Pakistan Journal of Medical & Health Sciences最新文献

{"title":"Frequency of Vitamin D Deficiency and its Association with CP Class in Cases of Liver Cirrhosis","authors":"Zoha Nasir, Muhammad Usaid Khan, Hina Batool, N. Nayyer, J. Iqbal, M. Zubair","doi":"10.53350/pjmhs22169993","DOIUrl":"https://doi.org/10.53350/pjmhs22169993","url":null,"abstract":"Objective: To find out the frequency of vitamin D deficiency and its association with CP class in cases of liver cirrhosis. Study Design: Cross sectional study. Place and Duration: Bahawal Victoria Hospital, Bahawalpur (From September 2021 to March 2022). Methodology: Total 195 cirrhotic patients of any etiology, 20-40 years of age both male and female were selected. Vitamin D deficiency and its association with CP class was assessed. Results: Mean age of cirrhotic patients was 38.46 ± 11.383 years. Out of 195 patients, vitamin D was deficient in 83 (43%) patients. Vitamin D deficiency was found in CP class A, B and C 7 (7.78%) patients, 13 (44.83%) patients and 63 (82.89%) patients respectively. CP class had significant (P = 0.000) association with vitamin D deficiency. Conclusion: In this study, higher proportion of cirrhotic patients had deficient levels of vitamin D. Most of the patients were between 20-40 years. A higher number of male patients had deficient levels of vitamin D. It is also concluded that vitamin D deficiency is significantly associated with CP class. Keywords: liver cirrhosis, CP class, vitamin D, hepatic osteodystrophy","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133431857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infants and Children who Experience From Rectal Prolapse","authors":"M. Y. Khan, S. Maroof, Fayaz Iqbal, Wardah Saleem, M. Shoaib, K. .","doi":"10.53350/pjmhs22169974","DOIUrl":"https://doi.org/10.53350/pjmhs22169974","url":null,"abstract":"Aim and Objective: to understand the outcomes of treating pediatric rectal prolapse with injection sclerotherapy using 5% phenol in almond oil. Setting & Design: Department of Pediatric Surgery MTI / LRH, Peshawar, Pakistan. A- Descriptive Study the duration of study from June 2021 to June 2022 Material & Method: In Pediatric Surgery, rectal prolapse is a prevalent issue with various potential solutions. Injection sclerotherapy was one of the techniques studied in this analysis of treatments for children with rectal prolapse. Patients who have had complete prolapse for more than three months were considered. Patients were checked in 24 hours before surgery. Before the procedure began, a Kleen Enema was administered. This operation was done while the patient was under general anesthesia. Sclerotherapy was performed by injecting a solution of 5% phenol in almond oil. While the patient was unconscious, an injection was placed in the rectum's submucosa. 8-10mL of a 5% phenol in almond oil solution was injected at 3-4 linear locations. Every patient was monitored for a whole month to look for signs of recurrence. Results: A total of 42 individuals were seen. There were 32 men and ten women among the total number of patients. Children as young as two years old and as elderly as eight years old were involved. A prolapse might endure between three months to four years. For 26 people, chronic diarrhea was a recognized problem. Sclerotherapy injections were administered to a total of 26 patients. There were no issues from the anesthesia or the procedure itself. There was no evidence of a recurrence during the one-month follow-up. Practical implication: This study will review our experience with the treatment of rectal prolapse in children and to formulate a management strategy based on outcome. Conclusions: Rectal prolapse may be successfully treated securely, affordably, and efficiently with injectable therapy using 5% phenol and almond oil. Keywords: Recto Prolapse, Sclerotherapy, children, injectable therapy, Sclerotherapy","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124596365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of Negative Appendicectomy after Evaluation by JM Ramirez & J Deus Score","authors":"Haider Kamran, Enas Nawaz Khan, S. Ghaffar, Uzma Shabbir, Muhammad Bilal Akbar, Valeeja Zafar","doi":"10.53350/pjmhs22169959","DOIUrl":"https://doi.org/10.53350/pjmhs22169959","url":null,"abstract":"Background: Acute Appendicitis (AA) is the commonest surgical emergency encountered by surgeon in public & private setup in Pakistan. When it comes to diagnosis, patient seldom presents with the typical bookish picture (symptoms / signs) of the condition. Diagnosis therefore remains an enigma many a times especially for house officers and residents during their emergency duty. Various scores had been developed to aid the diagnosis, Alvarado score although gained popularity and is practiced in our setup. This study was designed to evaluate one such score designed by JM Ramirez & J Deus, for its negative appendicectomy rate calculation with the view to adopt it to our routine practice if it turns