Management of supracondylar fracture of humerus in children by close reduction and immobilization of the elbow in extension and supination

A Supracondylar fracture of the humerus is the most common fracture in children around the elbow and is also called first decade injury. If not treated properly it may lead to disability due to elbow stiffness, and sequel of neuro-vascular injuries like Volkmann ischemic contracture etc. This study was undertaken to determine the outcome of close reduction and immobilization of the elbow in extension and supination in displaced supracondylar fractures of the humerus in children. This Quasi-experimental study was conducted in the Department of Orthopaedics, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from January 2007 to December 2007. The inclusion criteria was Gartland Type III [completely displaced] supracondylar fractures of the humerus and the exclusion criteria was open or closed Gartland type-III fracture associated with neurovascular injury. Close reduction under general anaesthesia was done and the elbow was immobilized in extension by the application of 2 plaster slabs according. The follow up is based on the overall rating using the modified Flynn global criteria. Out of 70 cases, in 56 cases [80%], reduction was acceptable; while in 14 cases [20%] it was unacceptable. Those with unacceptable reduction, 2nd attempt of close reduction were done but only eight were successful and the other six children required open reduction and internal reduction. Those with acceptable reduction went in to union with the carrying angle +/- 5 of the contra-lateral side and full range-of-motion. Excellent result were achieved in 35 cases [50%], good in 15 cases [21.43%], fair in 4 cases [5.71%] and poor in 6 [8.75%] patients. The extension method of close reduction and immobilisation with two slabs is safe method and give better cosmetic results in uncomplicated type III injures as compared to the flexion method

Evaluation of effects of clomiphene citrate on serum testosterone and FSH levels and seminal parameters in idiopathic oligospermia

Clomiphene citrate is a synthetic nonsteroidal drug that acts as an antioestrogen and competitively binds to oestrogen receptors in the hypothalamus and pituitary. This blocks the action of the normally low levels of oestrogen on the male hormone axis and results in increased secretion of GnRH, FSH and LH. The enhanced output of these hormones increases testosterone production and sperm production. A non randomised clinical trial was conducted in a sample of 21 idiopathic oligospermic men from local population with a mean age of 27.75 +/- 4.13 years, to evaluate the effects of clomiphene citrate in a dose of 100mg/day for five days, on serum testosterone, serum FSH, semen volume, sperm density, and total sperm motility. After clomiphene citrate therapy, mean serum testosterone level showed highly significant increase [p<0.05], mean serum FSH level showed significant increase [p<0.1]. Semen analyses were done at periodic intervals, 1[st] at day 1 i.e. before the 1[st] dose of clomiphene citrate, 2[nd] at 6[th] day i.e. 24 hours after the last dose of clomiphene citrate, and 3[rd] at 74[th] day of the trial. Clomiphene citrate administration resulted in statistically significant increase in the mean semen volume at day 6 [p<0.05], increase in the sperm density at day 74 [p<0.05], and increase in the total sperm motility at day 6 [p<0.05]

Career goals of trainee physicians in internal medicine

To survey Internal Medicine trainees' future career choices and factors influencing their decision-making. Cross-sectional study. The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority [22%] opted for internal medicine, while 78% selected sub-specialties with cardiology [20%] being the most sought- after sub-specialty. Majority [69%] wanted to spend more time in clinical activities compared to administration [18%] or research [13%]. Majority [92%] wanted to work in an academic setting. Availability of a structured training program [61%], ability to practice broad area of medicine [41%] and prestige of the specialty [41%] highly influenced their career choices. Forty one [82%] wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs