Lateral epicondylitis; comparison of autologous blood and corticosteroid in the treatment. A prospective, randomized, controlled trial

With aging, chemical hormonal and vascular factors have their part to play in lateral epicondylitis. The objective is to compare results of autologous blood injection and corticosteroid injection in treatment of lateral epicondylitis. Out Patient Department of Peshawar Institute of Medical Sciences, Peshawar from March 2013 to February 2014. Material and A prospective randomized control trail conducted on 58 patients fulfilling inclusion criteria. DASH score and VAS score used as outcome measures and both were recorded before injections and at each follow up made at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. P-value was calculated where applicable. Out of 79 patients 65 met the inclusion criteria. Mean age was 41.43 years +/- 13.43. 36 were females and 29 males. Dominant elbow involved in 39 patients. Mean duration of symptoms was 7.1 +/- 2.9 months. 7 patients lost in follow up. DASH score improved in both groups. but when compared there was no significance difference between the two groups [P value 0.33 at 12 weeks and 0.09 at 24 week follow up]. Similarly Mean VAS improved at 12 and 24 week follow up] in both groups but when compared the difference was non-significant [P value. 071 at 12 weeks and 0.12 at 24 weeks follow up. Both steroid and autologous blood injection has shown improvement in pain and physical activity and provide acceptable results although none superior to other significantly

Autologous blood injection in the treatment of lateral epicondylitis

Objective: to know the results of autologous blood injection in lateral epicondylitis. Out Patient department of Peshawar Institute of Medical Sciences, from March 2013 to December 2013

Material and Method: it is a prospective descriptive study conducted on 66 patients with lateral epicondyHt1s, fluffing the inclusion criteria presenting in DASH [Disability of the Arm, Shoulder and Hand] score was used as primary outcome measure and Thomsen provocative test to elicit pain and Nirschl score to evaluate pain function as secondary outcome. VAS score was used to measure pain. 2ml of autologous venous blood mixed with 1 ml of lignocaine 2% solution and injected by introducing the needle into lateral epicondyle of humorous at site which is most tender by peppering technique. Patients were followed up at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. Patient DASH score, VAS pain score and Nirschl score was recorded before autologous injection and at 12 and 24 weeks post injection. P-value of< 0.05 deemed to indicate statistical significance and was calculated where applicable

Results: mean age of the patients was 39.68 years +12.77. 32 of these patients were females And 34 were males. Dominant elbow was involved in 42 patients. Mean duration of symptoms was 8.9+3.2 months. During follow up 10 patients were lost [6 females and 4 males]. DASH score of patients improved from 86 to 64 at 12 weeks and to 49 at 24 weeks [P value <0.0001]. Mean VAS improved from 7 .63 to 3.89 and 1. 77 respectively at 12 and 24 week follow up [P value <0.0001]. Nirschl score of the patients receiving autologous blood injection improved to 3.69 and 1.66 at 12 and 24 weeks: follow up respectively from 5. 8 score of pre-autologous blood injection [P value <0.0001]

Conclusion: autologous blood injection has shown improvement in pain and physical activity and provide acceptable short to long term results

Frequency of religious themes in obsessive compulsive disorder

To assess the theme of religion on the symptomatology of obsessive compulsive disorder. This study was carried out at the Department of Psychiatry, Lady Reading Hospital, Peshawar from October 2005 to March 2006. Those who satisfied DSM-III R criteria for obsessive compulsive disorder were included in the study. Those suffering from neurological illnesses or any other psychiatric illness were excluded from the study. Fifty Muslim patients [36 Males and 14 females] fulfilled the DSM-III R criteria for obsessive compulsive disorder. The mean age of the group was 25.87 +/- 7.39 and for the 1[st] onset of obsessive compulsive disorder was 21.36 +/- 8.21 years. Themes of obsessions and compulsions were religious [60%], contamination [28%], and order/ safety [20%], in decreasing order of frequency. This study reflects the role of religion which gives content to various obsessions and compulsions which may be helpful in early diagnosis of obsessive compulsive disorder in our culture. Further more the impact of these findings in term of psychological method of treatment such as cognitive behavioral therapy [CBT] could be significant in Islamic culture

Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Knowledge and practice of general practitioners about schizophrenia

To obtain information about the number of patients attended by general practitioners in different stages of schizophrenia; relevant knowledge, diagnostic skills and ongoing practice concerning management of patients suffering from severe mental illness. For this cross sectional survey conducted from May to September 2010, a semi-structured questionnaire, obtained and modified from that of Simon AE et al was distributed among general practitioners working in Bannu district. The participants were requested to fill the questionnaire anonymously and return it to research worker. Out of 100, 72 general practitioners responded to the request of filling the questionnaire. Among them 60 [85%] were males. Only 17% replied that they could spare more than half an hour for the assessment of schizophrenic patients. Sixty four percent reported delusions and hallucinations as the most frequent symptoms of schizophrenia. Seventy percent relied on personal history for diagnosis of schizophrenia. Sixty percent practitioners considered pharmacotherapy as the first line therapy. More than half of them wanted to continue treatment for six to twelve months in first psychotic episode. Seventy percent preferred to refer the patients to specialist care for complete handover. No one of the working practitioners participated in continuing medical education CME on schizophrenia during the past few months of their professional life. The knowledge of general practitioners about signs and symptoms of schizophrenia is reasonable but they lack interventional skills. They need easily accessible specialized services for referral and regular training programmes to update their knowledge

First rank symptoms in the diagnosis of schizophrenia

To determine the usefulness of Schneider's first rank symptoms of schizophrenia. Patients suffering from schizophrenia, admitted to the Psychiatry Ward Khyber Teaching Hospital, Peshawar during the year 2009 were selected by non probability purposive sampling. It was a descriptive study and the diagnosis was made according to DSM-IV criteria. Patients were interviewed by using a semi structured questionnaire based on Present State Examination and first rank symptoms were assessed. Out of 100 patients suffering from schizophrenia, there were 58 males and 42 females. Thirty four [34%] [22 male and 12 females] reported having one or more first rank symptoms while sixty six [66%] patients although diagnosed with schizophrenia on DSMIV criteria did not show first rank symptoms. The most often found individual first rank symptoms in these 34 patients were voices commenting [n=14,%], made impulses [n=12,%], and voices arguing [n=12,%] None reported delusional perception. The reliability of the presence of first rank symptoms in Schizophrenia should be taken cautiously as only one third of the patients diagnosed with schizophrenia as per the DSM IV criteria showed any first rank symptom

Intramedullary Kirchner wire fixation of unstable radius-ulna fractures in children

To evaluate the results and outcome of paediatric unstable fractures of radius and ulna treated by Kirchner wire fixation. Prospective quasi experimental study from July 2004 to May 2007. Department of Orthopaedics and Trauma, Khyber Teaching Hospital, Peshawar. Children with displaced fractures of both forearm bones, in whom closed manipulation had failed. The children were treated with open reduction and internal fixation of both forearm bones with Kirchner wires [K wires]. Under general anesthesia and tourniquet control the fractures were fixed by retrograde method. Patients were followed every month for clinical and radiological union of fracture and for any complications. The K wires were removed after healing of fractures. The patients were assessed for symptoms such as pain, ability to participate in physical activities or sports, and physical examination was done to see range of motion of wrist, elbow and forearm, Grading of the results was done according to modified Price criteria. The total number of patients was 22. Sixteen were males and six were females. The age range was 6-12 years with an average age of 9.5 years. In most cases the middle third was involved. The average time of surgery was 65 minutes [range 50-95 minutes]. The average time for clinical and radiological union was 9.2 weeks. The mean interval between the initial surgery and removal of the K wires was 3.2 months. At final assessment there were 18 excellent, two good and two fair results. In unstable fractures involving both forearm bones, open reduction and internal fixation [ORIF] with Kirchner wires have excellent results amongst children

