International Medical Journal

Abstract : Topical phenytoin, due to its positive effects in healing of ulcers has been widely used in managing Diabetic ulcer foot in current practice. Aim of this study to evaluate the efficacy of topical phenytoin in DM foot ulcers in terms of reduction in wound surface area, rate of granulation tissue formation and number of days required for healing. All diabetic ulcer foot patients after the debridement the initial size of the ulcer and presence of granulation tissue were measured and twice daily dressings were done for each patient. The wounds were reassessed on 14th day. The measurements were recorded and compared with the initial size. The difference between the Study group and Control group in terms of no of days of hospital stay, increased rate of granulation tissue, wound surface area, which is statistically significant. Topical phenytoin dressings are more effective than conventional povidone iodine and saline dressing in terms of faster reduction in wound surface area, increased rate of granulation tissue formation and lesser number days taken for wound healing..
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The infection prevention and control activities during COVID-19 outbreak may affect every aspect in medical services, including medical rehabilitation. In geriatric patients, rehabilitation programs are essential to help in overcoming consequences of physical and cognitive impairments, and to prevent functional decline after hospitalisation. To protect both patients and healthcare professionals, direct contact through visits/ward round by HCPs will be reduced, and the rehabilitation programs will be emphasized on patient’s independence and/or caregiver competence. This study aims to evaluate the impact of service adjustment to functional capacity of the inpatient geriatric population in RSCM, Jakarta. This is a cross-sectional study. Data were taken through 45 medical records of geriatric patients who received inpatient care before pandemic (2016 to February 2020) and during pandemic (from March 2020). Functional ability was assessed by Barthel Index at hospital admission and discharge. From 23 geriatric patients who received inpatient care before pandemic, the mean difference of Barthel Index was 4.69. After pandemic, the mean difference of Barthel Index from 22 patients was 2.75. However, this is not statistically significant (p=0.074). There was no statistically significant difference in Barthel Index due to service adjustment in Medical Rehabilitation Department during COVID-19 era. There may be other factors contributing to patient’s recovery other than differences in health care services that are not analyzed in this study. Therefore, larger study is required to prove this beneficial effect.

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We report a case of a 39-year-old lady with underlying osteopetrosis who was planned for a staged bilateral total hip replacement. The aim of this case study is to discuss the surgical challenges that an orthopedic surgeon should be aware of pre-operatively and intraoperatively to overcome the challenges when treating an osteopetrosis patient with osteoarthritis of the hip requiring a total hip replacement.

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Many surgeons face a challenging situation of uncertain or unexplainable diagnosis while treating the intraabdominal malignancies. Intraoperative surprise or the tumour unrepeatability are the two main situations which an operating surgeon will try to not encounter. The aim of the study is to evaluate the role of preoperative laparoscopy as an additional tool to diagnose, assess staging and operability of intraabdominal malignant tumours. The group consisted of 30 patients with abdominal malignancy diagnosed by radiological criteria were submitted to staging laparoscopy before a planned open exploration and resection. The type of the study is the prospective observational case series. Patients were followed every three monthly. In follow up visits all patients underwent detailed clinical examination for metastasis. USG abdomen and chest X-ray were done on follow up. 43.3% patients in the current study were avoided from unnecessary laparotomy which is on the higher range than the as the literacy rate and the awareness about the disease varies when it is compared with the western population. Majority of the cases present at the advanced stage. Pre-operative Laparoscopic assessment is found to have a role in the staging of intra-abdominal malignancies, it appears to be a safe and effective means of directing appropriate therapy and avoiding unnecessary exploration. A Staging Laparoscopy performed initially before the planned surgical procedure to evaluate the operability is found to be safe & effective and need not be performed as a separate procedure in an another setting. Laparoscopic assessment pre operatively increases the respectability rate, decreases the nontherapeutic laparotomy rate, and decreases length of stay in patients with unrespectable disease.

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The reflection and retraction of mucoperiosteal flap is an essential step in most of the surgical procedures. Austin’s and Langenbeck’s retractors are most commonly used for flap retraction during intraoral surgical procedures. There is no literature on the amount of trauma created to the periosteal layer of the flap by these retractors. Hence, the present study aims at assessing and comparing the extent of trauma created to the periosteal layer of the flap when retracted with Austin’s and Langenbeck’s retractors during surgical removal of impacted mandibular third molars. The results show that 72% of flaps retracted with Austin’s retractor and only 16% of flaps retracted with Langenbeck’s retractor exhibited trauma to the periosteal layer as a result of flap retraction. Thus results indicate a significant increase in trauma rate to the periosteal layer of the flap when Austin’s retractor is used. Pearson Chi-Square test revealed a significant correlation between duration of the flap retraction and trauma rate in Austin’s group (p<0.05), but no such correlation was evident in Langenbeck’s group (p=0.466). Austin’s retractor causes more trauma to the periosteal layer of the mucoperiosteal flap compared to the Langenbeck’s retractor during the flap retraction.

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