out with lesser negative appendicectomy rate compared to other scores in practice. Methods: This descriptive study was designed & carried out at the Surgical “B” Unit of Ayub Teaching Hospital Abbottabad from November 01, 2020 to June 30, 2021. A total of 190 patients with suspected AA were included, assessed by the score and accordingly placed in three groups based upon their initial score. Group-I patients were discharged with the advice to come back to same unit / hospital if pain persists or recurs. Group-II patients were kept in observation for 24 hours and finally re-categorized either as Group-I or Group-III based upon a drop or rise in their score. Group-III patients were operated after preparation. Data collected over a special proforma was finalized at the time of discharge of patient, earlier in case of group I patients or after getting histopathology report in case of Group-III patients that was later analyzed with the help of SPSS-version 26. Results: Out of 190 patients included in study 129 were male while 61 were female patients. 49 patients presented with a score less than –15 (Group–I) & were discharged after evaluation. 53 patients had a score between –15 to 09 (Group–II), were therefore kept under observation till next 24-48 hour. Score of 30 dropped to Group-I range & were similarly discharged like Group-I patients. Score of 23 patients rose up to 10 or above (i.e. Group-III range) & were therefore operated like other 88 patients belonging to Group-III. 91 patients were having acutely inflammed, phlegmonous, gangrenous, perforated appendix or appendix with impacted faecolith / pus in the lumen, their appendicectomy specimen along with the specimen of 20 other difficult to diagnose cases on gross vision were sent for histopathology. H/P report confirmed 100 as positive & 11 as negative for appendicitis. 111 patients totally got operated, out of which 11 turned out negative appendicectomies. Frequency of negative appendicectomies overall was therefore 09.9%. It was 05.56% in male (i.e. 04/72) and 17.94 % (i.e. 07/39) in female patients. Conclusion: Score developed by JM Ramirez and J Deus proved quite helpful in the diagnosis of acute appendicitis & reduction of the frequency of Negative appendicectomies. Being simple, non-invasive & cos","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122840750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of HCV induced thrombocytopenia in Southern Punjab","authors":"Muhammad Usama , Ur Rehman, Alisha Afzal, M. Mumtaz, M. Zubair, Nouman Bhutta, J. Iqbal","doi":"10.53350/pjmhs22169991","DOIUrl":"https://doi.org/10.53350/pjmhs22169991","url":null,"abstract":"Objective: To determine the frequency of HCV induced thrombocytopenia in Southern Punjab Study Design: Cross sectional study. Place and Duration: Department of Medicine, Sir Sadiq Khan Abbasi Hospital (Civil Hospital) Bahawalpur. Six months (September 2021 to March 2022) Methodology: Total 264 patients of hepatitis C, both male and female having age 20-70 years were recruited. History was taken and clinical examination was done. Blood sample was taken and send to hospital laboratory for platelet count. Results: Mean age was 40.88 ± 12.94 years. Among 264 patients of HCV, thrombocytopenia was found in 75 (28%) patients. Total 75 (28%) patients were hypertensive and 189 (72%) patients were non-hypertensive. Diabetics were 67 (25%) and non-diabetics were 197 (75%). In age group 20-45 years, thrombocytopenia was noted in 53 (29.61%) patients while 22 (25.88%) patients of age group 46-70 years were found with thrombocytopenia. Statistically insignificant association between thrombocytopenia and age group was detected (P = 0.530). Thrombocytopenia was noted in 45 (29.41%) males and 30 (27.03%) females. Association of Thrombocytopenia with gender was not significant with p value 0.671. Conclusion: Present study showed a higher proportion of thrombocytopenia in cases of hepatitis C. Most of the infected patients were males and higher number of patients related to age group 20-45 years. No association of development of thrombocytopenia with age group, gender and diabetes mellitus was detected. Keywords: Liver cirrhosis, thrombocytopenia, hepatitis C, hepatocellular carcinoma","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115478597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Lord’s Anal Dilatation for Incontinence & Recurrence in the Management of Anal Fissure","authors":"Haider Kamran, Enas Nawaz Khan, Muhammad Ibrahim Shuja, Muhammad Tasleem, Uzma Shabbir, Valeeja Zafar","doi":"10.53350/pjmhs22169963","DOIUrl":"https://doi.org/10.53350/pjmhs22169963","url":null,"abstract":"Background: Fissure-in-Ano is a commonly seen entity in surgical practice. Various approaches had been adapted since ages for its management including both conservative & surgical. Amongst the surgical approaches Lord’s Anal Dilatation (LAD) is a modality long been practiced to manage patients not responding to conservative treatment & those with chronic anal fissure. Recent trend is towards preferential practice of Lateral Internal Sphincterotomy (LIS) in the management of anal fissure. Pleaders of LIS are critical as well to the approach of LAD, although LAD in many clinical setups is still a widely practiced & viable option, especially in third world countries. Objective of conducting this study is to evaluate the LAD in our hospital setup for its much debated complications of incontinence and recurrence. Methods: This descriptive study was designed & carried out at the surgical units of Ayub Teaching Hospital Abbottabad from November 01, 2012 to May 31, 2017. A total of 129 patients with acute anal fissure (not responding to conservative measures, being in agony) & chronic anal fissure (duration longer than 06 weeks) were included in study after taking informed consent. Patients were managed with LAD & later followed for 01 year for the evidence of permanent flatus / faecal incontinence & fissure recurrence. Results: Out of the 129 patients included in study we had successfully been able to follow 102 patients for one year, while 27 patients were lost at various stages of follow-up and thus dropped off the final stage of study (i.e. calculation of incontinence & recurrence rate). Post-operative pain intensity & early mobility factor was found much better in this study. 23 patients initially complaining of flatus incontinence for 02–09 days were settled with pelvic floor exercises while none was found with an early or late complication of faecal incontinence. Similarly follow-up for 01 year period revealed none with recurrence issue. Conclusion: LAD in our study proved a safe & effective approach in the management of patients with anal fissure un-responsive to conservative measures, having no permanent incontinence or recurrence issues & may therefore be safely practiced in our setup like LIS procedure. Keywords: Anal fissure, Lord’s anal dilatation, lateral internal sphincterotomy, incontinence, recurrence","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"36 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132639042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Posterior Sagital Ano Recto Plasty (PSARP) In Anorectal Malformation: Our Experience at tertiary care hospital M.T.I/L.R.H Peshawar","authors":"M. Y. Khan, S. Maroof, Fayaz Iqbal, Wardah Saleem, M. Shoaib, K. .","doi":"10.53350/pjmhs22169980","DOIUrl":"https://doi.org/10.53350/pjmhs22169980","url":null,"abstract":"Objective: This study aimed to evaluate the functional result of pediatric patients at MTI / LRH, Peshawar, who had Posterior Sagittal Anorectoplasty (PSARP) for anorectal abnormalities. Methods: Three hundred and fifty cases with anorectal anomalies were analyzed in this research from 2017 to 2021 at MTI/Lady Reading Hospital Peshawar. Except for female patients with rectogenital tract fistula, distal logograms were regularly done on all patients. Each patient diagnosed with an intermediate, high-type, or cloacal malformation underwent PSARP. Both intraoperative and postoperative mortality and morbidity rates were documented. Following the PSARP treatment, patients should continue to have their anesthetics dilated regularly for three to six months after discharge. Six months to a year of patient follow-up was conducted. Results: Three hundred and fifty patients (12–36 months of age) participated in the study (245 males and 110 girls). All patients had PSARP done. One hundred ninety-five males were diagnosed with a rectourethral fistula, 95 girls with a genitourinary tract fistula, and five girls with a cloacal malformation. There was a 2.5% death rate (9/35 operations) from the surgery and its aftermath. At the outset of treatment, 30% of patients had excellent outcomes, 45% experienced fair results, and 25% experienced poor outcomes. Ninety-nine individuals had chronic constipation, and 35 had anal stenosis. Sixty individuals had mucosal prolapse and perineal irritation. In 5 patients, recurrent UTIs occurred, and in 3 cases, orchitis. The urethral stricture was discovered in two patients, and a urethral diverticulum was identified, necessitating revision surgery. Practical implication: The recorded data outcomes will be useful for the surgeons in the same setting. Conclusion: Most severe and mild anorectal abnormalities were seen in male infants. Regarding bowel control, PSARP surgery is a safe option with positive functional outcomes. Keywords: Anorectal Malformation, Anomalies, Posterior Sagittal Anorectoplasty, Pull Through, Faecal Continence, Constipation.