Comparison of analgesic efficacy of intra-articular and peri-articular sacro-iliac joint injection in patients with sacro-iliac joint pain syndrome

Objective: To compare the analgesic efficacy of intra-articular vs peri-articular sacroiliac joint [SIJ] injection in patients with sacroiliac joint pain syndrome. Study Design: Prospective, randomized control trial. Place and Duration of study: The study was conducted at the department of Pain Medicine, Combined Military Hospital [CMH] Rawalpindi, from Jul 2015 to Jun 2016

Material and Methods: Forty eight patients of sacroiliac joint [SIJ] pain syndrome were randomly assigned into two equal groups. Group A [n=24] received intra articular SIJ injection of local anesthetic with steroid [Triamcinol one 40mg] under fluoroscopic guidance [drug volume 2.5] and group B [n=24] received Periarticular SIJ injection of local anesthetic with steroid [Triamcinolone 40mg] using land mark technique [drug volume 10ml]. Pain score was assessed at 0 [Preprocedural baseline], 4, 8, and 12 week intervals after intervention by using numerical rating scale [NRS]

Results: Mean NRS pain score of group A was 7.5 +/- 0.99 and 3.1 +/- 1.6 at 0 and 12 week respectively. Mean NRS pain score of group B was 7 +/- 1.10 and 5.55 +/- 1.0 at 0 and 12 week respectively. A p-value <0.05 at 12 week between group A vs group B. There was a reduction in mean pain score from baseline to 12 week in both the groups but this reduction in mean pain score was statistically significant in group A as compared to group B

Conclusion: Pain relief score was found to be statistically significant in fluoroscopic guided intra-articular technique as compared to peri-articular landmark technique for sacroiliac joint pain syndrome at 12 weeks post procedure

Comparison of analgesic efficacy of Systemic Lignocaine combined with Dexamethasone and Lignocaine infusion

Objective: To determine the analgesic efficacy of lignocaine combined with dexamethasone and lignocaine infusion in patients with advance cancer disease

Study Design: Randomized controlled trial

Place and Duration of Study: Pain centre Combined Military Hospital Rawalpindi, from Apr 2016 to Nov 2016

Material and Methods: Total 122 patients, 61 in each group, fulfilling the inclusion criteria were included in this study after approval of the ethical committee. The technique used was non probability consecutive sampling. Two groups were made; group-A received Lignocaine 2mg/kg and group-B Lignocaine 2mg/kg with dexamethasone 0.15mg/kg in continuous infusion over 30 minutes. Both regimen were administered twice weekly for a period of 12 weeks as an outdoor procedure. Numerical rating scale used to measure severity of pain. Baseline and outcome parameters of all patients' i.e. severity of persistent and breakthrough pain and percentage relief of pain were recorded and compared at 12 weeks. Mean +/- standard deviations were calculated for quantitative variables, while qualitative variables presented in frequency and percentages. Chi-square test used for qualitative variables while Independent sample t-test used to compare means. A p-value <0.05 was considered statistically significant

Results: When results of group-B compared with group-A, there was a significant reduction in severity of persistent pain from 5.68 +/- 2.08 to 2.83 +/- 1.01 [p-value <0.05], breakthrough pain from 5.90 +/- 2.07 to 3.06 +/- 1.09 [p-value <0.05]. The percentage relief of pain was 45.08 +/- 15.01 [ percent] when compared to baseline i.e. 23.35 +/- 8.55 [ percent] [p-value <0.05]

Conclusion: Lignocaine with dexamethasone has shown to be effective in reducing complex cancer related pain and disability when compared with Lignocaine alone

Comparison of Analgesic efficacy of Systemic Lignocaine combined with Dexamethasone and Lignocaine infusion in advance Cancer patients

Objective: To determine the analgesic efficacy of lignocaine combined with dexamethasone and lignocaine infusion in patients with advance cancer disease

Study Design: Randomized controlled triall

Place and Duration of Study: Pain centre Combined Military Hospital Rawalpindi, from Apr 2016 to Nov 2016

