Clinical factors affecting the outcome of arthocentesis

OBJECTIVES: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. MATERIALS AND METHODS: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( 7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038). CONCLUSION: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify “at-benefit” patients early and initiate specific treatment.

Clinical factors affecting the outcome of arthocentesis

OBJECTIVES@#This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement.@*MATERIALS AND METHODS@#Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( 7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038).@*CONCLUSION@#Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify “at-benefit” patients early and initiate specific treatment.

Single and Multiple Level One Stage Posterior Hemivertebrectomy and Short Segment Fixation: Experience with 22 Cases and Comparison of Single vs. Multilevel Procedures with Minimum 2-Year Follow-Up

STUDY DESIGN: Data of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively. PURPOSE: To report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results. OVERVIEW OF LITERATURE: Single stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported. METHODS: Twenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared. RESULTS: Average number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p<0.001). Mean preoperative and postoperative sagittal cobb angle was 32.1° (range, 7° to 76°) and 13.6° (range, 0° to 23°), respectively (p<0.005). Mean coronal and sagittal cob correction percentage achieved was 50.2% and 51.8% respectively. Mean follow-up was 49 months (range, 30 to 84 months). Mean loss of coronal and sagittal correction at final follow-up was 4% (0% to 13.6%) degrees and 3.5% (0% to 20%), respectively. CONCLUSIONS: Posterior hemivertebrectomy in congenital scoliosis is a safe treatment option for up to 3-level hemivertebrae. Excision of thoracolumbar hemivertebrae results in better correction than thoracic and lumbar hemivertebrae.

Single and Multiple Level One Stage Posterior Hemivertebrectomy and Short Segment Fixation: Experience with 22 Cases and Comparison of Single vs. Multilevel Procedures with Minimum 2-Year Follow-Up

STUDY DESIGN: Data of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively. PURPOSE: To report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results. OVERVIEW OF LITERATURE: Single stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported. METHODS: Twenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared. RESULTS: Average number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p<0.001). Mean preoperative and postoperative sagittal cobb angle was 32.1° (range, 7° to 76°) and 13.6° (range, 0° to 23°), respectively (p<0.005). Mean coronal and sagittal cob correction percentage achieved was 50.2% and 51.8% respectively. Mean follow-up was 49 months (range, 30 to 84 months). Mean loss of coronal and sagittal correction at final follow-up was 4% (0% to 13.6%) degrees and 3.5% (0% to 20%), respectively. CONCLUSIONS: Posterior hemivertebrectomy in congenital scoliosis is a safe treatment option for up to 3-level hemivertebrae. Excision of thoracolumbar hemivertebrae results in better correction than thoracic and lumbar hemivertebrae.

Frequency of infantile pyloric stenosis and ocular abnormalities in Turner's syndrome in Bahawalpur city

Turner's syndrome is one of the most common of all chromosomal abnormalities. Pyloric stenosis is the most common pediatric surgical disorder of infancy that requires surgery for associated emesis.4 Ocular abnormalities are common in Turner's syndrome, but are under estimated and often neglected. The study that was hospital - based observational, was conducted from September 1[st], 2005 to August 31, 2011 in the Al-Noor Hospital Yazman [Bahawalpur] in collaboration with ophthalmology department, Bahawal Victoria Hospital Bahawalpur. Laboratory investigations including electrolytes, blood gas analysis, and osmolality were done in pathology department, Quaid-e-Azam Medical College Bahawalpur. Frequency of pyloric stenosis in infants from 0 - 6 months 64.95% and infants 6 - 12 months is 35.09%, the ocular abnormalities amblyopia 19%, strabismus 23%, phoria only 43.5%, epicanthus 10%, hypertelorism 3%, ptosis 1%, nystagmus 0.5%. There is a high frequency of ocular abnormalities and pyloric stenosis in infants with karyotype XO. Timely diagnosis may save from devastating effects of ocular complications leading to blindness and life threatening alkalosis due to pyloric stenosis in infants below one year of age

Effect of landfill leachate on the stream water quality

The influence of leachate from open solid waste dumping near Salhad stream [Abbottabad, Pakistan] was investigated to quantify the variations of water quality during August 2007 to April 2008. Samples were collected from five different sites located along the Salhad stream. Two sites were located before the mixing of solid waste leachate with the surface water. One sampling site was of leachate and other two chemical parameters like pH, water temperature, electrical conductivity [EC], total dissolved solids [TDS], Biological oxygen demand [BOD], chemical oxygen demand [COD] and dissolved oxygen [DO]. Microbiological analysis was done by using Membrane filter technique. The results of various parameters determined strongly suggested that landfill leachate had severe deleterious impact on the water quality of Salhad stream. The parameters exceeding the allowable limits of WHO, EC and National Environmental Quality Standards included pH, TDS, BOD, COD, total bacterial counts and total coliform counts. Heavy metals like Pb, Cd and Cu were released from the leachate into the Salhad stream which might affect the sustainability of the aquatic life. Integrated, multi-sector approaches are required to deal with the contamination problem and sustainable management of the Salhad stream water

