ChatGPT saved research time, study participants reported that it also generated issues with data privacy and information accuracy. Power users felt the instrument was easier to use, although there was a range of comfort levels. While its capabilities were promising, most participants worried that using AI to make clinical judgments was risky.
CONCLUSION
ChatGPT can be a helpful addition to research-based tasks, but like any other technology, it may be misused in clinical settings. This calls for better training and optimization standards, which must be addressed in our medical practice.

Comparing the Effect of Stannous Fluoride Toothpaste with Placebo in Treating Dentinal Hypersensitivity

2024-12-28T00:08:45-06:00

OBJECTIVES

This study aimed to compare the efficacy of stannous fluoride toothpaste versus placebo in treating dentinal hypersensitivity.

METHODOLOGY

This quasi-experimental study was conducted at the Department of Periodontology, Rehman Medical Institute (RMI), Peshawar from July 25, 2023, to January 25, 2024. The study included 176 patients aged 18-70 years with at least two hypersensitive teeth. Participants were randomly divided into two groups: the test group (stannous fluoride toothpaste) and the control group (placebo). Sensitivity was measured at baseline, 3 minutes after application, and 15 days post-application using the Schiff Cold Air Sensitivity Scale (SCASS). Oral hygiene measures, clinical attachment loss, and gingival recession were also recorded. Data were analyzed using independent t-tests and Chi-square tests.

RESULTS
The test group showed significant improvement in SCASS scores compared to the control group (93.2% vs. 12.5%, p<0.001). Participants who used toothbrushes had significantly better outcomes than those using miswak or never engaging in oral hygiene. Participants who brushed more frequently experienced improved sensitivity relief, as effective brushing helps distribute the active fluorides uniformly across the teeth.

CONCLUSION

Stannous fluoride toothpaste significantly reduces dentinal hypersensitivity compared to placebo, supporting its use as an effective treatment for DH.

Exploring the Effects of the Covid-19 Pandemic on Obstetrics and Gynecology Postgraduate Trainee's Training in Lady Reading Hospital, Peshawar

2024-08-09T00:17:05-05:00

OBJECTIVES

To assess the effects of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) postgraduate trainees’ training experiences at Lady Reading Hospital, Peshawar

METHODOLOGY

A cross-sectional study was conducted among 103 OBGYN trainees infected with COVID-19 during the pandemic. Data were collected through a binary-response questionnaire. Demographic details and the impact of COVID-19 were analysed. Statistical analysis was performed by SPSS 24 while various trends were identified using Chi-square tests with significance set at p < 0.05.

RESULTS

The majority of the trainees reported negative impacts on clinical/surgical skills (96.1%), mental health impact was reported by 89.3% of trainees, fear of infecting family members by 93.2%, impact on research by 52.4% while 77.7% of trainees found online learning to be beneficial. Married trainees experienced notably higher mental health impact (p = 0.03) but reported more benefit from online training (p = 0.02). 37.9% of trainees reported to be engaged with telemedicine.

CONCLUSION

Trainees faced significant setbacks in terms of gaining clinical skills, sustaining mental health, achieving research goals, and adapting to new modes of education

Diagnostic Accuracy of Twinkling Artifact of Doppler Ultrasound in Predicting Urinary Tract Calculi Taking Ct Scan As Gold Standard.

2025-01-30T00:32:06-06:00

OBJECTIVES

This study aims to determine the diagnostic accuracy of the twinkling artifact of Doppler ultrasound in predicting urinary tract calculi by taking a CT scan as the gold standard in the patients presenting to the radiology department at Hayatabad Medical Complex Peshawar.

METHODOLOGY

A cross-sectional study was conducted in the Radiology Department of Hayatabad Medical Complex Peshawar in the duration of 22nd April 2021 to 22nd October 2021
A total of 206 suspected of having urinary tract calculi were included in the study consecutively and subjected to Doppler ultrasound followed by CT KUB.

RESULTS
The mean age of the sample was 42.3 + 9.1 years. 67% of the sample was male, and 33% were female. The mean duration of symptoms in our group of samples was 4.1 + 1.3 weeks. On twinkling artifacts with Doppler US, urinary tract calculi were observed in 53.4% of patients. In contrast, on follow-up CT KUB scans, urinary tract calculi were recorded in 73.3% of patients. The sensitivity of twinkling artifacts with Doppler US was found to be 71.5%, and the specificity was found to be 96.4%. The positive predictive value of the twinkling artifacts with Doppler US is 98.2%, and the negative predictive value is 55.2%.

CONCLUSION

Twinkling artifact on Doppler US has an acceptable sensitivity and specificity for detecting urinary tract calculi. As such, it is a useful radiological tool for diagnosing urinary tract stones in adults, and further studies are recommended to confirm its usefulness, particularly considering other explanatory effect modifiers.

Electric Pulp Tester Response Thresholds Across Electrode Placement Sites in Maxillary and Mandibular Anterior Teeth: A Cross-Sectional Study

2025-02-16T23:07:57-06:00

OBJECTIVES

To compare the Electric Pulp Tester (EPT) response thresholds at different electrode placement sites (incisal edge, third, middle third, and cervical third) in maxillary and mandibular anterior teeth.

METHODOLOGY

This cross-sectional study was carried out from December 2022 to March 2023. This study included individuals from the age range of 18 – 60 years. Six teeth of 60 individuals were assessed in the study. Randomly, either the right or left side of the arch was selected. EPT was performed on each tooth at four different sites (incisal edge, incisal third, middle third, cervical third, labially). The reading was noted when the individual felt tingling or warmth in the tooth. The digital readout at which the participant felt the sensation was considered the threshold. The data was analyzed using R/RStudio. Means of variables from each location were compared using ANOVA and Pair sample t Test while the critical level of significance was set at p ≤ 0.05.

RESULTS
No statistically significant differences were observed in EPT readings between maxillary and mandibular teeth across the tested regions (p > 0.05). In maxillary anterior teeth, significant differences were found across the four areas, with the middle third of central and lateral incisors (15.77 ± 8.13, p = 0.045; 16.30 ± 8.70, p = 0.032) and the cervical third of canines (17.58 ± 10.76, p = 0.028) showing the lowest threshold values. In contrast, no significant variations were observed in the mandibular anterior teeth across the four regions (p > 0.05).

CONCLUSION

The middle third of maxillary anterior teeth may be an optimal site for EPT electrode placement. However, no significant differences were noted across regions for mandibular anterior teeth.

Correlation Between Hemoglobin Levels and BMI in Dental Students: A Cross-Sectional Study

2025-01-21T22:48:58-06:00

OBJECTIVES

This study aimed to determine the frequency of anemia in undergraduate dental students and the relationship between hemoglobin level and body mass index (BMI) in dental students.

METHODOLOGY

A cross-sectional study was conducted at a dental college in Peshawar. with 370 out of 400 students participating after ethical approval. Questionnaires were distributed, and consent was obtained for hemoglobin testing. Students with blood disorders, cardiovascular issues, or eating disorders were excluded. Five milliliters of venous blood were collected under aseptic conditions for a complete blood count using an automatic analyzer. Height and weight were measured to calculate BMI (BMI = weight (kg) / height (m²)). Participants were classified into anemic and non-anemic groups based on WHO guidelines. Data analysis was conducted using SPSS version 24, employing Pearson correlation to explore the relationship between anemia and BMI.

RESULTS
Among the students (n=370) who took part in our research, 149 (40.2%) were male, and 221 (59.8%) were female. Among them, only 6 (4%) male and 181 (81.9%) female students were anemic. The mean hemoglobin value in males was 13.38 gm/dl (± 1.70); in females, it was 11.75 gm/dl (± 1.15). According to the World Health Organization (WHO), a hemoglobin level of < 12 gram/deciliter is considered anemic. Of the female students, 94 (42.5%) were underweight. 127 female students, or 57.4% of the total, had a BMI that was within the healthy range. Not a single female student was obese. Thirteen (8.7%) male students were overweight, whereas 136 (91.2%) fell within the acceptable body mass index (BMI) range. No male student was underweight. The correlation between Hb and BMI was r=-0.49, P<0.001.

CONCLUSION

A strong negative correlation of hemoglobin level with body mass index was found. Anemia is more prevalent in females, which is of concern and must be addressed.

Association of Osteopontin (OPN) Level in Diabetic Nephropathy Patients as an Early Diagnostic Marker

2025-01-23T01:21:32-06:00

OBJECTIVES

The study aimed to find an association between OPN levels and diabetic nephropathy as a serum marker in DM patients for early detection.

METHODOLOGY

A cross-sectional study was conducted for 6 months on 277 diagnosed cases of DM with 10 positive and 10 negative controls collected through non-probability sampling. Fasting blood sugar, HbA1c, serum urea and creatinine levels of known diabetic patients were measured to confirm their disease status and OPN using an ELISA Kit and compared in DM patients and controls. Statistical analysis was performed using SPSS v22.0. DM patients and negative controls were compared using unpaired one-way ANOVA and least square methods. The p-value of ≤0.05 was deemed statistically significant.