Material and Methods: Total 122 patients, 61 in each group, fulfilling the inclusion criteria were included in this study after approval of the ethical committee. The technique used was non probability consecutive sampling. Two groups were made; group-A received Lignocaine 2mg/kg and group-B Lignocaine 2mg/kg with dexamethasone 0.15mg/kg in continuous infusion over 30 minutes. Both regimen were administered twice weekly for a period of 12 weeks as an outdoor procedure. Numerical rating scale used to measure severity of pain. Baseline and outcome parameters of all patients' i.e. severity of persistent and breakthrough pain and percentage relief of pain were recorded and compared at 12 weeks. Mean +/- standard deviations were calculated for quantitative variables, while qualitative variables presented in frequency and percentages. Chi-square test used for qualitative variables while Independent sample t-test used to compare means. A p-value <0.05 was considered statistically significant

Results: When results of group-B compared with group-A, there was a significant reduction in severity of persistent pain from 5.68 +/- 2.08 to 2.83 +/- 1.01 [p-value <0.05], breakthrough pain from 5.90 +/- 2.07 to 3.06 +/- 1.09 [p-value <0.05]. The percentage relief of pain was 45.08 +/- 15.01 [ percent] when compared to baseline i.e. 23.35 +/- 8.55 [ percent] [p-value <0.05]

Conclusion: Lignocaine with dexamethasone has shown to be effective in reducing complex cancer related pain and disability when compared with Lignocaine alone

Sexual health among young sexually active females with vaginal candidiasis

Background: sexual health among females in a low middle income country like Pakistan substantially affects quality of life. Vaginal Candidiasis is a common infection found among the females leading to discomfort and pain during the sexual intercourse

Objective: to determine the sexual health, among young sexually active females with vaginal candidiasis

Methodology: it was a cross sectional study conducted in Nawaz Sharif Social Security Teaching Hospital, Lahore from 1[st] January to 31[st] December 2015. Two hundred sexually active married females between 16 - 22 years of age were selected by non- probability convenience sampling after obtaining their informed verbal consent. Three groups of study subjects were selected, Group A, Candida Positive, Group B, Candida negative and Group C with Vaginitis due to other cause. Complaints which were recorded and analyzed were dyspareunia, itching, vaginal discharge and vulvar soreness. Data through a pretested questionnaire was collected, entered in and analyzed by Statistical Package for Social sciences [SPSS] version 16

Results: in group A, 54% have dyspareunia, in group B, 17% were having dyspareunia and in Group C, 29% have dyspareunia. Growth of candida and oral contraceptive use was significantly associated with dyspareunia. [p<0.05]

Conclusion: this study showed that candida infection affects sexual health and is the major factor that hinders sexual intercourse due to dyspareunia. Use of oral contraceptives is an associated contributing factor in dyspareunia due to recurrent candidiasis

Helicobacter pylori infection in children presenting with recurrent abdominal pain

Objective: To determine the frequency of Helicobacter Pylori [H. pylori] infection in children presenting with recurrent abdominal pain [RAP]

Study Design: Descriptive cross-sectional study

Place and Duration of Study: This study was conducted at Combined Military Hospital [CMH] Quetta over a period of 10 months from 01-08-2011 to 31-05-2012

Material and Methods: A total of 83 children with recurrent abdominal pain were included in this study. Blood samples of patients were analyzed in laboratory of CMH Quetta for H. pylori Antibody [Ab] titers

Results: Mean age of the patients was 8.12 +/- 3.46 years. Distribution of gender showed that 44 patients [53.1%] were male while 39 patients [46.9%] were female. Mean duration of symptoms was 15.8% +/- 3.7 months. H. pylori infection was present in 27 [32.5%] patients. Topical ciprofloxacin is more effective in earlier control of congestion and discharge of ear in CSOM; [p value <0.001 and <0.005 respectively] as compared to Neomycin

Conclusion: H. pylori infection is common in children with RAP and presentation of epigastric pain in these patients can be considered as a warning sign to screen for H. pylori infection

Knowledge, skill and attitude of community midwives regarding intrauterine devices for family planning in Lahore

Objective: Study was designed to assess the knowledge, skill and attitude of community midwives before and after three days training workshop on the subject insertion of intrauterine device, as a tool for family planning

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at Community Medicine, Sharif Medical and Dental College, Jati Umra, Lahore and Department of Public Health, The University of Lahore from January 2015 to June 2015

Materials and Methods: An intervention study was conducted by collecting data from designing structured questionnaire which was answered by the midwives taking part in the training to evaluate their basic knowledge, skill and attitude towards use of intrauterine devices. This study was based on three phases. 1] assessment 2] intervention 3] evaluation. Thirty community midwives in the community based maternity homes of Lahore was selected as subjects. Data through a pretested questionnaire was collected and analyzed by statistical package for social sciences [SPSS]

