Pediatric forearm fractures; functional outcome managed with intramedullary rush nails - experience in a tertiary care hospital

Unstable forearm both bones fracture in children more than 10 years of age are difficult to manage with cast and surgical intervention is required. To determine the functional outcome of patients with unstable forearm fractures managed with intramedullary rush nail. This study was conducted at Department of Orthopedics, Civil Hospital Karachi from July 2011 to August 2013. All the patients with age in between 10 to 15 years, with close radius ulna unstable fracture presenting within 7 days of trauma or fall were included in the study. All the fractures were stabilized with intramedullary rush nails. Functional outcome was assessed at 12 weeks. There were 79 patients included in the study. Mean age was 13.17+/-2 years. There were 52 male patients [65.8%] and 27 females [34.2%]. There were 24 patients with history of road traffic accident, 29 patients with fall and 26 patients with blunt injury. Acceptable outcome was found in 64 [81%] patients and observed more in male children [p=0.001] and children above 13 years of age [p=0.027]. Union was achieved in all the patients. Six patients had pin site irritation and 2 had superficial infection. Intramedullary fixation with rush nail in unstable forearm fractures in the children appeared to be an effective method of fixation and provided acceptable outcome in 64 [81%] patients

Comparison of dietary intake and dietary requirement in post operative adult cardiac surgical patients in ICU

To estimate optimum energy and protein intake and to examine the differences in actual intake versus optimum protein and energy requirement during first three days of patients at surgical ITC of AFIC. A descriptive, cross sectional study was conducted by using purposive sampling technique. One hundred patients admitted in adult ITC of Armed Forces Institute of Cardiology and National Institute of Cardiovascular Diseases between periods of 10[th] July to 10[th] December 2013, fulfilling study criteria were included in study sample. Data was collected from hospital records [bedside charts] and food frequency questionnaire [FFQ]. Protein and energy intake on 1[st], 2[nd] and 3[rd] post operative day was calculated and compared with pre- calculated optimum protein and caloric requirement. Mean caloric intake on 1[st] post operative day was 583 k/cal, on 2[nd] post operative day 679 kcal and on 3[rd] post operative day was 820 k/cal which were 70%, 65% and 68% respectively less than the optimum requirement. Whereas mean protein intake was 13 grams on the 1[st] post operative day and 13.2 and 22.3 grams on the 2[nd] and 3[rd] day respectively which was 85%, 83% and 72% less respectively on first, second and third post operative day. The results suggest that the energy and protein intake of patients was below estimated requirements. Attention must be paid to malnutrition and nutrition in general in the hospital wards

Fracture shaft of femur; management outcome in children between 10 to 14 years of age treated by intramdullary rush nail

In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Male were 58% while female were 42%, the average age of the patients were 11.78+/-1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries

Primary post partum hemorrhage. An obstetric catastrophe: a review of 270 cases

To see the frequency, causes of Primary Postpartum Hemorrhage [PPH], and identify the management options and to apply them successfully for control of primary PPH. So as to reduce the maternal morbidity and mortality rate. Retrospective study. This study was conducted in Gynae Unit-IV, Bolan Medical Complex Hospital, Quetta from January 2011 to July 2012. The data was collected from the records of patients who were admitted as case of Primary PPH and developed PPH during the delivery / Cesarean section. The data was noted on predesigned Proforma which include, complete obstetrical history, abdominal and pelvic examination and relevant laboratory investigations. The maternal condition was assessed and managed according to Hospital protocol. All maternal complications were noted. The patients who were bleeding at the time of delivery due to non - obstetrical condition were excluded from study. A total 270 cases of PPH were diagnosed. Major causes of Primary PPH were uterine atony in 143 [53%] retained placenta, in 49 [18%] ruptured uterus in 43 [16%] cases. The risk factors for uterine atony were prolonged 1[st] and 2[nd] stage of labour, grand multipara and retained placental tissues. Patients were managed both medically and surgically. The major morbidities were anemia 32%, hypovolemic shock 26%, puerperal sepsis 15% and acute renal failure 5%. Primary PPH is an important cause of serious morbidity and one of the leading causes of maternal mortality in the developing and developed world. The majority of deaths are preventable by the active management of 3[rd] stage of labour followed by a logical management protocol