RESULTS
Osteopontin has a significant relation with diabetes duration only. Serum biomarkers of the DM show significant osteopontin levels with 0.00 p values for HBA1C and all biomarkers of Diabetes. The least-square distribution of the different biomarkers with osteopontin level at 95 % confidence interval and standardized coefficients show lower and upper bound and significant levels. Osteopontin levels show 0.29 and 0.38 lower and upper bound at a 95% confidence interval, with a 0.79 considerable level and 0.25 t distribution, with 0.01 beta values for diabetes duration. Blood creatinine level is 0.02 and 0.05 lower and upper bound, with 0.36 significance level for Osteopontin and 0.02 standard error. Osteopontin levels 11ng/dl to 20 ng/dl have been found in 88 cases, while 09 in positive controls and 12 in negative controls. Meanwhile, only two positive controls were found>20 ng/dl osteopontin level.

CONCLUSION

Serum (OPN) was positively correlated in positive controls and low levels in negative control and regular diabetic patients with no nephropathy.

Frequency and Pattern of Root Resorption on Radiographic Inspection Saidu College of Dentistry, Swat - A Cross-Sectional Study.

2025-02-13T00:44:13-06:00

OBJECTIVES

This study aimed to determine the frequency and pattern of root resorption through radiographic evaluation at Saidu College of Dentistry, Swat.

METHODOLOGY

A cross-sectional survey was conducted at Saidu College of Dentistry, Swat, on 204 cases using the non-probability consecutive sampling method. Patients aged 14 and older, of both genders, and Pakistani nationals were included, provided they had complete radiographs and demographic data. Cases with unclear radiographs, systemic bone disorders, or prior root canal treatment were excluded. Root resorption was categorized into apical (ARR), internal inflammatory (IIRR), and external (ERR) based on radiographic findings. Chi-square/Fisher exact tests applied to stratify root resorption patterns by age and gender at a significance level of p<0.05.

RESULTS
The mean age was 25.63 ± 6.22 years, with 103 (50.49%). Root resorption was present in 29 (14.22%) cases, with ARR being the most frequent (19, 9.31%), followed by ERR (6, 2.94%) and IIRR (4, 1.96%). Males had a higher prevalence of resorption (17, 58.62%) than females (12, 41.38%), though this was not statistically significant (p=0.29). ARR was significantly more common in males (15, 78.95%), whereas ERR was exclusively observed in females (6, 100%). IIRR was equally distributed between genders (2, 50% each) and was found exclusively in younger individuals (4, 100%). Age group differences were not statistically significant (p=0.53), but ARR (13, 68.42%) and ERR (5, 83.33%) were more common in the 14–30 years group.

CONCLUSION

Root resorption was observed in quite a high number, with apical resorption being the most common, followed by external and internal inflammatory resorption.

Exploring Challenges to the Students and Faculty in an Undergraduate Integrated Dental Curriculum; A Qualitative Study.

2025-03-14T23:28:44-05:00

OBJECTIVES

To explore challenges to the students and faculty in an Undergraduate Integrated Dental Curriculum.

METHODOLOGY

The qualitative phenomenological study was conducted in Peshawar Dental College, Peshawar from June to October 2023 (05 Months).Dentistry students and faculty who had experienced the integrated curriculum were recruited with consent, by purposive sampling. After the ethical approval, three focus group discussions were held where the interview guide was structured using Sanford’s theoretical framework featuring open-ended questions, validated by subject experts. The student’s focus group consisted of eight students of basic sciences, (first and second year), and clinical sciences, (third and final year) of Bachelor of Dental Surgery. Whereas the two faculty focus groups consisted of basic sciences and clinical sciences faculty. The focus group discussions were audio recorded and transcribed, using Otter AI and transcribed verbatim, and analyzed using Braun and Clarke’s thematic content analysis,

RESULTS
Out of 20, eight students and twelve faculty members belonging to the same institute participated in the focus group discussions. The identified themes were, (a) Challenges of an Integrated System (b) Strategic Assessment Reformation & feedback, (c) Supportive Measures and benefits of an Integrated Curriculum.

CONCLUSION

Several challenges were identified in the integrated dental curriculum. The students’ challenges included a heavy workload, rapid pace, and limited revision time. The faculty faced challenges like resistance to change, inadequate infrastructure, and assessment validity concerns. They required comprehensive training in integrated teaching methodologies and effective assessment strategies.

