Traumatic Injuries of the Dorso-lumbar Spine, Review of Surgical Approaches

In this review we supply information on medical methods for thoraco-lumbar spine fracture management, their efficiency and complication rates, based on previously published researches and also give background information on epidemiology and classification of thoraco-lumbar fractures. We conducted a narrative review over the literature using electronic databases as; MEDLINE, and EMBASE for studies involving data on Dorso-lumbar Spine traumatic injuries, published in September 2019. Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of back cracks is essential in order to establish a typical language for therapy indicators and results. Clinical exam, mechanism of injury, and imaging are heavily trusted to choose regarding medical versus non-surgical management.

Metabolic dysregulation in early onset psychiatric disorder before and after exposure to antipsychotic drugs

Antipsychotic Drugs (APDs) are being widely prescribed to treat various disorders, including schizophrenia and bipolar disorder; however, abnormal glucose metabolism and weight gain have been reported with Atypical Anti-Psychotic drugs (AAPDs) that can lead to insulin-resistance and type 2 diabetes mellitus. The study was designed to assess various biochemical parameters including insulin and blood sugar before and after exposure to APDs in order to exclude the involvement of psychiatric disorders and certain other factors in metabolic dysregulations. Fifty seven APDs-naïve patients with first episode psychosis were divided into six groups who received olanzapine, quetiapine, risperidone, aripiprazole, haloperidol or combination of olanzapine with escitalopram and haloperidol. The serum samples were taken before the intake of the first dose and then on follow-up. Decrease in the level of elevated insulin and glucose was observed post-treatment in some patients, while others were observed whose insulin and glucose levels increased post-treatment, yet some patients did not show any disturbance in the insulin and glucose levels. It is concluded that psychiatric disorders by itself, narcotics, cigarette smoking and use of oral snuff may be also be implicated in metabolic dysregulations. The effects of APDs on insulin and glucose in healthy volunteers might be different than in patients with psychiatric disorders.

Frequency of drug Induced Hyperglycemia during remission induction therapy in adults with Acute Lymphoblastic Leukemia

Objectives: To determine the frequency of drug induced hyperglycemia during remission induction and its associated risk factors in adult acute lymphoblastic leukemia [ALL] patients

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May 2017 to Nov 2017

Material and Methods: Fifty one adult patients of newly diagnosed ALL were enrolled in the study. Inclusion criteria included, eighteen years or older, treatment naïve. Patients with history of diabetes, on-going treatment or were taking drugs causing hyperglycemia were excluded from the study. Possible risk factors were recorded including age, body mass index [BMI], gender, family history of diabetes, history of hypertension and disease risk stratification for ALL. Patients were started on standard or augmented Berlin-Frankfurt-Münster [BFM] protocol according to risk category. Fasting and random glucose levels were done twice a week during induction chemotherapy. Hyperglycemia was diagnosed when patients experienced blood glucose greater than 126 mg/dL as fasting or greater than 200mg/dL as post prandial. Data were analyzed using SPSS version 23

Results: Eighteen of our fifty one enrolled patients [35.3 percent] experienced hyperglycemia during induction chemotherapy. There was also significant increase in fasting blood sugar levels from baseline readings after induction chemotherapy [p-value<0.001]. Univariate analysis demonstrated significant association between fasting high blood sugar after induction chemotherapy with age [p-value <0.001] and BMI [p-value=0.034]. While on multivariate analysis only age [p<0.001] was found to have significant association with hyperglycemia

Conclusion: Hyperglycemia was observed in less than half of our adult ALL patients during induction chemotherapy. Age was a significant risk factor associated with hyperglycemia

Impact of low versus high vaccum suction drainage on duration of hospital stay after modified radical mastectomy

To determine the efficacy of low pressure vs high vacuum suction drains after modified radical mastectomy in terms of earlier removal and its impact on duration of hospital stay. A randomized clinical trial. The study was conducted at Military Hospital Rawalpindi and CMH Peshawar over a period of 12 months from March 2010 to March 2011. Sixty trucut/biopsy proven, early invasive breast cancer patients undergoing modified radical mastectomy were randomized into groups A [n=30] and B [n=30] to receive high vacuum [400 mm Hg] suction drains or low vacuum suction drains [200 mm Hg] at completion of operation. Drains were recharged to the specified pressure daily and drain output was recorded. Drains were removed when the daily drainage reduced to 30 ml. 28 patients in group A and 27 patients in group B were finally included in the study. Mean hospital stay in low vacuum suction group was 4.96 +/- 0.898 days which was 32.9% shorter than 7.39 +/- 1.397 days for high pressure suction group [p< 0.005]. The use of low vacuum vs high vacuum drains after modified radical mastectomy reduces the hospital stay significantly

Element Content of Some Ethnomedicinal Ziziphus Linn. Species Using Atomic Absorption Spectroscopy Technique.