Hepatitis C virus genotypes in Bahawalpur

This study was conducted at Medical Unit-II Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur from May 1st, 2005 to December 31st 2005. The objective of this study was to determine hepatitis C virus [HCV] genotypes in Bahawalpur, Pakistan. In consecutive 105 anti-HCV [ELISA-3] positive patients, complete history and physical examination was performed. Liver function tests, complete blood counts and platelet count, blood sugar fasting and 2 hours after breakfast, prothrombin time, serum albumin, serum globulin and abdominal ultrasound were carried out in all the patients. Tru cut biopsy was performed on 17 patients. We studied HCV RNA in all these patients by Nested PCR method. HCV RNA was detected in 98 patients and genotyping assay was done by genotype specific PCR. Among total of 105 anti-HCV positive patients, HCV-RNA was detected in 98 patients. Out of these 98 patients there were 57 [58.2%] males and 41 [42.8%] females. Their age range was 18-75 years. The age 18-29 years 26 [26.5%], 3o-39 years 35 [35.7%] and 40-75 37 [37.8%], while to [10.2%] patients were diabetics and 34 [34.7%] patients were obese. Liver cirrhosis was present in to [10.2%] patients. Forty two [43.9%] patients were symptomatic while 56 [57.1%] were asymptomatic. Out of 98 patients 11 [11.2%] were un type-able and 87 [88.8%] were typeable. 70/98 [71.4%] were genotype 3; 10/98 [10.2%] were genotype 1; 03/98 [3.1%] were genotype 2; 03/98 [3.1%] were mixed genotype 2 and 3; 01/98 0%] were mixed genotype 3a and 3b. Genotype 3 is the most common HCV virus in our area which shows that both virological and biochemical response will be better. Because HCV genotype 3 is more frequent among the drug users which points towards unsafe injection practices in our area

Clinical and angiographic findings in patients with significant left main coronary artery stenosis

To evaluate the clinical and angiographic features of patients with significant [>50%] left main coronary artery [LMCA] stenosis. In this prospective descriptive study, we evaluated clinical and angiographic features of 100 consecutive patients with significant LMCA stenosis, which were selected from 1284 patients undergoing coronary angiography at Punjab Institute of Cardiology, Lahore. Significant LMCA stenosis was seen in 7.7% patients. There were 83 males [83%] and 17 females [17%]. Age of the patients ranged from 35 to 72 with mean age of male patients 55.84 +/- 9.99 years and that of female patients 54.12 +/- 9.89 years. Severe angina [NYHA class III-IV] was the most common finding. 54% of the patients had ST depression in resting ECG while ECG was found to be normal in 19 [19%] patients. Hypercholesterolemia was the most commonly found risk factor. 94% patients had disease in other coronary arteries and left anterior descending artery [LAD] was the most commonly involved vessel. Majority of the patients [>70%] had preserved left ventricular [LV] systolic function. All patients underwent coronary angiography safely without any serious complication. Among patients undergoing routine coronary angiography about 8% had significant LMCA stenosis. Most of these had disease in other coronary arteries, especially in males. Severe angina along with diffuse ST depression in multiple ECG leads and strongly positive exercise test were common findings in patients with LMCA stenosis However no specific clinical features were found which could distinguish the patients with LMCA stenosis from other patients with coronary artery disease [CAD]

Frequency of hepatitis C infection in diabetes mellitus

The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. A cross-sectionalObservational-descriptive analytic study. A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection. They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay [ELISA-3] which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence[rural or urban] Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Among a total of 250 patients, 120 [48%] were male and 130 [52%] were female. Two hundred and forty-four [97.6%] patients were of type-II DM and 06 [2.4%] patients were of type-I DM. 22 [8.8%] patients were on insulin therapy while 228 [91.2%] were on oral hypoglycemic agents. Anti-HCV test was positive in 69 [27.6%] diabetic patients as compared to blood donors 41 [0.62%]. In anti-HCV positive group, longer duration of diabetic mellitus [15yrs 15.94%], poor control of diabetic mellitus[87%], insulin therapy[17.39%] hypertension[91.3%] and nephropathy[94.2%] were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Hepatitis C infection is common in diabetic patients as compared to control group [27.6% vs 0.62%]. Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy

Congenital alveolar proteinosis

Pulmonary alveolar proteinosis is recently described as a rare cause of lung dysfunction and respiratory distress in term neonates. In several cases, a deficiency or insufficiency of surfactant protein B SP-B has been caused by a frame shift mutation in the gene encoding SP-B. Three siblings with congenital pulmonary alveolar proteinosis showed clinical and radiological evidence. Histopathological and immunohistochemical studies in the last sibling revealed deficiency of SP-B, one of the group of 3 specific lipoproteins that reduce the surface tension between air and liquid interface within pulmonary alveoli, suggesting a gene associated illness