Outcomes of Posterior Component Separation Technique with and Without Transverse Abdominus Release in the Management of Complex Abdominal Wall Hernias

2025-01-30T00:31:47-06:00

OBJECTIVES

To evaluate and compare the outcomes of the Posterior Component Separation (PCS) technique with and without Transversus Abdominis Release (TAR) in the management of complex abdominal hernias, focusing on recurrence rates, complications, and overall surgical effectiveness.

METHODOLOGY

This retrospective cohort study was conducted at Hayatabad Medical Complex, Peshawar, from January 2020 to April 2023. A total of 87 patients with complex midline and lateral hernias were included. Complex hernias had defects >8 cm, >20% abdominal domain loss, multiple defects, or recurrence. Lateral hernias were post-open cholecystectomy incisional hernias. Data on demographics, comorbidities, and surgical details were analysed using SPSS v20. Chi-square and Fisher’s exact tests were applied for categorical variables, and an independent t-test was used for continuous variables (p<0.05 considered significant).

RESULTS
Of 87 patients, 42 (48.3%) underwent PCS-TAR, while 45 (51.7%) had PCS without TAR. The mean operative time was 120 ± 10.6 minutes. Complications occurred in 24 (27.6%) patients, significantly higher in the TAR group (38.1% vs. 17.8%, p=0.034). Recurrence was observed in 7 (8%) patients. Seroma formation was more common in the TAR group (16.7% vs. 2.2%, p=0.009). Mortality occurred in one patient due to pulmonary embolism.

CONCLUSION

Posterior component separation technique with or without transversus abdominis release is a neoteric surgical procedure for managing large complex hernias. It has an excellent outcome with minimal complications, resulting in improved quality of life for the patients.

Correlation Between Self-Esteem, Locus of Control, And Quality of Life in Individuals Undergoing Drug Addiction Rehabilitation: A Cross-Sectional Study

2025-03-03T01:01:04-06:00

OBJECTIVES

This study aimed to assess the levels of self-esteem, locus of control, and quality of life in patients attending drug addiction rehabilitation centers. It also sought to explore the relationships between self-esteem, locus of control, and overall quality of life at different stages of treatment. Additionally, the study intended to determine whether self-esteem and locus of control can predict the quality of life in these patients.

METHODOLOGY

A cross-sectional descriptive correlational design with a sample size of 142 participants conducted at rehabilitation centers in Peshawar over six months. Participants were recruited through non-probability convenience sampling. Data was collected through structured interviews using validated questionnaires, including Rotter’s Locus of Control Scale, Rosenberg’s Self-Esteem Scale, and the Drug User Quality of Life Scale (DUQOL).

RESULTS
Among 141 male participants, 83% had moderate self-esteem and internal control. The mean DUQOL score was 66.48 (SD=7.649). Pearson’s correlation showed positive associations between DUQOL and Drug-Related Locus of Control (DR-LOC) (r=0.059) and DR-LOC and self-esteem (r=0.077), while DUQOL and self-esteem were negatively correlated (r=-0.016). Significant associations were found between age and self-esteem (F=1.765), age and DR-LOC (F=0.567), and education level and self-esteem (F=1.168). Higher control was linked to better quality of life and self-esteem, with age and education significantly influencing self-esteem.

CONCLUSION

These findings underscore the importance of addressing psychosocial factors in addiction recovery, suggesting that enhancing self-esteem and fostering an internal locus of control (ILoC) may improve the quality of life (QoL) for individuals in rehabilitation.

Prevalence and Contributing Factors of Gingival Hyperplasia in Orthodontic Patients

2024-12-28T00:01:18-06:00

OBJECTIVES

This study evaluates the prevalence and factors contributing to gingival hyperplasia in orthodontic patients in Peshawar.

METHODOLOGY

A cross-sectional study was conducted at the teaching dental hospital of Peshawar from January to September 2025, involving 300 orthodontic patients aged 15-40 years. Clinical examinations assessed gingival enlargement using the Gingival Overgrowth Index (GOI). Statistical analyses examined associations between gingival hyperplasia and factors such as age, gender, oral hygiene practices, and duration of orthodontic treatment.