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128142834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic Control Among Type 2 Diabetics: Comparison of Patients Coming to Specialized Clinics vs General Clinics for Diabetes","authors":"Khawar Qureshi, S. Danish, F. Ahmed","doi":"10.53350/pjmhs22169987","DOIUrl":"https://doi.org/10.53350/pjmhs22169987","url":null,"abstract":"Objective: To analyze the difference of glycemic control (Mean HBA1c) between patients consulting at specialized Diabetic clinic and those coming to usual general practices. Study Design: Quasi Experimental study Place and Duration: OPDs of general Practice clinics and Outpatient department of a specialized diabetes clinic at Sialkot for 3 months. Methodology: Total n=250 patients were inducted using consecutive sampling technique carried for 3 months. The sample was divided into two groups “Diabetes Specialist clinics” (n=125) and with traditional setup without a team approach as “general practice clinics” (n=125).In this study patients included were of both gender with age group comprising > 40 years and history of T2Dm for at least one year. Type1 dm, gestational diabetes and those without signing consent were excluded. Data was collected using structured questionnaire by primary investigator after informed consent and at the end of three months the difference of means of HBa1c of two different groups. Analysis was done on SPSS version 22 using independent sample t-test. Mean and standard deviation were taken for numerical data, while for categorical data, percentages and frequency were taken out. Statistically significant p value was viewed as < 0.05. Results: When Independent T Test was applied, in specialist clinic HBA1c was 8.51±1.23 whereas in General practice clinic it was 9.57±1.62 with statistically significant difference (p value 0.000). When ANOVA applied to see differences in HBA1c among those with primary, secondary, Intermediate and graduate level education, statistically insignificant results were found (p value 0.373). Likewise, when compared by duration of diabetes, statistically insignificant results were found (p value 0.379). Results were statistically insignificant (p value 0.95), when compared based on rural and urban residence. Conclusion: The study shows statistically significant difference in glycemic control (HBA1c) levels between those coming to general practice clinics and those consulting at specialized diabetic clinics. Keywords: Diabetes, Diabetes Specialist clinic, HbA1C","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"os-54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127719403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Secukinumab in Moderate to Severe Psoriasis Vulgaris: A Prospective Study","authors":"S. Tirmizi","doi":"10.53350/pjmhs22169983","DOIUrl":"https://doi.org/10.53350/pjmhs22169983","url":null,"abstract":"Objective: Psoriasis is a chronic inflammatory skin disorder that potentially needs long-term treatment. Multiple remedies treating psoriasis have been accepted in which Secukinumab is a totally humanized, IL-17A monoclonal used for the treatment of moderate to severe plaque psoriasis. Hence, this study focused to evaluate the effectiveness of Secukinumab in moderate to severely affected psoriasis patients. Methodology: This was a Prospective interventional multicenter study conducted by using consecutive sampling technique. The ethical approval was approved from the Institutional Review Board. The duration of study was about one year after synopsis approval. A total of 138 adult patients between 18-65 years of both genders with diagnosed cases of psoriasis vulgaris having lesions on scalp, face, hands, and genital areas were included. Treatment started by the single dosage of 300 mg Secukinumab that was administered subcutaneously once weekly for 4 weeks and followed up by once a month for 52 weeks. Paired t-test was used to evaluate the association between baseline and at various weeks of follow ups. Results: The study results showed that out of 138 patients, 112(81.2%) were males and 26(18.8%) were females and their mean age was 40.47±9.55 years. As far as severity of Psoriasis is concerned, 55(39.9%) were moderately affected while 83(60.1%) were severely affected. Concerning distribution of Psoriasis, Plaque Psoriasis was observed in 117(84.8%) patients, 57(41.3%) reported Scalp Psoriasis, 137(99.3%) reported Pustular psoriasis, and Itching was reported in 120(87.0%) patients. Comparison of baseline PASI scores with different weeks in moderately and severely affected psoriasis patients revealed that there was statistically significant rapid reduction observed from mean of baseline PASI scores till 12 weeks (p<0.001), Conclusion: This study concluded that Secukinumab is an extremely effectual, rapid-acting biological therapy with no evident side effects. Furthermore, it was observed that secukinumab significantly reduced the baseline PASI score till 12 week rapidly in moderately and severely affected psoriasis patients. Keywords: Psoriasis vulgaris, PASI score, rapid-acting biological therapy, Secukinumab,","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122588608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast Induced Nephropathy and its Predictors after Primary Percutaneous Intervention","authors":"N. ., Aftab Ahmed Solangi, Amir Jamil, Zahirullah ., K. ., Rizwan Ahmed