Perinatally acquired tuberculosis in a neonate

To report a case of perinatal tuberculosis that appeared on the 21th day of life of an infant born to a mother with latent tuberculosis. Clinical Presentation and Intervention: A preterm male infant was born by spontaneous vertex delivery at 33 weeks gestational age to a 33-year-old primiparous Philippine woman. The infant was well until the 21st day of life when he developed recurrent episodes of cyanosis and bradycardia. A chest radiograph showed infiltrates which were thought to be bacterial in origin. Blood, urine, and cerebrospinal fluid cultures were normal. Tracheal aspirate revealed acid-fast bacilli by Ziehl-Neelsen stain, later confirmed to be Mycobacterium tuberculosis by culture in Lowenstein-Jensen medium. The mother was later diagnosed as a case of tuberculosis with symptoms, signs and radiologic manifestation of hilar lymphadenopathy with mild pleural effusion and positive tuberculin skin test. Both infant and mother were treated with intravenous isoniazid, intravenous rifampicin, oral pyrazinamide, and intravenous pyridoxine. Both recovered. A preterm male infant perinatally acquired tuberculosis, most likely by inhalation of the bacteria during delivery. Both infant and mother responded well to antituberculous treatment

Medicinal uses of date fruit [phoenix dactylifera linn.] in district Khairpur, Sindh, Pakistan.

Date is a very delicious fruit. It contains high nutritional and medicinal value and is also a cheaper source of energy and nutrients. The local inhabitants/herbalists [Hakeems] of this area employ this fruit as a natural medicine in different disorders particularly in general debility. Interviews with known elderly people and herbal practitioners were carried out to determine medicinal value of this fruit. This paper reports literature survey and its local uses in order to check its efficacy in various complaints

Coagulation disorders in patients with carcinoma of the hepatobiliary and pancreatic system

Coagulopathies are common accompaniments of hepatic disease. Besides other pathologies, carcinomatosis also involves the hepatobiliary system and pancreas. Liver is at the center of coagulation and is affected by these diverse pathological conditions. An analysis of coagulation disorders was performed in patients with Coagulopathies secondary to carcinomas of hepatobiliary system, with a view to study the spectrum of disorder. Twenty-five patients with coagulation disorders were studied. Of these 7[28 percent] had hepatocellular carcinoma, 12 [48 percent] had metastatic liver disease, 3 [12 percent] patients had carcinoma of gall bladder, 2[8 percent] had carcinoma head of pancreas and 1[4 percent] had a periampullary growth. Patients with deficient /defective Vit K dependent factors showed a markedly prolonged PT [36 percent].40 percent had prolonged PT and APTT, whereas the TT was affected in those with deficient/defective fibrinogen. Patients with DIC fared the worst with prolonged coagulation test times, raised FDP concentration and thrombocytopenia

Pattern of urinary calculi in Faisalabad

To find out the pattern of constituents of urinary calculi in Faisalabad. DESIGN: Consecutive case study. SETTING: Urinary stones received from government and private hospitals by pathology department of Punjab Medical College, Faisalabad. PERIOD: January, 1992 to December, 1994. SUBJECT: One hundred and eighty three patients [n = 183] with urinary stones disease [n

Sensorineural deafness: an unusual complication in the management of double compartment hydrocephalus

Double compartment hydrocephalus indicates separate and individually progressing hydrocephalus of the supratentorial and infratentorial CSF ventricles, which may appear in sequence or simultaneously. Most of the reports in literature describe this entity in patients with stenosis of aqueduct, treated by a CSF shunt for months or years followed by the appearance of infratentorial hydrocephalus. A young man of 24 years presented with signs of progressive rise in intracranial pressure and cerebellar signs. CT scan revealed gross dilatation of the lateral and third ventricles with marked enlargement of the fourth ventricle. Y-shunting was performed with remarkable clinical improvement except for a complaint of partial sensorineural loss of hearing through the right ear which was attributed to the placement of the tip of fourth ventricular catheter in the brain stem

Mean duration of hospital stay of IHD patients at CCU Mayo Hospital, Lahore

The objective of the study was to determine the mean stay of patients with acute myocardial infarction and unstable angina admitted to Coronary Care Unit of Mayo Hospital, Lahore. This prospective study carried out during one year period included three hundred fifty patients. Out of these, two hundred and fifty-seven [73.4%] were males and ninety-three [26.6%] were females. About 59.4% had acute myocardial infarction as per WHO criteria, 33.7% had associated Left Ventricular Failure [LVF]. The average stay was 11 +/- 0.43 days. Those with Acute Myocardial Infarction stayed for average of 10 +/- 0.43 days. The shortest stay was for young patients between forty-one to fifty years old. The longest stay with extensive ant. wall myocardial infarction patient was 13 +/- 2.6 days. It is concluded that patients stay much longer in CCu in one set-up. This may be due to physician's attitude or condition of the patient admitted in CCU

Thrombotic occlusion of the axillary artery in a neonate

A case is reported of ischaemia of the right arm in an apparently normal newborn infant caused by a thrombus in the first few hours of life. Complete obstruction of the axillary artery was shown by catheterisation. Thrombectomy was performed via the brachial artery with the establishment of a good blood flow in the arm. Follow-up showed a normal child with no residual effects