RESULTS
Gingival hyperplasia was noted in 45% of the participants involved in the study. A more detailed analysis revealed that this condition was particularly prevalent among individuals with poor oral hygiene practices, affecting 63% of this group. Additionally, those undergoing treatment for longer than 12 months showed a significant prevalence rate of 54%. When examining the data by gender, it was found that females exhibited a slightly higher incidence of gingival hyperplasia at 48%, compared to 41% in males. This suggests that oral hygiene and treatment duration may play critical roles in developing gingival hyperplasia, which warrants further investigation to understand the underlying mechanisms and potential preventive measures.

CONCLUSION

Gingival hyperplasia is prevalent in nearly half of orthodontic patients, emphasising the importance of rigorous oral hygiene practices and regular professional monitoring during treatment.

Aging Population and the Changing Paradigm of Hip Fracture Management

2025-03-03T00:32:10-06:00

As the global population ages, the issue of hip fractures in healthcare is becoming more significant. Once seen mainly as a concern for orthopedic surgeons, hip fractures are now recognized as a symptom of aging. The management approach has shifted to emphasize early mobilization, multidisciplinary collaboration, and comprehensive geriatric care. Traditionally, treatment focused on surgical fixation and postoperative rehabilitation. However, emerging evidence shows that a multidisciplinary approach improves patient outcomes. Hip fracture patients are often frail and have multiple comorbidities, necessitating medical intervention beyond orthopedic care. The involvement of geriatricians, especially ortho-geriatricians, is crucial for optimizing perioperative management and supporting long-term recovery. Recent studies underscore the growing burden of hip fractures worldwide. In 2019, approximately 4.1 million hip fracture cases were reported globally among individuals aged 50 and older.¹ Projections indicate that hip fractures will nearly double by 2050, primarily due to demographic shifts and an aging population.² This trend is particularly concerning for developing countries, where healthcare systems may face challenges in managing the increasing incidence of such injuries. Mortality rates associated with hip fractures remain alarmingly high. One-year all-cause mortality rates range from 14.4% in Singapore to 28.3% in the United Kingdom.³ These statistics highlight the critical need for timely and effective interventions to improve patient outcomes.

Modern hip fracture management now relies on coordinated efforts from various healthcare professionals. Early involvement of doctors, including geriatricians and anesthetists, ensures thorough preoperative assessment. Physiotherapists and occupational therapists are vital for enhancing outcomes in early mobilization. Pharmacists manage polypharmacy and optimize osteoporosis treatment while nursing staff provide continuous care. In Western healthcare, social services and family support are key for effective post-discharge care. Communication among all stakeholders is crucial for patient-centered care. Centralized hip fracture wards with standardized protocols have better outcomes than fragmented care models.⁴ A key change in hip fracture management is the emphasis on early surgery, ideally within 36 hours of admission, which has been shown to decrease mortality and improve functional outcomes. Delays should be avoided, even for chronic conditions that cannot be immediately addressed. Enhancing hydration and resuscitation before surgery improves readiness and prognosis. Additionally, early, full-weight-bearing mobilization after surgery is now encouraged to reduce complications like deep vein thrombosis and pneumonia. Tailored anesthesia approaches, particularly regional techniques like fascia iliaca blocks, are effective in reducing opioid use and lowering the risk of postoperative delirium in elderly patients. Hip fractures, often due to osteoporosis, provide a chance to start long-term treatment to prevent future fractures. Every patient with a neck or femur fracture should be evaluated for osteoporosis and prescribed appropriate medications such as bisphosphonates. Fracture liaison services can help ensure adherence to treatment guidelines.

Government policies and healthcare directives are vital in hip fracture management, as early surgery and multidisciplinary care can improve clinical outcomes and efficiency. Studies like the HIP ATTACK trial offer valuable insights for refining treatment protocols. While developed healthcare systems effectively implement these approaches, developing countries face challenges like limited resources and workforce shortages. Nevertheless, the gradual incorporation of principles such as early surgery, dedicated orthopedic wards, and multidisciplinary teams can lead to significant improvements. Collaboration between local and international institutions is essential for knowledge exchange and training to enhance care in these regions. Government support is crucial for policy changes and funding to promote early mobilization and osteoporosis management. By combining global best practices with adaptable local strategies, developing healthcare systems can significantly improve hip fracture outcomes and overall quality of life for aging populations. The management of hip fractures has transitioned from being mainly a surgical issue to a comprehensive, multidisciplinary challenge that necessitates the coordinated efforts of various healthcare professionals. As the global population ages, adopting and enhancing these strategies is essential to ensure that hip fracture care meets the complex needs of elderly patients. The future of hip fracture management will be defined by collaboration, innovation, and a focus on patient-centered care.