Yaqoob","doi":"10.53350/pjmhs22169949","DOIUrl":"https://doi.org/10.53350/pjmhs22169949","url":null,"abstract":"Background: contrast-induced nephropathy (CIN) is the most common complications associated with contrast media after angiographic procedures. The therapeutic intervention for CIN after the procedure, to date, is not yet conclusive. Therefore, the main reliance for the management of CIN is considered to be adequate assessment of risk-benefit and the preventive strategies. A little research has been done to identify the predictors of CIN in Pakistan. Objective: To assess the incidence and the predictors of CIN in our setting. Methodology: A total of 120 patients of Punjab Institute of Cardiology, Lahore who underwent primary PCI during January to July 2022, were observed to CIN through cross-sectional observational study. The baseline and some postprocedural laboratory findings, angiographic and interventional characteristics were observed on a pre-formed Performa and the data was analyzed using SPSS. Logistic regression analysis was implied to assess the independent predictors of CIN. Results and conclusion: CIN developed in 15% of the patients. LVEF, admission blood glucose, haemoglobin, eGFR, and contrast volume greater than 100 ml were all shown to be linked with CIN in univariate analysis. Age, eGFR, admission serum glucose, diabetes mellitus, and contrast volume more than 100 ml were shown to be independent predictors of CIN in the study participants.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124532591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Strategies for Choledochal Cysts in Infants and Children Our Experience at Department of Pediatric Surgery ,L.R.H, Peshawar","authors":"M. Y. Khan, S. Maroof, Fayaz Iqbal, Wardah Saleem, M. Shoaib, K. .","doi":"10.53350/pjmhs22169977","DOIUrl":"https://doi.org/10.53350/pjmhs22169977","url":null,"abstract":"Objective: This study aims to understand more about choledochal cysts and how they are managed in children under 12 years old. Setting and Design: A Descriptive Study at Department of Pediatric surgery L.R.H. Hospital Peshawar. Method and Material: The most common kind of malformation of the biliary tree in Pakistan is choledochal cyst malformation (C.C.M.). Congenital choledochal anomalies range from asymptomatic to life-threatening cholangitis or pancreatitis. Surgeons now recommend total cyst ectomy and bilioentenric anastomosis. This five-year research examines. Clinical presentation, blood and laboratory testing, imaging, surgery, and predictive data were evaluated from case records. Twenty-three children with choledochal cysts were treated between January 2019 and December 2021, and their clinical presentation, diagnostic tests, and treatments were recorded. ERCP or a cholangiogram confirmed choledochal cysts after ultrasound diagnosis (P.O.C.). Before surgery, children with cholangitis received antibiotics and percutaneous transhepatic biliary drainage (excision of the cyst and jejunal loop interposition hepaticoduodenostomy) Results: Twenty-three patients were analyzed; eight presented with chronic abdominal pain, five with a history of cholangitis, two with acute cholangitis, four with biliary peritonitis, and one with a history of pancreatitis. Following cyst excision, Roux-en-Y hepaticojejunostomy (RYHJ) was performed in 13 patients, and hepaticoduodenostomy (H.D.) was performed in 4 patients. One example of congenital choledochal malformation type II was treated with cyst excision and drainage because cholangitis and jaundice threatened the patient's life. The median age was 3, and the gender distribution was about even. Of the patients who sought care, 18 presented with jaundice, 15 with abdominal discomfort, 12 with fever, and 9 with a mass in their stomach. Only four people had all three symptoms of characteristic jaundice, pain, and lump. Overall, the results of both ERCP in 7 patients and P.O.C. in 14 cases were favorable. There were two distinct clinical presentations: I infantile form (less than a year), which included nine infants with jaundice in all, acholic stool in 7, lump abdomen in 4, but only one with classical triad; and (ii) childhood form (more than a year), which included twelve patients with abdominal pain, jaundice, and cholangitis. Twenty patients had a type I cyst, and three had a type Iva cyst. Only two kids said no to surgery, while the rest went through with it. Only three newborns were lost during surgery, but the other 18 did well following their follow-up visits (median 25 months). Six had extrahepatic biliary atresia, two had congenital hepatic fibrosis, and one had congenital biliary cirrhosis. Practical implication: Our study will provide a new data to the health care providers about choledochal cysts and how they are managed in children under 12 years old Conclusions: However, total cyst removal and Ro","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114170221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}