Ziziphus species have wide distribution and uses worldwide traditionally as medicine. The flame atomic absorption spectroscopy was employed for the estimation of element contents of different plant parts of Ziziphus species collected from different areas of Pakistan. The results of the present study provide justification for the medicinal usage in the treatment of different diseases. The metal contents in the samples were found at different levels which play a vital role in cure of diseases. These results can give the importance about the herbal drugs prepared from these plant materials in herbal remedies and in pharmaceutical companies.

Mother's knowledge over child- toilet training in Sebardan village in Erbil

Child toilet training is a paramount skill to learn, it virtually involves many steps for parents to endorse should the child success. The aim of the study was to assess mother's knowledge about child-toilet training in Sebardan Village in Erbil. A cross-sectional descriptive study was carried out in Sebardan Village in Erbil Governorate from the 1st / March / 2010 to the 30th / May / 2010. A convenience sample of 300 mothers with their children under the age of five years old was selected. Less than half [31.4%] of the mothers age were between 21-25 years old, [85.4%] of them were housewives, [34%] completed a primary school and all of them were from the rural areas. Less than half [40.4%] of mothers whom their male children exhibited physical readiness to reduce their number of wet diapers. Our survey concluded that mother's knowledge had an effect on the child's readiness for toilet training, and highly significant relationship between mother's level of education and their knowledge of their child's readiness [physical, mental and psychological] toward toilet training at p

Combat related vascular trauma

To determine the frequency and pattern of different types of vascular injuries, their management and surgical complications. Case series. Combined Military Hospital, Peshawar, from August 2008 to August 2010. All patients of vascular injuries were included. Traumatic amputation, amputation for extensive soft tissue, or nerve injury, death due to reasons other than vascular injuries or Mangled Extremity Severity Score [MESS > 7] were excluded from study. Data included patient profile, time and date of admission, place, site, type and mechanism of injury, associated injuries, vital signs, treatment, type of vascular repair and outcome. Decision to operate was mainly based on clinical diagnosis and hand-held Doppler finding. There were 170 vascular injuries in 96 patients; 76.4% were arterial and 23.5% were venous. Gunshot wounds was main cause [54%] and extremities were the commonest site [85%]. Arteries were repaired in 87% and veins in 40% cases. Venous interposition graft was the preferred method of repair. The overall limb salvage rate was 95%. Thrombosis and infection of the graft and repair were the main causes of secondary amputation. Haemorrhage, reperfusion injury and infection were the main causes of death. Every effort should be made to repair an injured artery to preserve a limb and life. Tourniquet, prophylactic fasciotomy and vascular shunts play an important role. Management of life threatening injuries, unstable fracture of long bones and debridement before definitive repair of artery is important

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Surgical management of diabetic foot and role of UT [university of Texas] classification

To evaluate the role of University of Texas Classification in the management of Diabetic foot. Descriptive study. Surgical unit II Combined Military Hospital Rawalpindi [2003 to 2008] and Department of Surgery Combined Military Hospital Peshawar [July 2008 to Jan 2010]. A total of 300 patients who reported to Surgical Department with a foot ulcer or infection and diagnosed to have Diabetes Mellitus were studied. Patients of both gender and age > 12 years were included. Patients of end stage renal disease, compromised immunity or on steroid therapy were excluded. Detailed history and clinical examination were recorded. Routine investigations including complete blood examination, urine routine examination, renal function tests, x-ray foot, chest x-ray, ECG and pus for culture and sensitivity were recorded. Lesions were classified according to University of Texas classification and treated accordingly. Majority of the patients were of 50 to 70 years ago group. Male to female ratio was 4:1. Big toe was the commonest site followed by fore foot and heel. Patients were classified according to UT classification. Patients were managed with antibiotics, dressings, incision and drainage, debridement, vacuum assisted closure [VAC] with or without skin grafting and amputations of different types. Staphylococcus aureus was the commonest isolate. Our study has shown that UT classification is an effective system of assessing the severity of diabetic foot at the time of presentation and planning its management. Amputation rates, time of healing and morbidity increases with increasing stage and grade

Giant aneurysm of the extracranial internal carotid artery

Aneurysm of the extracranial internal artery is a rare condition with incidence of 0.8-1% of all aneurysms. It can give rise to serious complications like; haemorrhage due to rupture, stroke and thrmboembolism. Its treatment is technically challenging. One such case of giant aneurysm of extracranial internal carotid artery was found in 70 years old lady. The aneurysm was treated by proximal and distal ligation of the internal carotid artery and excision of the aneurysm with excellent postoperative recovery and early follow-up

Hydatid disease of Bone

A case of primary hydatid disease of the right femur is reported that presented with pathological fracture and was diagnosed at the time of exploration for biopsy. The patient was treated by removal of all cysts, irrigation with scolicidal solution, bone grafting and immobilisation of the fracture followed by four cycles of oral Albendazole. Eosinophilia and serological tests reverted to normal but the patient died due to acute myocardial infarction six months later. This uncommon condition should be considered in the differential diagnosis of pathological fractures, bone pain or osteolytic lesions, especially in patients of rural and farmer background

Hypospadias: one stage repair

To evaluate the cosmetic and functional results of one stage repair of hypospadias, using parameatal based flip-flap urethroplasty. A prospective study from 1990 to 2002 at AFIU Rawalpindi, CMH Kohat, Jhelum, and Pano Aqil Cantt. And AK CMH Muzaffarabad. Fifty patients underwent one stage repair of hypospadias by parameatal based flip flap urethroplasty, using ventral penile and scrotal axial skin flap. The urethral meatus was subcoronal in 6 [12%], Distal penile in 32 [64%], proximal penile in 8 [16%] and penoscrotal in 4 [8%]. Some modifications and combinations were used to ensure better vascularity of the flaps; natural verticals slit meatus and reduce complications. An 8 Fr polythene feeding tube used as stent with its tip inside the urinary bladder was removed on 7th or 8th postoperative day. The mean follow up period was 12 to 36 months. We achieved good cosmetic and functional results in 86% patients. Urethrocutaneous fistula occurred in 3[6%] patients, meatal stenosis in 2 [4%], residual chordee in 1[2%] and disruption of repair due to flap necrosis in 1 patient. Only four patients required redo surgery for fistula, residual chordee and failed repair due to flap necrosis. Meatal stenosis responded well to regular dilatation with the cone tip of an ophthalmic ointment tube, twice daily for 2-4 weeks. Postoperatively the penis was straight with natural vertical slit meatus and good stream of urine. One stage parameatal based flip flap urethroplasty, with some modifications, give very good functional and cosmetic results in primary as well as salvage repair of hypospadias

Two-stage hypospadias repair: a method applicable to all types of hypospadias

To assess the results of two-stage repair in proximal hypospadias and cases of distal hypospadias with chordee, revision surgery and in circumcised cases. Design: Prospective study. Place and Duration of Study: Combined Military Hospital, Kharian and Pano Aqil, from July 1998 to June 2002. Patients and Nineteen patients, with distal as well as proximal hypospadias, underwent two-stage hypospadias repair during the last 04 years. Splitting of glans and full thickness grafting was carried out in the first stage. Tubularization was carried out 3-6 months later and the repair was covered with water proofing layer. The results were evaluated. Distal hypospadias was seen in 13 patients, 06 cases had proximal hypospadias, 08 patients had undergone repair previously by different techniques and 05 cases were circumcised. Chordee was seen in 12 cases. Common age of presentation was below 5 years. Adequate cosmetic and functional results were achieved in all these cases. Fistula occurred in 02 cases and meatal stenosis was seen in 01 case, which responded to regular dilatation. Two-stage hypospadias repair gives excellent cosmetic and functional results in all cases of proximal hypospadias and cases of distal hypospadias with chordee, revision surgery and circumcised cases