Intoxication by the Berries of Coriaria Myritfolia - A Case Report

2025-02-12T23:53:49-06:00

T Coriaria Myritfolia is a shrub that grows 2-3 meters tall. The exact local name of the plant is unknown, but in Hindi, some species of Coriaria are called “Divi-Divi”. We report a case of intoxication following ingestion of fruits of Coriaria Myritfolia. A 6-year-old boy, the previously healthy child, was brought to the pediatric emergency department after accidentally ingesting red berries from a tree growing wild in district Haripur. On inquiry, the parents of the child reported that after the ingestion of an unknown quantity of fruit, the child felt nauseated and vomited. We sought care from a local Physician who treated the outpatient as a case of food poisoning. The child didn’t get better and, after 4-6hr from the ingestion of berries, felt a generalised-tonic-clonic seizure with up rolling of the ball and incontinence. The parents immediately brought the child to a tertiary care hospital. Upon arrival at the hospital, the patient was somnolent with generalised hypotonia. The Prophylactic 10mg Diazepam (0.4mg/kg) is given per rectal. The peripheral intravenous line passed. Initial labs were not conclusive except for hypokalemia and metabolic acidosis. He was started on the prophylactic antiseizure elixir of Phenobarbital 5mg/kg/day and levetiracetam 400mg/ day. CT brain was normal. The patient was discharged after 3^rd day of admission on anti-seizure medications. We concluded that the intoxication with the fruits of Coriaria Myritfolia could be managed successfully if the patient came to the hospital within 6-8 hours with anti-seizure medications.

Subhepatic Perforated Appendicitis Complicated by Intestinal Obstruction: A Case Report

2025-02-06T01:28:16-06:00

Subhepatic appendicitis is an anatomical variant of acute appendicitis that sometimes occurs secondary to midgut malrotation or developmental abnormalities during fetal development. It represents only 0.01% of cases of appendicitis and can be misdiagnosed for other intra-abdominal conditions like acute cholecystitis or liver abscesses, resulting in delayed diagnosis. This is a case of a 30-year-old patient with subhepatic perforated appendicitis complicated by intestinal obstruction. The patient was taken for emergency exploratory laparotomy after thorough investigations and clinical examination. Subhepatic appendicitis was found intraoperatively. Appendectomy was performed under aseptic techniques. Postoperatively, the patient was stable and tolerating oral fluids. This case highlights the role of imaging and early surgical approach in managing subhepatic appendicitis.

Revolutionizing Impact of Point of Care Ultrasound (Pocus): A Game-Changer for Decision Making at Bedside Especially in Emergency Obstetrics and Gynecology

2025-02-10T01:17:53-06:00

Dear Editor,

I am writing to highlight the transformative potential of Point-of-Care Ultrasound (POCUS) in emergency obstetrics and gynecology. It provides immediate bedside imaging, enabling life-saving decisions without delays. Its portability, cost-effectiveness, and ability to minimize patient movement make it indispensable in busy, resource-limited settings. Its capacity to streamline care, improve outcomes, and reduce strain on overburdened healthcare systems caught my attention. It is not just a tool-it’s a paradigm shift in emergency obstetrics and gynecology, and its widespread adoption deserves prioritization.

Unlike traditional ultrasound, which often requires scheduling and specialized technicians, trained professionals can perform Point-of-Care Ultrasound at the bedside, promoting a patient-centered approach.^1,2 In obstetrics, it is invaluable for assessing fetal viability, gestational age, fetal presentation, and complications like placental abnormalities or ectopic pregnancies. A recent multicenter cohort study by Knights et al. demonstrated that POCUS in the third trimester reduced undiagnosed breech presentations at term from 16.5% to 3.5% (p < 0.001), significantly improving perinatal outcomes.³ In gynecology, Point-of-Care Ultrasound aids in diagnosing ovarian cysts, fibroids, torsion, and pelvic inflammatory disease, often avoiding invasive procedures.^4,5 Vinayak et al. showed that training midwives in rural areas to use Point-of-Care Ultrasound with tablet platforms improved diagnostic capabilities in low-resource settings.² Similarly, Prasad et al. emphasized the importance of training midwives to determine fetal presentation using handheld devices, calling it "the need of the hour" to reduce maternal and neonatal morbidity.⁶

However, successful implementation hinges on proper training to ensure accurate image acquisition and interpretation. Structured training programs have been shown to improve the reliability of Point-of-Care Ultrasound findings significantly.⁷

I believe this technology deserves to be highlighted for its far-reaching implications in transforming maternal and gynecological healthcare globally.