Results: 50-70% of community midwives had the basic knowledge of IUD, insertion skill and its benefits, before going through the training. After the training, knowledge of IUD, its insertion skill and advice to women increased up to 85-100% among the participants. Results clearly show that the knowledge of the community midwives regarding use of IUDs use as a family planning tool was minimal and increased after getting the training

Conclusion: Study finding suggested that training is essential for the community midwives for improving their knowledge, technical skill for insertion of IUD, and aptitude for counseling to the families upon follow up visits

Frequency of healthy overweight adult females in a cluster

Objective: To find out the frequency of healthy overweight / obese females as determined by body mass index in a cluster

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Out-Patient Department of CMH Landi Kotal hospital from 1[st] Jan 2016 to 30[th] June 2016

Materials and Methods: non-probability convenience sampling between 18-24 years of age was taken. They were subject to anthropometric and body mass index measurements. Blood pressure and resting heart rate were taken. Further data was collected by a questionnaire, based on socio-demography, physical activity, self- perception of body weight and health status. Informed consent was taken prior conducting the study

Results: Among 500 females, mean age was 19 +/- 1 year, and age range was 18 to 24 years. 436 cases belonged to rural areas and 64 cases belonged to urban areas. 104 individuals [20.8%], belonged to group 1; 320 [64%] individuals belonged to group 2; 60 [12%] individuals belonged to group 3; 16 [3.2%] individuals belonged to group 4. Blood pressure and pulse rate were recorded under standard conditions in all groups [Table 1]. None of the individuals had irregular pulse. All females responded to the pre-tested questionnaire. According to the collected data, 89% knew that overweight was related to diseases. About losing weight; 18% individuals replied as dieting, 22% individuals replied as exercise, 54% individuals replied both dieting and exercise and 6% individuals did not know the way to lose weight

Conclusion: Frequency of overweight / obesity was 15% among healthy adult females. Health awareness campaigns to deliver the message for healthy eating habits, regular exercise and maintaining ideal weight will be extremely helpful in controlling the obesity in the community

Role of dexamethasone in brachial plexus block

To evaluate the effect of dexamethasone added to [lignocaine] on the onset and duration of axillary brachial plexus block. Randomized controlled trial. Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline [0.9%] and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone [8 mg]. Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Group A showed the onset of action of 21.64 +/- 2.30 min and in group B it was 15.42 +/- 1.44 min [p < 0.001]. Duration of nerve block was 115.08 +/- 10.92 min in group A and 265.42 +/- 16.56 min in group B [p < 0.001]. The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly

Post operative nausea and vomiting [ponv]: comparison of timing of administration of antiemetics in prolong surgeries

The objective of this study was to compare the timing of administration of Ondansetron and Dexamethasone in terms of prevention of postoperative nausea and vomiting when given at induction verses thirty minutes before the end of prolong surgeries. Randomized control trial. The study was conducted in Main Operation Theatre of Combined Military Hospital Rawalpindi over a period of six months from 17 Apr 2009 to 16 Oct 2009. Cases were selected from OPDs, emergency and also by referral. Total 120 patients were included in this study [60 patients in each group] Group A patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams intravenous at induction and group B patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams thirty minutes before reversal of neuromuscular blockade at the end of surgery. Mean age was observed 41.7 +/- 3.7 and 39.9 +/- 1.9 in group-A and B, respectively. Comparison of pre-induction and 30 minutes before end of surgery at 0-6 hours reveal nausea and vomiting in 11 [18.3%] in group-A and in 3 [5.0%] patients of group-B. Results were statistically significant [p=0.022]. At 7-12 hours results were also statistically significant when comparison was made between group-A and B [p=0.051], while at 13-24 hours difference between two groups was statistically non-significant [p=0.314]. It is therefore established that administering a combination of Inj. Ondansetron 4mg with Inj. Dexamethasone 8mg, was more efficacious in reducing post-operative nausea and vomiting at 0-6 hours when administered 30 minutes before the completion of surgery

Knowledge and attitudes regarding bleeding gums among school children of Peshawar

