Medico Research Chronicles

Predictors of Clinical Outcomes In Surgically Treated Displaced Acetabular Fractures: A Single-Center Prospective Study

Dr. Rohit Tyagi — 2025-04-10

Background: Acetabular fractures represent challenging injuries requiring complex surgical interventions to restore joint congruity and function. This prospective study aims to evaluate the functional and radiological outcomes of surgically treated displaced acetabular fractures and identify factors that predict clinical results.

Methods: A prospective analysis of 118 patients with displaced acetabular fractures treated surgically at a single tertiary care center was conducted over an 18-month period. Patients were followed for 12 months postoperatively. Fractures were classified according to the Letournel and Judet system. Functional outcomes were assessed using the Modified Harris Hip Score, while radiological outcomes were evaluated using Matta's reduction criteria. Statistical analysis was performed to identify factors associated with clinical outcomes.

Results: The mean age was 41.36 years, with males comprising 73.7% of patients. Road traffic accidents (53.4%) were the predominant injury mechanism. Associated both-column fractures (25.4%) were most common, followed by T-type fractures (24.6%). The Modified Stoppa approach was most frequently employed (54.2%). According to the Modified Harris Hip Score, 48.3% of patients achieved excellent results, 34.7% good, 11.9% fair, and 5.1% poor. Anatomical reduction (<1mm displacement) was achieved in 65.3% of cases. Marginal impaction (p=0.01), initial displacement magnitude (p=0.02), and quality of reduction (p=0.001) showed significant associations with functional outcomes. However, demographic factors, fracture patterns, and surgical approaches did not significantly influence results.

Conclusion: Surgical management of displaced acetabular fractures yields favorable outcomes in the majority of cases. The quality of reduction is the most critical determinant of functional recovery, emphasizing the importance of anatomical reduction as the primary surgical objective. Marginal impaction and initial displacement magnitude are additional important predictors of outcome. These findings highlight key factors that surgeons should consider when managing these complex injuries to optimize patient recovery.

Precision Anesthesia: Nalbuphine-Levobupivacaine vs. Fentanyl-Levobupivacaine in Spinal Blocks

Dr. Misra Jasmeen — 2025-04-10

Background: Intrathecal adjuvants enhance the efficacy of local anesthetics in spinal anesthesia. This study compared nalbuphine and fentanyl as adjuvants to hyperbaric levobupivacaine for lower abdominal surgeries.

Methods: In this prospective, randomized, double-blind study, 100 ASA I-II patients undergoing lower abdominal surgeries were allocated into two groups: Group LN (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 0.8 mg nalbuphine intrathecally, and Group LF (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 25 μg fentanyl intrathecally. Onset and duration of sensory and motor blockade, hemodynamic parameters, postoperative analgesia using Visual Analog Scale (VAS), and adverse effects were assessed.

Results: The onset of sensory block (2.795±0.599 min in Group LN vs. 2.625±0.562 min in Group LF; p=0.921) and time to complete motor block (10.38±1.081 min vs. 10.59±1.004 min; p=0.766) were comparable between groups. The duration of sensory block (282.29±23.09 min vs. 306.88±29.06 min; p=0.0001) and motor block (178.46±7.59 min vs. 242.96±39.17 min; p=0.0001) were significantly longer in Group LF. VAS scores were significantly lower in Group LN at 1.5, 2, 2.5, and 3.5 hours postoperatively (p<0.05). Hemodynamic parameters remained largely stable in both groups. The incidence of adverse effects was comparable, with pruritus observed exclusively in Group LF (4%).

Conclusion: Fentanyl provided prolonged sensory and motor blockade, while nalbuphine offered better early postoperative analgesia with faster motor recovery and absence of pruritus. Both adjuvants maintained hemodynamic stability with minimal adverse effects, suggesting their selection should be tailored to specific surgical requirements and desired recovery profiles.

Comparison of Outcome Between Anti-Tubercular Therapy Alone and Selective Neck Dissection Followed by Anti-Tubercular Therapy in Retreatment Cases of Tubercular Cervical Lymphadenopathy

Dr. Shahin Sultana Shimu — 2025-05-01

Background: Tubercular cervical lymphadenopathy (TCL) is a common form of extrapulmonary tuberculosis (EPTB), frequently presenting with painless cervical lymph node swelling. Treatment primarily involves anti-tubercular therapy (ATT), but in cases of relapse or treatment failure, the addition of surgical intervention may enhance outcomes. This study aims to compare the outcomes of ATT alone versus a combination of selective neck dissection (SND) followed by ATT in retreatment cases of tubercular cervical lymphadenopathy.