Modified French osteotomy for cubitus varus deformity

To evaluate the outcome of Modified French Osteotomy for correction of cubitus varus deformity. Descriptive quasi-experimental study from Feb. 2000 to Oct. 2003. Dept. of Orthopaedics and Trauma, Post-Graduate Medical Institute, Hayatabad Medical Complex, Peshawar. All children, aged 3-12 years, with cubitus earns deformity were included in the study. Pre-operative clinical as well as radiological assessment of upper extremities were done in all cases. Modified French osteotomy was done to correct the deformity. All patients were followed for seven months. Physical examination for the range of motion, scar and post-operative complications were assessed. Antero-posterior and lateral radiographs of the elbow were obtained, and the carrying angles and lateral condylar prominence index were measured and recorded. Out of the total 30 patients, 26 were male and four female. Left side was involved in 24 cases and the right side in six. The average age at the time of osteotomy was seven years [range 3%-12 years]. The average pre-operative carrying angle was 25.2° [range 18-30°] and the post-operative angle 8.7° [range 5-13° valgus]. The average preoperative range of motion was 122.6° [range 105-135°] and the post-operative range 123.86° [range 90-135°]. The average pre-operative lateral condylar prominence index [LCPI] was 175.56 [range 128-232] and the post-operative lateral condylar prominence 156 [range 100-240]. Based on Bellmore criteria, 25 patients showed excellent, three good and two a poor result. Modified French technique of supracondylar osteotomy has excellent results in the management of cubit vs varus in terms of cosmesis, radiological findings and fewer complications

Isolated posterior cruciate ligament tear: a rare sports related injury

Isolated injury of the posterior cruciate ligament [PCL] of knees is an extremely uncommon occurrence. Majority of such injuries follow motor vehicle collision and sports associated accidents. Magnetic resonance imaging [MRI] is the most reliable and highly sensitive cross sectional imaging modality to confirm the diagnosis. The case under review emphasises the use of MRI in knee injuries involving ligaments and menisci

Diagnosis of liver abscess by ultrasound

Amoebic liver abscess is common in Pakistan whereas pyogenic abscess is more prevalent in the west. Timely diagnosis of the liver abscess significantly lowers the morbidity and mortality. Present study involves ultrasound examination of 200 consecutive patients in a five year period [September 1990 - August 1995] at civil teaching hospital, Abbottabad and private clinics. One hundred and ninety six patients [98%] had amoebic liver abscess. In a similar number of cases the abscess was solitary. Abscess was located in right hepatic lobe in 184 [92%] Majority of patients [76%] were males while 24% were females. Age of our patients was between 10-60 years and size of the lesion varied between 3-16 cm. Ultrasound has proved to be excellent imaging modality in the diagnosis liver abscess. In selected cases abscess can be aspirated or drained under ultrasound guidance

trichobezoar Diagnosed by ultrasound

Trichobezoar is rare and its diagnosis by ultrasound even rarer. It results from eating hair, a type of pica, usually found in irresolute women below thirty. Traditionally its diagnosis has been made on barium meal examination. The case under review clinically presented as a big epigastric mass for which ultrasound was advised. Trichobezoar produces a very characteristic and diagnostic appearance on ultrasound and must be considered in the diagnostic workup of such a condition

Neuroleptic malignant syndrome and malignant hyperthermia

In recent years, reports of neuroleptic malignant syndrome and malignant hyperthormia have been appearing in psychiatric literature with increasing frequency. In this paper experience with eight such cases has been described. Four cases ended fatally within two hours of developing hyperthermia. They all occurred during the hot summer months from June to August and three of them were on lithium in addition to neuroleptics. No warning signs or symptoms of lithium toxicity were observed. Of the four cases who could be saved none of them were on lithium, three occurred during months of May/June, two had developed hyperthermia. Bromocriptine was used in three cases as anticholinergic and intravenous diazepam was not of much help