The objective of this cross sectional study was to assess Knowledge, Attitude and Practices [KAP] regarding bleeding gums in school going children of Peshawar. Seventy-four percent of students were aware of the term bleeding gums whereas 26% did not have any idea. Sixty three percent of the students were suffering from bleeding gums and 51% consulted a dentist in order to get them cured. While the rest used some home remedy or did nothing, and ignored bleeding gums. Based on these results it was concluded that the school going children of this study were not fully aware about bleeding gums and their effects on oral health

Evaluating effectiveness of warming endotra-cheal tube in blind nasotracheal intubation in maxillofacial surgery

Objective: to compare the intubation time, number of attempts to intubation and complications of BNTIbyusing normal ETTs against those softened by warming them with water at 50[degree]C

Methodology: eighty adult patients both male and female scheduled to undergo elective maxillofacial surgery under general anesthesia [GA] were randomly divided into two groups; Group A: BNTI carried out in patients using ETT without warming, Group B: BNTI using ETT warmed and softened with water at 50[degree]C for 5 minutes. The intubation time, number of attempts to intubation and complications of BNTI in both the groups were recorded and compared

Results: we found that BNTI in group B required lesser time and lesser number of attempts for intubation, with low incidences of complications as compared to group A. We found that the most frequent position of nasotracheal tube was tracheal followed by esophageal and anterior positions

Conclusion: ETT softened by warm water facilitated BNTIwith reduced frequency and severity of observed complications like epistaxis, bronchospasm, laryngospasm, painful nose and post-operative sore throat

An audit of cesarean sections in Military Hospital Rawalpindi

To analyze the rate, the frequency of different indications and the most common indication of cesarean sections in Military Hospital Rawalpindi. Cross sectional study. Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to February 2012. A total of 3555 pregnant females delivered during study period were enrolled in the study. Health volunteers and the cases of uterine rupture, pregnancy with fetal anomaly, or termination of pregnancy were excluded from the study. All patients were admitted in labor room. Detailed obstetric and gynecological history was taken. Detailed general physical examination and obstetric examination was done. Baseline investigations were checked. Fetal anomalies were ruled out by anomaly scan. Strict fetomaternal monitoring was done during labor. Cervical foley catheter and prostaglandin E2 [Prostin] tablets were used for induction according to Bishop score. Clinical record of all patients, including mode of delivery and indication, was analyzed in terms of percentage and frequency and documented in a special performa after written informed consent. Filled performas were attached with patient's case notes. Patients enrolled in the study over six months were 3555, out of which 1620 [45.5%] were delivered by cesarean section, 1901 [53.4%] were spontaneous vaginal deliveries and 34 [0.9%] were delivered by vaginal birth after cesarean [VBAC]. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section [44.4%], followed by failed trial of labor [27.1%] and fetal distress seen in 165 [10.1%] cases. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section 44.4%

Awareness of oral health in educated community of khyber pakhtoonkhwa

Oral health may be defined as a standard of health of the oral and related tissues which enables an individual to eat, speak and socialize without active disease, discomfort or embarrassment and which contributes to general well being. Students play an important role in health promotion and to impart preventive information among the family and the society. Hence the purpose of this study was to investigate oral health knowledge, attitude and practice among the educated population

Objectives: To assess Knowledge, Attitude and Practice towards oral health among educated population

Methods and Materials: The study group comprised of 240 people, data on oral health Knowledge, Attitude and Practice [ KAP] were collected by means of self administered questionnaire .The data was analyzed using the SPSS version 16.0 software. The individual scores were summed up to yield a total score and given in subtitles for each question. Frequency, distribution, number and percentage were calculated. The study design was cross-sectional survey

Result: The results showed that among 240 respondents 200 [83.3%] agreed that smoking causes oral cancer, 24 [10%] disagreed while 16 [6.7%] did not know .160 [67%] brush their teeth in correct method , 23 [9%] do not brush their teeth in a correct method while 57 [24%] don't know proper tooth brushing technique . 72 [30%] consumed soft drinks at least once a day ,34[14%] at least once a week and 86 [36%] consumed it occasionally

Conclusion: Result of this study suggest that oral health Knowledge, Attitude and Practice [KAP] of the respondents were quiet satisfying regarding the knowledge about dental care but has to be improved in the other two aspects [i.e. attitude and practice] through oral health promotion programmes. These programmes are needed to improve KAP of educated community

Use of a portable oxygen concentrator and its effect on the overall functionality of a remote field medical unit at 3650 meters elevation

