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Background: The therapeutic challenge of managing acute full-thickness burns is significantly ameliorated with the introduction of dermal regeneration templates (DRTs). However, an updated synthesis of evidence-based data on the efficacy and safety of different DRTs is required., Methods: This systematic review and meta-analysis conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines aims to evaluate the role of various DRTs in comparison with split-thickness skin grafting in managing acute burn injuries after excision and debridement. A total of 28 randomized clinical trials were assessed, encompassing a wide array of DRTs., Results: The study outcomes pointed to the diverse effectiveness of DRTs, with Integra demonstrating peripheral nerve reinnervation potential and TransCyte promoting rapid re-epithelialization. Some DRTs showed scar formation and skin quality comparable to those of autologous skin grafts. In terms of wound infection, certain treatments, including TransCyte, exhibited a significantly low infection rate. The evaluation of scar quality suggested that various interventions produced acceptable or improved outcomes without hypertrophic scarring. Recovery rates after the interventions displayed a range, with certain treatments showing rapid recovery and satisfactory results., Conclusions: The current systematic review points to the potential benefits of DRTs in managing burn wounds. Further research is necessary to shed light on the long-term impacts of these interventions on wound healing, scar quality, and patient recovery., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Staghorn calculi (SC) are defined as large kidney stones that fill the renal pelvis and at least one renal calyx. They represent 10-20% of all renal stones in developing countries and require prompt diagnosis and management. Massive SC (over 5 cm) are treated exclusively via open surgery, despite percutaneous nephrolithotomy (PCNL) being the gold standard treatment for large stones. Descriptions of PCNL for massive SC are very limited in the literature., Case Presentation: We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5 cm and 1.8×4.5 cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained., Discussion: We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size., Conclusion: This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5 cm., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To assess the impact of body mass index on early outcomes of coronary artery bypass grafting in terms of morbidity and mortality., Methods: This retrospective comparative study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, and comprised data of patients who underwent isolated coronary artery bypass grafting from December 2007 to December 2015. Analysis of variance and chi-square test were used for analysis of groups formed on the basis of body mass index. SPSS 20 was used for data analysis., Results: Of the 2,366 patients, 830(35.1%) had normal body mass index, 1,024(43.3%) were overweight, 402(16.9%)were obese and 110(4.6%) were morbidly obese. The overall mean age was 55.82±9.58 years. The mean age of morbidly obese patients was significantly lower (p=0.02). Additive euro score was high in patients with normal body mass index (p=0.006). Post-op creatine kinase muscle and brain MB levels and incidence of peri-operative myocardial infarction was significantly high in obese and morbidly obese groups (p=0.002 and p=0.01, respectively). Hospital stay time was significantly longer in obese and morbidly obese patients (p=0.01). The incidence of post-operative complications was the same in all groups (p>0.05). Operative mortality was also the same between the groups (p=0.58)., Conclusions: Higher body mass index was associated with increased risk of short-term morbidity in terms of myocardial infarction after surgery and increased length of hospital stay. Our study did not support the concept of obesity paradox.

Objective: Primary objective of this study was to evaluate the impact of significant left main stem (LMS) stenosis on the early outcome of coronary artery bypass graft (CABG) surgery., Methods: A Retrospective non-randomized analytical study was conducted in Cardiac surgery department, Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan, Pakistan. The data of patients who underwent isolated CABG at our institution from February 2008 to March 2014 were analyzed. Two thousand six hundred two (2602) patients of isolated CABG were divided into 2 groups according to the LMS disease. Group I (n=2088): without significant LMS disease and Group II (n=514): with LMS disease. Data was analyzed using SPSS V16. The groups were compared using Student's t-test for numeric variables. Chi-square test and Fishers Exact test were used for categorical variables. P-value ≤ 0.05 was considered as significant difference., Results: Out of two thousand six hundred two, 2088 patients were in Non.LMS group (Control Group) and five hundred fourteen were in LMS Group (Study Group). Patients with LMS disease were older. In both groups there was no statistically significant difference regarding gender distribution, risk factors of IHD, pre-operative renal function and preoperative CKMB levels. Significant number 50 (9.7%) of patients were unstable in LMS group and they needed urgent surgery (p-value <0.0001). Need and duration for inotropic support and intra-aortic balloon counter-pulsation support were significantly high in LMS group (p-value <0.0001, 0.002, 0.003 respectively). Similarly Mechanical ventilation time and hospital stay were higher in LMS group. Incidence of pulmonary complications and operative mortality were significantly higher in LMS group (p-value 0.005 and 0.001 respectively). Mortality of CABG patients with significant left main coronary stenosis was 13 out of five hundred fourteen (2.5%) as compared to just 17 out of two thousand eighty eight (0.8%) in control group., Conclusion: This study showed that significant LMS disease is an independent risk factor for early cardiopulmonary morbidity and mortality after CABG surgery.

Objective: To determine the frequency, experiences and correlates of sexual violence among female adolescents in Riyadh city, Kingdom of Saudi Arabia., Methods: A cross-sectional survey was conducted in 2 schools in Riyadh city for adolescent females starting from January 2008 for 3 months. Five classes with 25 students in each were randomly selected from intermediate and secondary grade of each school. Four hundred and nineteen students were included. A self-answering questionnaire was distributed and collected after 15 minutes by 3 research assistants., Results: Forty-two adolescent students (10%) were exposed to sexual violence. Only 31% of the students were taught how to react to sexual violence. Students whose order was > or = 5th among siblings and who had unsupportive parents in discussing sexual issues were more exposed to sexual violence (chi2=4.02, p=0.044, chi2=4.24, p=0.039)., Conclusion: Being > or = 5th in order among siblings and having unsupportive parents in discussing sexual issues were correlates for exposure to sexual violence.