APPLICATION OF PATIENT FUNCTION RECOVERY AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT

ABSTRACT Introduction: The anterior cruciate ligament (ACL) is one of the important structures of knee joint stability. Objective: To investigate the application of medical training therapy (MTT) in the functional recovery of patients after anterior cruciate ligament reconstruction. Methods: Eighty patients who were treated in a secondary hospital were selected as the study subjects and were divided into a control group and an observation group according to a random number meter, with 40 cases per group. We compared Lysholm knee function scores, the range of motion (ROM), daily life capability (ADL scale), pain degree (VAS rating), knee stretch muscle score, and standing balance ability score of the two groups 3 months after intervention. Results: After intervention, the first time getting out of bed, the doctor-patient satisfaction score, and the average length of stay were better in the observation group than in the control group (P<0.05). The excellent rate of knee function in the observation group was 92.50%, which was significantly higher than 70.00% in the control group (P<0.05). Conclusions: MTT therapy can significantly improve knee the function and pain level of patients after anterior cruciate ligament reconstruction, shorten the length of hospital stay, promote rehabilitation, improve the therapeutic effect, and improve the quality of life of patients. Level of evidence II; Therapeutic studies - investigation of treatment results.

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019;

A prospective comparative study of surgical release of carpal tunnel syndrome with and without flexor tenosynovectomy

Background: Carpal tunnel syndrome (CTS) is a common condition causing hand pain and numbness. The rationale of tenosynovectomy is to remove the flexor tenosynovium that is contributing to increased volume within the carpal canal, thus removal of this tenosynovium should give more space for the median nerve and there by relief from symptoms. Aims and Objectives: The main objective of our study was to assess the role of routine flexor tenosynovectomy in the treatment of CTS. Materials and Methods: Eighty-six hands with CTS were randomized into two groups, either to carpal tunnel release with or without flexor tenosynovectomy. All patients were requested to fill up the self-administered questionnaire for the assessment of symptom severity and functional status, examined for 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score preoperatively, 2 weeks, 1 month, and 6 months follow-up. Results: After the surgical release, both groups improved significantly with respect to symptom severity and functional status, 2-point discrimination, grip and pinch strength, scar tenderness and patient satisfaction score but there was no significant difference between the two groups. There were two cases of post-operative wound infection and one case of mild reflex sympathetic dystrophy. Conclusion: We conclude that routine flexor tenosynovectomy during surgical release of carpal tunnel in patients with CTS does not provide any added benefit nor does it increase any morbidity.

Pengaruh Efisiensi Waktu Tunggu, Biaya Pelayanan, Kebersihan, serta Kenyamanan Ruangan terhadap Kepuasan Pasien (Studi Pada Pelayanan Instalasi Rawat Jalan Rumah Sakit Medika Lestari)

Seeing the importance of patient adherence in a patient's therapeutic journey and several factors related to patient adherence, we tried to assess patient satisfaction with the outpatient unit of Medika Lestari Hospital in 2021. Therefore, we conducted a cross-sectional study of patients aged 18–59 years to assess their satisfaction with the services of the Medika Lestari Hospital outpatient unit on 28 July 2021. We evaluated 4 main dimensions, namely: (1) Efficiency, (2) Convenience; (3) Cleanliness; and (4) Financing. The survey instrument was prepared based on the consensus of the research team and has good validity and reliability based on the Pearson and Cronbach–alpha tests. All statistical analyzes were performed with SmartPLS software version 3.3.3. A total of 206 patients were recruited, with a composition of 102 (49.51%) males and 104 (50.49%) females. There were 43 (20.87%), 103 (50%), 46 (22.33%), and 14 (6.80%) patients, respectively, in the age categories 18-25 years, 26–35 years, 36–45 years, and 46–59 years, respectively. We found that the average patient satisfaction with outpatient services at Medika Lestari Hospital was 4.23 (84.6%). The average patient satisfaction score for the outpatient service at the Medika Lestari Hospital is 4.23±0.363. In addition, we also found that service efficiency, cost, cleanliness of the service room, and comfort of the service room had a positive effect on patient satisfaction in the outpatient unit at Medika Lestari Hospital.

Clinical Outcome of Coccygectomy Using a Paramedian Curvilinear Skin Incision in Adults and Children With Meta-Analysis of the Literature Focusing on Postoperative Wound Infection

Study Design A single surgeon case series and meta-analysis of literature Objective To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors. Methods 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients’ satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis. Results The average age of patients was 39 years with a mean duration of symptoms prior to surgery of 7.4 years. The mean Oswestry Disability Index improved from 29 to 7.7 ( P < .001). The mean pain Visual analogue scale improved from 8 to 2 ( P < .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24 hours, nonabsorbable skin sutures and glue were associated with low infection rate. Conclusions Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.

A COMPARISON OF POST-OPERATIVE ANALGESIA WITH INTRAOPERATIVE PECTORAL NERVE BLOCK VERSUS CONVENTIONAL TECHNIQUE IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED STUDY

Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects.