Effects of hot shot [non cardioplegic blood based] on cardiac contractility and rhythm as parameters of myocardial protection in CABG surgery

To compare the effects of warm blood cardioplegia along with hot shot [non-cardioplegic blood based] at the end of ischemic time to warm blood cardioplegia without hot shot to assess resumption of effective electromechanical activity and need for internal electrical cardioversion as indicators of myocardial protection and preservation. Randomized control trial. The study was conducted at Armed Forces Institute of Cardiology [AFIC], Rawalpindi for a period of 10 months [March 2009 - Dec 2009]. Total 100 patients of coronary artery disease having coronary artery bypass grafting [CABG] surgery were equally and randomly divided into two groups using random numbers table. Group A [n=50], consisted of warm blood cardioplegia with non cardioplegic blood based hot shot and group B [n=50], consisted of warm blood cardioplegia only. The adequacy of myocardial protection techniques was assessed by noting the time interval [in seconds] between declamping of the ascending aorta and patient regaining electromechanical activity. Additional parameters were rhythm, use of internal cardiac defibrillation, inotropes, IABP requirement and ECG evidenced peri-op MI. Average age in group A was 56.98 +/- 9.47 years and in Group B it was 59.14 +/- 9.35 years. In group A there were 48 [96%] males and group B there were 43 [86%] males with p-value of 0.081. Comparison of preoperative variables of both the groups revealed no difference in cross clamp time [p=0.52], CPB time [p = 0.68] and endarterectomy [p=0.55]. The electromechanical activity [contractility of heart] returned within 7.53 +/- 2.09min in group A as compared to 9.81 +/- 2.6min in group B [p<0.001]. Significantly high frequency was observed for defibrillation [p=0.025], inotropic support [p=0.045] and IABP insertion [p=0.041] in group B as compared to group A. In CABG surgery the additional use of hot shot [non cardioplegic blood based] during cardiopulmonary bypass [CPB] is effective in myocardial protection and preservation by resuming early contractility of heart, benefit of no detrimental effects like dysrhythmias and less requirement of chemical or mechanical cardiac support

Awareness during coronary artery bypass grafting surgery

To determine the frequency of awareness in patients undergoing coronary artery bypass grafting [CABG] with cardiopulmonary bypass [CPB]. Cross-sectional Survey. Armed Forces Institute of Cardiology, Rawalpindi - Pakistan. A total of 100 patients [both males and females] of age > 18 years, undergoing elective CABG, were interviewed 24-72 hours after anesthesia using a modified Brice questionnaire. Patient's anesthesia record was consulted and the drugs and doses used at induction and maintenance of Anesthesia at different stages of the surgery were noted down. Overall frequency of awareness was found to be 5%. It was found to be less in patients who received propofol infusion during CPB compared to the patients who did not. Regular use of sedation with propofol infusion during CPB can reduce the frequency of awareness. Bispectral index [BIS] monitoring can prove to be a helpful monitor of the depth of anesthesia during CPB

Modified ultrafiltration in adult cardiac surgery is it really beneficial? A pospective randomized clinical trial