Methods: A single-blind, randomized controlled trial was conducted at Dhaka Medical College Hospital from January 2022 to July 2023. A total of 48 patients with retreatment cases of TCL were randomly assigned to either Group A (SND + ATT) or Group B (ATT alone). Data were collected on demographic characteristics, clinical presentation, lymph node involvement, diagnostic methods, and treatment outcomes. Patients were followed up every two months for six months to assess treatment efficacy.

Results: The study found no significant differences in demographic characteristics between the groups. In terms of treatment outcomes, Group A showed a significantly higher cure rate (95.83%) compared to Group B (75.0%) (p = 0.043). Recurrence of disease was significantly lower in Group A (4.16%) than in Group B (25.0%) (p = 0.042). Complication rates were similar between the groups (Group A: 4.16%, Group B: 12.5%), with no significant difference (p = 0.300).

Conclusion: The addition of Selective Neck Dissection to Anti-Tubercular Therapy in retreatment cases of tubercular cervical lymphadenopathy significantly improves cure rates and reduces recurrence without increasing complications. These findings suggest that surgical intervention may be beneficial for patients with TCL who fail or relapse with medical therapy alone.

Clinico-Demographic and Radiological Profile of Bronchiolitis Patients in a Tertiary Care Hospital in Bangladesh

Dr. Shakila Khan — 2025-04-30

Background: Bronchiolitis is the most common cause of hospitalization in infants below 2 years of age. It usually presents with breathing difficulty, cough, fever and runny nose. The treatment of bronchiolitis mainly supportive. Objectives: The aim of this study was to find out the clinico-demographic and radiological characteristics of bronchiolitis for its proper diagnosis and management. Methods: This is a cross-sectional observational study was done in the Department of Pediatrics, Bangladesh Shishu Hospital and Institute from July 2019 to June 2021. A total 100 patients between ages of 2-months to 1-year admitted with the diagnosis of bronchiolitis, were included in this study. Data were collected in the form of age, gender, clinical features, laboratory and radiological findings Results: most of the cases are less than 6 months and the majority patients were males (58%) and females were (42%). Cough, fast breathing and wheezing were present in most of the children. all patient had difficulty in breathing and chest indrawing. Cough was a presenting feature of 96% cases, fast breathing was in 89% cases. Wheezing was in (82%) cases. Predominant radiological findings are hyperinflation and hypertranslucency. Hypertranslucency was present in 97% cases whereas hyperinflation was present in 93% cases. Conclusion: We concluded that bronchiolitis patients present with typical clinical and radiological features which can help for its diagnosis and management.

Efficacy of the Posterior Urethral Incision Technique (PUIT) in Urethrocutaneous Fistula Repair Following Hypospadias Surgery

Prof. dr. Md. Shahjahan — 2025-04-16

Background: Urethrocutaneous fistula (UCF) is the most common complication following hypospadias repair, often requiring secondary surgical intervention. Despite advancements in surgical techniques, recurrence remains a significant challenge. The Posterior Urethral Incision Technique (PUIT) has been proposed as an alternative approach to improve UCF repair outcomes. This study evaluates the efficacy of PUIT in reducing UCF recurrence following hypospadias surgery. Methods: This prospective interventional study was conducted in the Pediatric Surgery Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, from January 2017 to April 2018. A total of 30 patients aged 1–12 years with single UCF at least 6 months post-urethroplasty were included. PUIT was performed in all cases, and outcomes were assessed based on fistula closure rates and recurrence. Data were analyzed using SPSS version 26, with a significance level of p < 0.05. Results: The most common site of UCF was the coronal region (40%), followed by distal penile (33.3%), mid-penile (13.3%), and proximal penile (13.3%) sites. The overall success rate of PUIT was 83.3%, with 5 patients (16.7%) experiencing recurrence. Recurrence was highest in coronal fistulas (40%), with a statistically significant association between fistula location and recurrence (p < 0.001). Conclusion: PUIT is an effective technique for UCF repair, achieving a high success rate and low recurrence rate. It improves tissue approximation and reduces suture line tension, making it a reliable approach for fistula closure. Further studies with larger sample sizes and longer follow-up periods are recommended to validate its long-term efficacy.