Comparison of analgesic efficacy of transversus abdominis plane block with local wound infiltration using 0.25% levobupivacaine for post cesarean analgesia: A randomized controlled trial

The key component of Enhanced recovery after cesarian section (ERAC) is to improve maternal and child outcome and enhance recovery by dint of effective non opioid based pain control. We aim to compare the efficacy of Transverse abdominis plane (TAP) block with local wound infiltration for postoperative analgesia in cesarian section (CS).Eighty-two patients undergoing caesarean section under spinal anaesthesia were randomized to undergo local wound infiltration(Group I) (n=41) versus landmark guided bilateral TAP plane block (Group T) with 20ml of 0.25% levobupivacaine postoperatively Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS). Requirement of analgesia, patient satisfaction, time for the first and second rescue analgesia, and the incidence of side effects was also noted. The median VAS was more in the group I compared to group II and was statistically significant (p=0.0032). The mean time to first rescue analgesia was prolonged in group I (4.060 ± 0.682 hrs) compared to group T (3.302 ± 0.519 hrs)(P&#60; 0.001). The mean total analgesic requirement in 24 hours was reduced in group T (89.63 ± 41.82) as compared to group I (137.2 ± 33.13) (P&#60;0.001. Group (T) compared to group I patient had a higher mean patient satisfaction score (1.487 ± 0.589) (2.097 ± 0.430) respectably (P &#60; 0.001).TAP block provides better quality of analgesia and can be safely incorporated as a part of multi-model analgesic regimen postoperative pain over local infiltration in cesarian section.

Fractional carbon dioxide laser, platelet –rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A prospective randomized comparative trial)

Vitiligo is a disease that causes the loss of skin color in patches due to loss of melanin pigmentation of specific areas of the skin. Although several hypotheses have been proposed, the leading theory is still the auto-immune etiology linked to specific genetic mutations. Vitiligo can also be associated with several autoimmune diseases. There is no curative treatment for vitiligo but, several treatment modalities are considered. Topical therapies like steroids and Calcineurin inhibitors are of popular use in clinical settings also, steroids can be administered systemically in vitiligo patients. Physical therapies as fractionated CO2 (Fr: CO2) laser and Narrowband-UV (NBUV) phototherapy represent a gold standard in treatment in clinical practice. Moreover, intralesional therapies are emerging, one of which is autologous platelet-rich plasma injection. Aim of the study This study aimed to evaluate and compare the efficacy and safety of Fr: CO2 laser, PRP, combined Fr: CO2 laser and PRP, combined Fr: CO2 laser and NB-UVB, combined Fr: CO2 laser, PRP and NB-UVB in the treatment of vitiligo as well as reporting the side effects. Patients and methods This study included 20 vitiligo patients with at least 6 patches of stable vitiligo (120 patches), the patches were divided into six groups according to the treatment modality. Assessment of treatment response was done through patient satisfaction score and Vitiligo analysis by computer-assisted grid (VACAG). Results Regarding surface area reduction in included patients, fractional CO2 laser achieved the best results followed by triple combination therapy (CO2 with PRP and NB-UVB), the least response was with CO2 with PRP treatment. Patient satisfaction in the current study had a different outcome, PRP treated patients exhibited the highest satisfaction scores while triple combination treated group showed the least satisfaction scores.

Therapeutic Effects of Tranexamic Acid Cream in Comparison to Hydroquinone 4% Cream in Treatment of Melasma: A Split Face Comparative Study

Background Melasma is a chronic, acquired pigmentary disorder characterized by gray-brown macules and patches affecting photodistributed part of the face such as the bridge of the nose, cheek, upper lip, forehead, and mandible. It is seen mostly in women of reproductive age group and has an onset usually after pregnancy. However, in around 10% of the cases, males are also affected. Objectives The aim of our study was to assess and compare the therapeutic effects of tranexamic acid cream versus hydroquinone 4% cream in treating patients with melasma. Patients and Methods This prospective split face comparative study included thirty three patients with their age ranging from 18 to 40 years, participated for treatment of different types of melasma, recruited from outpatient clinic of Dermatology department Ain Shams University Hospitals during the period from January to June 2019. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research. All patients received full information about description of the procedure of treatment, possible side effects, photo documentation and they all provided informed consent. Results Both topical TA and HQ 4% cream were efficient in treatment of different types of melasma as shown by significant decrease in Hemi MASI score, patient satisfaction score, significant decrease in average level of melanin measured by Antera 3D camera and significant decrease in area % of melanin by histopathological evaluation after 3 months of treatment, although slight recurrence of melasma was observed one month after stopping both treatments. Meanwhile, no significant difference was observed in treatment response of TA and HQ regarding Hemi MASI score, patient satisfaction score, average level of melanin (Antera 3D camera). This could be attributed to the small number of included patients. Conclusion We concluded that the TA appears to be a promising therapeutic option in the treatment of melasma. TA has fewer adverse effects, same or even better results in comparison with other melasma targeting therapies as hydroquinone cream.

Evaluation of the Efficacy of Intense Pulsed Light in Skin Rejuvenation

Background The pathology of skin aging is a very complex process. There are extrinsic and intrinsic factors which contribute to the pathogenesis of skin aging. Intrinsic (chronological) aging is caused by inherited genes, and extrinsic aging caused by many external factors such as exposure to the sun. With increasing age, more people are seeking to maintain the health of their skin and the demand for treatment of aged skin has raised.(1) Aim of the Work To evaluate the efficacy of Intense Pulsed Light in skin rejuvenation with assessment by antera 3D camera. Patients and Methods This study is a single arm interventional study which included 21adult housewives female patients complaining of different signs of facial photodamage, their age ranged between 30 -40 years, recruited from outpatient dermatology clinic of Ain Shams University Hospital, from June 2018 to January 2019. Patients were subjected to 4 sessions of IPL treatments 2 weeks apart for skin rejuvenation. Evaluation of treatment response was done through Global Aesthetic Improvement Scale (GAIS), Antera 3D camera and patient satisfaction score. Results There was highly significant decrease in indentation index of wrinkles, roughness index of skin and average level of melanin (average of whole face) measured by Antera 3D camera after last IPL treatment session (p value=0.001). Conclusion IPL is proven to be safe and elicited a significant skin rejuvenating effect without prolonged downtime.It is effective in treating various manifestations of photodamaged skin, as consistently enchoed by patient satisfaction scores, GAIS and Antera 3D camera results.