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Background Surgical site infection (SSI) is the most commonly occurring infection in postoperative patients. This study is conducted to evaluate the prevalence of SSI in patients following gastrointestinal tract surgery and identify the risk factors. Method A cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, between December 2021 and May 2022. A total of 132 patients participated in the study who were at least 18 years older and had undergone the gastrointestinal surgical procedure. Patients who refused to give consent, died after the procedure, and were diagnosed with SSI after they were discharged were excluded from the study. We performed a chi-squared test. Result A total of 132 patients were included in the study, of which 63 (47.7%) were males, while 69 (52.3%) were females. SSI was more commonly found among the age group of 41-70 years with 29 (38.7%) patients. Presurgical features including hemoglobin of11 mg/dL, albumin of3.5 g/dL, blood glucose of80 mg/dL, and emergency surgery were found to be associated with the SSI having a significant p-value. Similarly, the surgical and postsurgical features significantly associated with the SSI having a significant p-value were the presence of surgical trauma, wound irrigation with normal saline, malignancy, bowel preparation, longer duration of the surgery, intraoperative hypotension, operative site, drain insertion, and the absence of a second antibiotic. Conclusion The early identification and management of the demographical, presurgical, surgical, and postsurgical risk factors can help reduce the incidence of SSIs. Bowel preparation should be encouraged, and unnecessary delays during the surgical process leading to increased procedure time should be avoided. Extra precaution needs to be provided for the patients highly susceptible to SSIs.

Since its first use as a bone void filler at the end of the 19th century, calcium sulphate products have been adapted in different ways to aid orthopaedic surgeons. Calcium sulphate local antibiotic delivery systems offer a promising solution in the delivery of high antibiotic concentrations locally for an extended period of time. Over the years, multiple centres have reported side effects such as wound drainage, heterotrophic ossification and hypercalcaemia. This study was carried out to assess the risk of wound drainage in prosthetic joints after implantation of antibiotic-impregnated calcium sulphate beads. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 182 articles. The studies without reported post-operative complications, mainly drainage outcomes, were excluded. After screening, seven articles were deemed suitable and selected. Out of the 1,112 cases identified, 43 joints developed wound drainage after calcium sulphate bead placement. This complication was resolved in all these cases by either conservative or operative approaches. The factors implicated in the development of wound drainage include the volume of the product used, procedural placement and host factors. The result of this systematic review shows that calcium sulphate products can be used for treatment and prophylaxis in prosthetic joints with a risk of post-procedural wound drainage. This risk, however, is lesser with the use of synthetic calcium sulphate products as compared with conventional calcium sulphate products.

Introduction Helicobacter pylori (H. pylori) infection is prevalent worldwide. H. pylori therapies' adverse effects can contribute to noncompliance among patients. This study aimed to assess the association between compliance to H. pylori eradication therapy and adverse effects using various drug regimens. Method We conducted an observational study from September 2017 to February 2020 in two tertiary care hospitals in patients with dyspeptic symptoms. H. Pylori detection was done by histopathological examination of gastric mucosa during upper gastrointestinal endoscopy or stool for H. pylori antigen. Patients with positive results were randomly assigned one of the nine different regimens consisting of a combination of proton pump inhibitors along with at least two antibiotics. The antibiotics used in different combinations were amoxicillin, clarithromycin, metronidazole, doxycycline, levofloxacin, and bismuth sulfate. The treatment groups received standard triple therapy with and without probiotics, sequential, concomitant, levofloxacin-based triple therapy, or sequential and bismuth-based quadruple treatments. All treatments were given for two weeks. At the end of the treatment period, patients were interviewed about completing treatment and any adverse effects they may have experienced during therapy. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 22.0 (Armonk, NY: IBM Corp.). Results A total of 250 patients were included in the study (62% males, 38% females) with a mean age of 37 years ± 13 years (range 12-84 years). Most patients completed the treatment regimen (80.4%), and 19.6% did not complete treatment because of adverse effects (p

Ciprofloxacin is a commonly prescribed antibiotic due to its broad spectrum and good safety profile. However, recent evidence suggests that it has the propensity to cause idiosyncratic drug-induced liver injury. There are 25 reported cases of ciprofloxacin induced severe liver injury in the literature. Here, we describe another case of acute cholestatic liver injury due to ciprofloxacin. A 32-year-old female presented to the gastroenterology department with a week's history of pruritus, jaundice, and abdominal pain. Her symptoms started three days after completing a ciprofloxacin course for urinary tract infection. Her hepatic enzymes were elevated and showed a cholestatic pattern. An extensive workup, including viral serology, autoimmune profile, and imaging studies, did not reveal any underlying cholestasis cause. Her liver biopsy findings were consistent with drug-induced cholestasis. A diagnosis of ciprofloxacin-induced cholestatic liver injury was made based on the onset of symptoms and liver enzyme derangements following the use of ciprofloxacin, improvement in clinical as well as biochemical parameters after cessation of ciprofloxacin, and the liver biopsy findings. The patient received supportive treatment, and her liver enzymes returned to baseline six weeks after admission. Clinicians need to be aware that if the patient develops any liver injury symptoms while using ciprofloxacin, the drug should be stopped immediately, and a thorough evaluation should be done. The patient should also be advised to avoid ciprofloxacin and other quinolones in the future.

Sacral giant cell tumors (GCTs) are rare entities that exhibit slow progressive growth and become clinically apparent when they reach a considerable size. The current case report discusses the presentation, investigation, and management of a young male patient diagnosed with a large sacral mass. A 17-year-old male patient presented with uremia, bilateral lumbar pain, and severe weakness of his lower extremities. Imaging revealed a midline sacral mass causing bilateral upper tract obstruction. The patient underwent bilateral nephrostomies followed by a partial en bloc sacrectomy and curettage of the tumor bulk. Histopathology revealed a giant cell tumor of the sacrum. Postoperatively, the patient received adjuvant radiotherapy and rehabilitation for his neurological symptoms. Sacral GCTs are essentially benign but behave like a malignant tumor in view of frequent recurrences and reports of malignant transformation. Surgery with wide local excision remains the ideal modality for complete clearance of sacral tumors. Nevertheless, limitations include their large size, difficult operative access, risk of fatal intraoperative bleeding, and inevitable high postoperative morbidity.

Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals' quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management. We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords 'chronic scrotal pain', 'testicular pain' and 'orchialgia', and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria. After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%). The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient's state, the severity of the complaint and what options have already been tried.

The purpose of this review is to summarize the pathophysiology of ejaculation and look into prevalence, aetiology, diagnosis, and treatment of painful ejaculation. We carried out a comprehensive search of PubMed in order to look for literature on male painful ejaculation using keywords post-orgasmic pain, painful ejaculation, dysejaculation, odynorgasmia, post-orgasmic pain, or dysorgasmia. Painful ejaculation has an alarming prevalence throughout the world, between 1 to 25%. It has a detrimental effect on patients' quality of life as it reduces individual self-esteem and is associated with sexual dysfunction. Its aetiology includes simple infection or inflammation of the urinary tract, benign prostate hyperplasia, ejaculatory duct obstruction, post-radical prostatectomy and side effects of certain medications. Once reported, it should be investigations and treatments should be tailored according to the etiology. Both medical and surgical treatment is available depending on the cause of painful ejaculation. Due to the sensitive nature of its presentation, it is a symptom that can be identified best when specifically asked. Our understanding regarding painful ejaculation is very limited and only a few articles have revealed insight into this topic. Further research is required in order to set proper guidelines for diagnosis and treatment of painful ejaculation.

Introduction The aim of the study was to compare the clinical and patient-reported outcomes among open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) patients. Materials and methods This was a prospective single centre, case-cohort study conducted in a tertiary care hospital with 62 patients. In both techniques, dismembered Anderson-Hynes pyeloplasty were undertaken. Post-operatively patients underwent visual analogue scale (VAS) assessment for pain, days to ambulation and comparison of the short- and long-term outcomes of the two procedures. Results There was no difference in the physical and functional outcomes between the two surgical approaches at 12 months period after surgery. However, patients in the laparoscopic group did report a higher rate of satisfaction at six weeks and six months’ postoperatively. Likewise, patients in LP experienced less pain during the postoperative period (p-value

Masseter muscle rigidity following administration of succinylcholine for induction of general anesthesia is considered an early warning sign for the possibility of an episode of dreaded complication i.e., malignant hyperthermia. This report describes a case of masseter muscle rigidity encountered at the start of an emergency surgical procedure. After succinylcholine administration, laryngoscopy and intubation were not possible due to the masseter muscle spasms. This led to the use of laryngeal mask airway and propofol for the successful conclusion of the procedure with no intraoperative or postoperative complications. Later, the patient was discharged with instructions to avoid the contributing triggers in the future and recommendations of caffeine-muscle biopsy.

Introduction The personality of a human being consists of his behavior, cognition, emotional abilities, and interaction with his surroundings. The personality of an individual is modified by his ability for social perception, life experiences, and training. The pattern of study in which a person acquires education has a great influence on their personality. Objective To compare the personality traits and academic performance of boarders and non-boarders studying in a medical university. Material and methods It is a comparative, descriptive cross-sectional study done at Rawalpindi Medical University, Pakistan. The duration of the study was from January 2019 to April 2019. A questionnaire was randomly distributed among the students of Rawalpindi Medical University and filled under supervision. The questionnaire had two parts: (1) Academic performance information and (2) Big Five inventory (BFI-40). Only MBBS students of Rawalpindi Medical University were included. For statistical analysis, the independent t-test was applied using the Windows IBM Statistical Package for the Social Sciences Version 22 (SPSS, IBM Corp., Armonk, NY, US). The statistically significant value was taken as 0.05. Results Out of 300 questionnaires distributed, 287 were properly filled, giving a response rate of 95.6%. The Cronbach's alpha value was .750. The mean age was 20.87±1.344. There were 216 (75.1%) male and 71 (24.9%) females. One-hundred eighty-three (63.8%) were boarders and 104 (36.2%) were non-boarders. The mean scores of extraversion, agreeableness, and conscientiousness were higher for boarders while the mean scores of neuroticism and openness were higher for non-boarders. High average percentages in professional exams were common in non-boarders while boarders were taking more supplementary exams comparatively. Conclusion Self-discipline, surgency from external activities/situations, and getting along with others are common traits among boarders. On the other hand, non-boarders are more creative but emotionally unstable. The academic status of boarders is comparatively poor. Thus, the hostel administration should be particularly concerned about the activities of boarders, and parents should be aware of their child's academic status. Teachers should pay special attention to the character development of students.

Background With the growth of global terrorism and rapid advancements in the field of science, the threat of a nuclear, biological, and chemical (NBC) attack remains imminent. This study assesses perceptions of preparedness of health care professionals in case of an NBC attack/incident in a tertiary care hospital. Patients and methods We conducted a descriptive, cross-sectional study of 200 health care workers (including nurses and doctors) in a tertiary care hospital, from October 2018 through December 2018. Participants answered 17 yes/no questions and five 5-point Likert scale questions. We analyzed the data using chi-square tests and one-way analysis of variance. Results Most participants (73.6%) reported availability to an isolation facility, and a majority of participants (72%) reported they had access to ventilators. Approximately 60% of participants reported they had access to beds, and 44.6% reported access to a laundry facility. Most participants (65.3%) knew of an employee assistance program while 31.1% did not know about such a program at their institution. More than 50% of the respondents think they can deal with an emergency involving an NBC attack while 60% of the respondents did not think that their institution would be able to protect them in the event of an NBC attack/incident. Overall, the participants were not adequately prepared for a mass scale NBC incident. The level of preparation was linked to the number of courses and training programs completed by the participants, with postgraduate medical personnel having the maximum level of preparedness, followed by medical graduates and nursing personnel. Conclusion Given the inadequate level of preparedness for an NBC incident as indicated by our findings, drills and seminars on large-scale emergencies such as an NBC attack should be included in the curriculum of undergraduate medical and nursing students in order to impart them the necessary training and confidence in dealing with an NBC incident.

Background This study assessed anxiety and depression levels among parents of children with intellectual disability (ID) and analyzed their coping strategies. Methods One hundred parents of children with ID were recruited through child psychiatry outpatient services in a tertiary care setting in Lahore, Pakistan. A structured questionnaire including sociodemographic details, the Agha Khan University Anxiety Depression Scale, the Family Stress and Coping Questionnaire, Brief COPE questionnaire, and Support questionnaire were used for data collection. Results The mean age of parents was 35 years, and the majority of parents (86%) in the study were females. Seventy percent of the parents had significant levels of anxiety and depression. Parents mostly used emotion-based coping to deal with their anxiety and depression; self-distraction, behavioral disengagement, and venting were the main coping strategies used. Conclusions The study showed family stressors, various coping strategies, and support sources in depressed parents who are taking care of their intellectually disabled children. Based on these results, effective culturally sensitive intervention programs can be designed to educate parents and help them effectively cope with stress.

N-acetylcysteine (NAC) is a well-known antidote for acetaminophen toxicity and is easily available over the counter. It has antioxidant and anti-inflammatory properties and an established tolerance and safety profile. Owing to its neuroprotective effects, its clinical use has recently expanded to include the treatment of different psychiatric and non-psychiatric disorders. Although a number of randomized controlled trials have documented the clinical evidence for NAC, there are no reviews that summarize the evidence. The present scoping review summarizes the study designs, the patient characteristics, the evidence and the limitations in randomized controlled trials designed to explore the efficacy of NAC for psychiatric conditions in the pediatric population.