The supply of oxygen is a complex issue in disaster situations and snowbound mountainous areas. Innovative solutions are required for safe anesthesia practice; one such innovation is a small portable oxygen concentrator for oxygen therapy in remote austere environment. We conducted this study to ascertain the economy achieved by employing this equipment to improve functionality of a surgical unit in an austere environment. Retrospective review of patient records and cylinder consumption from 1st October 2008 to 30th March 2009 was carried out and this data was classified as group A. While group B consisted of all the patients, who required oxygen therapy from 1st October 2009 to 30th March 2010, and were divided into sub-groups, on the basis of type of anesthesia or oxygen therapy. They were further categorized with respect to use of oxygen concentrator or oxygen cylinder for oxygen provision. The percentages of patients in these subgroups were summed to ascertain the economy achieved in the use of oxygen cylinders by comparing cylinder/patient ratio between group A and B respectively. Percentage economy achieved was then calculated. In group A cylinder/patient ratio [21/53] was '0.4' as compared to [3/81] '0.03' of group B. Percentage economy achieved was hence found to be [0.4/0.03%]] 1333%. Use of oxygen concentrator is an innovation which is economical, easily applicable and highly recommended in remote austere environments

Epidural anaesthesia; Comparison as an alternative to general anaesthesia in open cholecystectomy

To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamic changes and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epidural anaesthesia. Quasi experimental study. Combined Military Hospital Rawalpindi from 15 October 2007 to 15 April 2008. American Society of Anaesthesiology [ASA] physical status [PS] I and ll patient of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group A [n=30] received general anaesthesia [GA] and group B [n=29] received thoracic epidural anaesthesia [EA], Patients of both the groups were assessed for peri-operative haemodynamic changes, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain P-value. P-value of less than 0.05 was considered significant. 9 out of 30 patients [30%] of group "A" [general anaesthesia] and 4 out of 29 patients [13.79%] in group "B" [epidural anaesthesia] had vomiting. Shivering was seen in 3 out of 30 [10%] in group "A" [general anaesthesia] and 1 out of 29 [3.44%] patient in group "B" [epidural anaesthesia]. Urinary retention was seen in 1 out of 30 [3.33%] in group "A" [general anaesthesia] and B out of 29 [27.5%] in group "B" [epidural anaesthesia]. Urinary retention was relieved by psychotherapy. None of the patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility [passage of flatus and start of oral sips]. ln group "A" [general anaesthesia] 6 patients [20%] started oral sips in first post operative day, 16 patients [53.33%] on second post operative day, 8 patients [26.66%] in third post operative day. ln the group "B" [epidural anaesthesia] 13 patients [44.8%] started oral sips on first post operative day, 15 [51.72%] on second post operative day and one patient [3.44%] on third post operative day. Regarding the length of hospital stay 17 patient [56.66%] of group "A" [general anaesthesia] were discharge by third post operative day and 22 patient [75.77] were discharge by third post operative day in group "B" [epidural anaesthesia]. The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomiting in patients undergoing open cholecystectomy.

Treatment of type III supracondylar fracture of humerus in children, Backslab vs. no Backslab after open reduction internal fixation

To compare the results of application of pop back slab Vs no back slab after open reduction internal fixation in type III supracondylar humeral fracture. Randomized controlled trial. Department of orthopedics, Fauji Foundation Hospital Rawalpindi Duration: From 01 August, 2008 to 3ljuly, 2009. Patients with type III supracondylar humeral fracturers aged between 05 to 12 years were recruited from the outpatient and emergency department of Orthopaedic surgery Fauji Foundation Hospital [FFH], Rawalpindi. Open reduction internal fixation was done, Kochers approach was used and fixation was secured with two k-wires. Of total 70 patients, 52 [74.28%] were males and 18 [25.72%] were females. Forty two [60%] of the patients had age range between 05 to 08, and 28 [40%] were between 09 to 12 years old. In 51 [72.85%] left elbow was involved while right elbow was involved in 19 patients [27.15%]. Outcome of the procedure was analyzed according to Flynn's criteria showing excellent results in 21 patients [60%], good in 9 [25.71%], fair in 04 [11.43%] and poor in 01 [2.86%] in Group-I [with back slab] while in Group-II [without back slab] the results were excellent in 22 patients [62.85%], good in 7 [20%], fair in 04 [11.43%] and poor in 02 [5.72%]. By comparing patients with and without back slabs after OR1F of supracondylar fractures, we found no additional benefit in terms of stability, instead achieving early rehabilitation period, avoids extra cost and save valuable time of the surgical team without compromising any functional and cosmetic difference

relationship of skin to epidural space depth with different physical parameters in obstetric patients

