Bridging the gap for clinical pharmacist in developing countries like Pakistan

Clinical pharmacists should be increasingly important members of the healthcare team in developing countries such as Pakistan. Survey of literature was conducted to identify the determinants of clinical pharmacy in Pakistan. Lack of trained human capital, shortage of resources, patient overburden, inefficient pharmacy education curriculum, and limited job opportunities are some of the determinants of clinical pharmacy profession in developing countries. The underutilization of clinical pharmacists paves the way for an increased incidence of medication errors, adverse drug events, irrational prescribing, and suboptimal therapeutic outcomes. Integration mapping is an important framework for providing guidelines in protocol planning for improvement in a profession. A step by step change is required to promote the growth of clinical pharmacy profession in Pakistan

Dual plating osteosynthesis technique used for fixation of inter - condylar distal humerus fractures via transolecranon approach

Introduction: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome

Objective: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures [DHF] via trans-olecranon approach

Methodology: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al [AO]. Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study

Results: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years [range 20 - 50 years]. Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients [23.8%]

Conclusions: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory

Frequency of serum cortisol suppression in patients using 0.05% clobetasol propionate as topical steroid for more than 3 weeks

Objective: To determine the frequency of serum cortisol suppression in patients using 0.05% clobetasol propionate as topical steroid for more than 3 weeks

Study Design: Cross sectional Study

Place and Duration of Study: Both outdoor and indoor patients of Dermatology Department, Military Hospital [MH] Rawalpindi for duration of 6 months i.e. from 18[th] April 2012 to 17[th] October 2012 were selected

Patients and Methods: A total of 189 patients were included in the study. Non-probability purposive sampling technique was used. Early morning [0800 hrs] serum for cortisol levels was taken before starting the treatment and same was repeated after 3 weeks at AFIP. Effect modifiers like age and gender were controlled through stratification. The data was analyzed using SPSS version 10. The quantitative variables like age, duration of illness were calculated by taking standard deviation and mean whereas the qualitative variables like gender, suppression of serum cortisol levels were calculated by taking percentages and frequency. Frequency of serum cortisol suppression was presented according to gender and age groups

Results: Majority of the patients selected were between 31-40 years i.e. 44.98% [n=85]. Gender distribution was 61.90% [n=117] males and 38.10% [n=72] females. Frequency of serum cortisol suppression in patients using 0.05% Clobetasol propionate as topical steroid for more than 3 weeks was seen in 33.33% [n=63]

Conclusion: The frequency of serum cortisol suppression was significantly higher amongst patients using clobetasol propionate 0.05%. Therefore patients prescribed clobetasol propionate 0.05% topically should be checked for serum cortisol suppression regularly if the application is intended to be used for more than 3 weeks

Efficacy of steroid injection in the treatment of trigger finger

Objective:To assess the efficacy of local steroid injection in trigger finger

Materials and Methods:This prospective study was conducted at department of Orthopaedics,Civil Hospital, Dow University of Health Sciences, Karachi, from March 2012 to 2013. Males and females with complain of trigger finger were included in this study during the specified period. All patients were injected depomedrol with plain xylocaine at the nodule site and functional outcome was assessed with respect to pain relief and finger movement

Results: Study included 43 patients with trigger finger.29 were males and 14 were females. Right hand fingers were involved in 24 patients, remaining had left hand fingers involvement. 10 involved the index finger,7 middle finger, 4 ring finger,10 little finger and 12 thumb. 9 patients had associated rheumatoid arthritis and 15 were known cases of diabetes. Remaining patients were primary with no known co-morbid. All patients had pain relief initially and regained movement of finger. 10 patients required repeated injection after 3 months. Maximum pain relief and regaining of movement after steroid injection was 4 months

Conclusion:Local steroid injection provides excellent symptomatic pain relief and regained movements without any complication in patients with trigger finger

Radial head fracture mason type III and IV treated with K-wire Fixation

Objective: To assess the functional outcome of radial head fracture Mason type III and IV treated with K-wire fixation

Materials and Methods:This prospective study was conducted at Department of Orthopaedics,Civil Hospital,Dow University of Health Sciences Karachi from 2013 to 2015. Patients with Radial head fracture type III and IV were included in the study

Results:A total of 42 patients were included in this study. Out of these 36 were males and 6 were females. Right side was injured in 18 patients and left side in 24 patients. 32 patients were with Mason type III radial head fracture and 10 were Mason type IV fractures. All fractures were fixed with open reduction and internal fixation with K-wire. Lateral approach was used in all fractures. In Type IV elbow was reduced with close technique. Outcome was measured on the basis of Morrey elbow scoring system. 22 patients with type III radial head fracture had excellent results while10 with type III had good result. All patients with radial head fractureType IV had good results

Conclusion:Assessment of functional outcome of radial head fracture Mason type III treated with K-wire fixation showed excellent outcome in majority of patients while Type IV had good outcome.Mason type III radial head fractures should be reduced and fixed with K-wire. It maintains the stability of elbow joint and elbow function