Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Mar 2021
Case ReportsHenoch-Schönlein Purpura Presenting with Acute Abdomen.
Henoch-Schönlein Purpura (HSP) is an autoimmune, systemic, non-granulomatous vasculitis characterised by self-limiting clinical course, and leukocytoclastic vasculitis of small vessels. Deposition of immune complexes that contain IgA is the hallmark of vascular involvement. Adults with HSP have a higher incidence of complications and death. ⋯ Although corticosteroids do not prevent recurrences, evidence in literature suggests that these are beneficial in resolution of the arthritis and abdominal pain. Aggressive therapy with corticosteroids or cyclophosphamide is not successful in reducing renal damage, except in patients with crescentic nephritis. Key Words: Henoch-Schönlein purpura, Gastrointestinal complications, Steroids, Surgery.
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J Coll Physicians Surg Pak · Mar 2021
Correlation of Blastocyst Quality and Pregnancy Outcome during Freeze - Thaw Cycle.
To explore the relationship between the blastocyst quality and biochemical pregnancy or early embryonic cessation of development during the freeze-thaw cycle of in vitro fertilisation embryo transfer (IVF-ET). ⋯ Embryos with Grades excluding C in the score had better developmental potential and better prognosis. The rate of early embryonic development arrest in the ICM Grade C group was higher than that in the TE Grade C group. Key Words: Embryo quality and score, Blastocyst, Biochemical pregnancy, Early embryonic cessation of development.
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J Coll Physicians Surg Pak · Mar 2021
Relation of External Beam Radiotherapy Dose with Subclinical Hypothyroidism in Patients undergoing Adjuvant Neck Radiation after Surgery for Squamous Cell Carcinoma of Head and Neck.
The objective of this study was to find out the radiation dose relationship with subclinical hypothyroidism in the postoperative head and neck squamous cell carcinoma patients, who underwent adjuvant neck external beam radiotherapy. It was a prospective cohort study done between June 2018 and January 2020. One hundred patients, who were fulfilling the criteria of histological proven postoperative head and neck squamous cell carcinoma (SCC) of AJCC 2018 stage I to III, were enrolled. ⋯ After one year of completion of treatment, 27.8% patients (n = 25) developed subclinical hypothyroidism among those patients (n = 90), who received radiation dose more than 30 Gy to thyroid gland. None of the patients had subclinical hypothyroidism among those patients (n =10), who received radiation dose below 30 Gy to thyroid gland (p= 0.062). Key Words: Head and neck cancer, Neck radiotherapy, Subclinical hypothyroidism.
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J Coll Physicians Surg Pak · Mar 2021
Observational StudyEarly Surgical Management of Appendicular Mass in Pediatric Patients.
To find out the feasibility and safety of early surgery in pediatric patients who presented with appendicular mass. ⋯ This study was conducted on 60 children, who were diagnosed with appendicular mass. Patients were operated after initial stabilisation and investigations. Variables analysed included demographic characteristics, clinical presentation, intraoperative surgical difficulties and postoperative complications. Data were entered into SPSS version 22. Chi-square test and Fisher Exact test were used for finding statistical significance among variables. A p-value of <0.05 was considered as significant. Results: There were 41 (68.4%) male and 19 (31.6%) female patients with the mean age of 8.3 + 2.9 year. Mean duration of pain was 3.8 + 1.8 days. In 41 (68.4%) patients, mass was composed of appendix with adherent ileal loops and omentum, while in 19 (31.6%) patients frank pus was also found within the mass. Thirty-four (56.6%) patients had suppurative appendix without gross perforation, while in 26 (43.4%) patients partially sloughed / gangrenous perforated appendix found. Intraoperative difficulties were more in patients with complex mass (p=0.004). Postoperative complications were observed in 14 (23.3%) patients. These were more frequent in female patients (p=0.001), with sloughed, gangrenous perforated appendix (p=0.034) and complex mass (p=0.008). Superficial wound infection was the most common complication noted in 9 (15%) patients. In 5 (8.3%) children, deep seated intra-abdominal collections were found. The mean hospital stay was 3.4 + 1.5 days. Conclusion: Early surgery in pediatric patients with appendicular mass was found feasible with minimal complications. This obviated the need of prolonged follow-up and interval appendectomy with its inherent risks. Key Words: Appendicular mass, Appendicular lump, Appendectomy, Child.
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J Coll Physicians Surg Pak · Mar 2021
Dehydroepiandrosterone Sulfate (DHEAS) Levels in Polycystic Ovarian Syndrome (PCOS).
To compare DHEAS levels among subjects with and without PCOS, evaluating differences between lean-PCOS or obese-PCOS phenotype for insulin resistance, anthropometric indices, glycemic and lipid parameters. ⋯ DHEAS levels were high in lean-PCOS in comparison to obese-PCOS and non-PCOS females. However, receiver operating curve (ROC) analysis showed DHEAS as a weaker marker for diagnosing PCOS than FAI and modified FG score. Key Words: DHEAS, Polycystic ovarian syndrome (PCOS), Homeostasis model assessment for insulin resistance (HOMAIR), Rotterdam criteria, Free androgen index.