Biceps brachii rupture in an elderly male

The biceps is the supinator and secondary flexor muscle of the forearm. Injury to the long head of the biceps occurs in the middle aged and elderly; most commonly due to trauma and sudden eccentric contraction of the biceps whilst lifting a weight. It can be diagnosed clinically and further confirmed by sonography and Magnetic Resonance Imaging [MRI]. Treatment is conservative in the majority of cases and involves activity modification, pain relief, range of motion and strengthening exercises, physical therapy and weight lifting precautions. Surgical management, which includes tenodesis and tendon transfer, is reserved for individuals who are active, involved in sport and for those preferring cosmesis. Conservative management has good results with little loss in supination and flexion power, complete independence in activities of daily living and complete resolution of symptoms. Clinical suspicion, early clinical diagnosis and conservative management can prevent morbidity/complications and assist in early recovery

Identification of barriers in the reintegration of pakistan military amputees at the workplace

Objective: : To identify barriers in the reintegration of Pakistan military amputees at their workplace and to suggest remedial measures

Methodology:A cross-sectional questionnaire-based study was planned and hospital ethics committee approval was obtained.Two part survey was constructed consisting of demographics and questions about the possible barriers at the workplace. Fifty eight military amputees [20-60 years, with disability class A and B due to major amputation of a limb] were approached and requested to fill in the questionnaire after explaining the rationale and possible benefits of the study. Response rate was 100%

Results: All patients were males. Most of the patients had trans-tibial amputation [41]. Majority were matriculate and earned between Rs. 20,000- 40,000 [53.4%]. All patients were provided with latest modular prosthesis of Ottobock [Germany] and Ossur [USA], free of cost with life time maintenance and replacement by Armed Forces Institute of Rehabilitation Medicine [AFIRM]. Majority of the patients could ambulate independently, were confident after provision of prosthesis and were spared by their units for timely follow-up. Major barriers included lack of accessible washrooms in the unit, too much time off-work and lack of confidence even after provision of prosthesis

Conclusion: Amputee rehabilitation can lead to successful and complete community re-integration. Pakistan Army is providing comprehensive amputee rehabilitation services to those who sustain a limb loss. However, certain barriers can hinder the rehabilitation process and it is important to identify and remove these barriers for better functional outcomes in amputees

need for medical rehabilitation during floods: a cross-sectional survey of physicians from Pakistan armed forces

Objective: To analyze the spectrum of medical issues during floods and to document the needs for medical rehabilitation expertise during floods in Pakistan

Methodology: A questionnaire based cross sectional survey was designed. Medical officers from Pakistan Army who provided services in the flood affected areas of Pakistan during 2010-14 were selected. Data recorded included the area, time since flood,number and types of patients seen per day, medical issues encountered and trauma cases seen. We also inquired about the need for rehabilitation medicine physicians during floods and if any rehabilitation interventions were needed or offered during rescue operations. Data was analyzed using SPSS version 20

Results: Forty self-administered questionnaires were distributed among physicians who had recently returned after performing duties in the flood hit areas. The response rate was 70% [28]. All the respondents were medical officers from Army Medical Corps. There were 15 males and 13 female respondents with an average of 1 year experience. They had reached the flood affected areas1-4 weeks post-floods and spent an average of 30 days in those areas. Majority of the doctors were in Rahimyar khan and surrounding areas. Average number of patients attended was 147 patients/physician/day. Gastrointestinal diseases, skin infections and conjunctivitis were the commonest issues seen, followed by respiratory illness and minor trauma [bruises and lacerations]. Only one case each of head injury and fracture were reported. None of the respondents considered early rehabilitation intervention mandatory in acute flood situation, however, weekly visits of medical, surgical, skin and eye specialist, gynaecologist and psychiatrist were recommended

Conclusion: Frequent medical consultations in floods involve gastrointestinal disorders, skin diseases, conjunctivitis and respiratory illnesses. General duty doctors trained in common flood related ailments are sufficient. However weekly visits by consultants is recommended. No specialized rehabilitation and other services are required in initial days of floods

Arthritis mutilans: Case report of an uncommon squeal of psoriatic arthritis

Psoriatic arthritis [PsA] is a seronegative spondyloarthropathy that presents clinically in different forms. Arthritis mutilans is a rare yet the most aggressive and disabling form of PsA that requires early diagnosis and aggressive therapy preferably in the form of biological agents to prevent or stop the irreversible destruction of small joints. We describe here, report of a case of long standing PsA who developed arthritis mutilans resulting in disability, compromised mobility and a poor quality of life

Frequency of urinary tract infection [UTI] and commonest causative organisms in spinal cord injury patients with various voiding modes

To determine the frequency of urinary tract infection and commonest causative organisms in spinal cord injury patients with various modes of voiding in rehabilitation setup in Pakistan. A descriptive study of 100 spinal cord injury patients. The Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi from September 2007 to March 2008 on clinical samples received from admitted patients in CMH Rawalpindi and AFIRM. In 100 patients of spinal cord urine samples were subjected to Urine Routine examination and Urine Culture sensitivity. Urine culture revealing a bacterial colony count of 105 cfu/ml or higher were considered positive for urinary tract infection [UTI] if present with symptoms. Significant bacteriuria was investigated for spectrum and sensitivity pattern as well. Of all 100 spinal cord patients 52 patients [52%] had symptoms suggestive of UTI but only 37 patients [37%] had significant bacteriuria on urine culture supported by high level pyuria were declared to have UTI. E-coli was the most commonly isolated organism with total no of 20 cases [54.1%] followed by Pseudomonas 6 cases [16.2%], Klebsiella pneumoniae 3 cases [8.1%], Proteus mirabilis 3 cases [8.1%], Citrobacter freundi 2 cases [5.4%] and the least frequent was Morganella morganii with 1 case [2.7%]. UTI was most frequent in patients with indwelling catheter and was least associated with self voiding. Urinary Tract Infection was commonly observed among spinal cord injury patients. E-coli was the commonest isolated pathogen followed by Pseudomonas, Klebsiella pneumoniae, Proteus mirabilis, Citrobacter freundi, Candida and Morganella morganii in descending order of frequency. UTI was most frequent in patients using indwelling catheter as a mode of voiding