The objective of the study was to find out the correlation between the skin to epidural space depth and different physical parameters like age, height, parity, weight and Body mass index in obstetric patients. Prospective non-probability purposive correlational study. This study was conducted in Department of Anaesthesia and Intensive care, Combined Military Hospital, Quetta, over duration of one year from may 2005 to April 2006. This was prospective correlational study and total of 100 obstetric patients belonging to ASA-I and II class were included. All patients received epidural anaesthesia with 16/18G Tuohy's needle and an epidural catheter was passed at the level of L3-L4/L4-L5 interspace. The skin-to-epidural space depth was marked on the Tuohy's needle with a marker and was subsequently measured with a scale. This study was conducted on parturients undergoing Caesarean section having ages between 18-40 years with mean 27.27 + SD 4.90 years, weight between 44-92 kg with mean 62.73 + SD 9.37 kg, height 142-166 cm with mean 153 + SD 5 cm, parity between primigravida to gravida 9 with mean 2.43 + SD 2.24 and body mass index of 19-38 kg/m2 with mean 27 + SD 4 kg/m2. The skin-to-epidural space depth ranging between 31 mm to 78 mm with mean of 41.59 + SD 6.49 mm was noted. Pearson correlation coefficient for the relation of skin to epidural space depth with patient's age was r=0.317 [p=0.001], with weight was r=0.618 [p=0.0001], with height was r= -0.004 [p=0.966], with body mass index was r=0.623 [p=0.0001] and with patient's parity was r=0.210 [p=0.028]. It was concluded that the skin-to-epidural space depth had statistically significant strong correlation with weight and body mass index but statistically significant weak correlation with age and parity, and statistically insignificant correlation with height

Post spinal headache; comparing needles of 25 and 27 gauges for incidence of post spinal headache

The main objective of the study was to give emphasis for use of smaller caliber spinal needles with the bevel placed sagitally to get the best results and reduce the incidence of PDPH in the patients getting spinal anesthesia. The study on PDPH was conducted as comparative and prospective. Study comparing the two different spinal needles of 25 G and 27 G [different calibers for incidence of Post dural puncture headache]. This study was conducted in Anaesthesiology department CMH Lahore. For this study the literature from different books/magazines/journals and internet was consulted to make the study comparable. The study design contained the patients selection through randomization technique. Proper criteria for selection of the patients were opted and in it only A.S.A.1 Patients were studied. Similarly certain specific age group [young patients] were kept for this study to get accurate results, proper caparison and patients and already got spinal anaesthesia were not tested too. Quincke Babcock spinal needles of 25G and 27G were easily available in the market. This clinical trial contained eighty patients divided in two groups. After taking all precautionary measures they were given spinal anaesthesia and after it they were observed for spinal headache [study performa annexed]. Epidural blood patches were also given in those patients who were given spinal anaesthesia with 25G needle, where required. The results of the study were tested by use of Chi's square test with 1 of freedom. The results confirmed the hypothesis that smaller caliber needle [27G] caused no PDPH while bigger caliber needle [25G] caused headache in percentage of patients. In the end the references from the concerned literature were cited and results were found comparable as given in the literature. The role of smaller caliber needles was well evaluated in this study

Free non-vascularized fibular graft in treatment of bone defects

To determine the usefulness of free non-vascularized fibular graft in the treatment of nonunions and bone defects. Design: Prospective descriptive study. Place and Duration of Study: The study was conducted at Combined Military Hospital/Military Hospital Rawalpindi from September 1997 to June 2000. Subjects and A total of twenty-one cases where free non-vascularized fibular graft was used were included in the study. The indications were varied and included nonunited femoral neck fractures, post-infective and post-traumatic bone defects and bone tumour/cyst resection defects. Overall union was achieved in 76.2% of cases [85.7% in upper limb and 71.4% in lower limb]. Stress fracture occurred in two [9.5%] cases in lower limb. Infection was the cause in all five [23.8%] cases with failure of union and graft resorption. Use of free non-vascularized bone graft in selected patients with suitable recipient bed is a simple and costeffective procedure still valid to bridge bone defects in our setup