Cardiopulmonary bypass initiates systemic inflammatory response syndrome [SIRS] causing deleterious effects on various body systems with increased morbidity. Modified ultrafiltration [MUF] is a technique that removes excess water and inflammatory mediators from the circulation in the post-bypass period resulting in reduced bleeding, less blood transfusion requirements and overall reduced morbidity. 96 patients were randomly selected and divided into two groups. In Group I called MUF group [n=50], modified ultrafiltration was carried out for 15 min in the post bypass period. Group II called NON-MUF group [n=46], MUF was not carried out. Clinical assessment was based on ASA class. Mean cardiopulmonary bypass and aortic cross clamp times were 95.42 and56.94 min and 77.98 and 43.64 min in the MUF and NON-MUF groups respectively. Variables were expressed as mean and percentage. In the MUF group, there was increase in Hb by more than 2g/dl in 32 patients [64%] whereas in the NON-MU F group, this increase was only in 12 patients [20%] Mean postoperative chest drainage was far less [422 ml] in MUF group as compared to NON-MUF group [842.50 ml]. Transfusion [449.12ml Vs 996.58 ml] and postoperative ventilatory requirements [40% Vs 47.8%] were also less in MUF group than NON-MUF group. Inotropic support was nearly comparable in both the groups but overall morbidity [Low cardiac output state, sepsis, reopening] was less in the MUF group [18%] as compared to NON-MUF group [30%]. Mean ICU stay was also less in MUF group [mean 51.52 hrs] than in NON-MUF group [mean 55.43 hrs]. One patient in each group died. Modified Ultrafiltration is associated with improved hemoglobin, less postoperative bleeding, reopening and transfusion requirements with overall reduced morbidity and ICU stay. However, the need for inotropes were not significantly different in the two groups

Frequency of dens evaginatus of permanent anterior teeth

To calculate the frequency of dens evaginatus in permanent teeth. Design: A descriptive study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Dentistry [AFID], Rawalpindi from April 2002 to April 2003. Subjects and A clinical and radiographic analysis of 5400 permanent anterior teeth was conducted to determine the occurrence of this developmental malformation. Dens evaginatus was found in about 2.4% of the permanent anterior dentition and was more frequent in the maxilla, particularly in the lateral incisor. This anomaly was less frequent in the mandible. This study shows that dens evaginatus of anterior teeth is more common in the permanent dentition particularly, the maxillary incisors. Furthermore, the frequency of dens evaginatus is high in males than females

Comparison of vertical with lateral condensation technique in obturation of root canal system

To compare vertical condensation with laterally condensed gutta-percha technique in obturation of root canal system. Design: A comparative study. Place and Duration of Study: The Armed Forces Institute of Dentistry [Operative Deptt], Rawalpindi. Subjects and Fifty six human permanent extracted teeth were collected from central incisor to second molar from the both arches and in vitro root canal procedure was carried out. Warm vertical technique resulted in a uniform smooth surface and least observable space between gutta percha and canal wall, especially in middle and apical region. Root canal obturation by warm vertical condensation is better than cold lateral condensation

Penetration depth of nickel titanium and stainless steel finger spreaders in curved root canals

To compare, radiographically, the differences in the penetration depths of nickel titanium and stainless steel finger spreaders in curved root canals. Design: A comparative study. Place and Duration of Study: The study was carried out at Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from September 2001 to June 2002. Materials and Fifty patients with curved mesial canals of their mandibular first molars were randomly selected for the study. The angle of curvature for each root canal was radiographically determined before instrumentation. Canals were prepared by K flexo file using the step back preparation technique. The apical preparation was done upto no. 30 and cervical flaring upto no. 45. Gates Glidden drills nos. 2-4 were used in the cervical 2-3 mms of the canal. A no. 20 stainless steel and a fine medium nickel titanium finger spreader were inserted alternately into the same prepared canal and radiographed using the paralleling technique. The distance from the tip of the spreader to the apex of the root was measured radiographically by vernier calliper. Penetration of nickel-titanium finger spreader was significantly [p<0.05] deeper than the stainless steel spreader of comparable size. The ease of stainless steel penetration decreased with increasing angle of curvature of the canal. Nickel-titanium spreaders may give better results for lateral condensation in curved canals because of their deeper penetration

Autotransplantation of endodontically treated third molars

To determine the success rate in autotransplantation of endodontically treated third molars. Design: A descriptive study. Place and Duration of Study: This study was carried out at Armed Forces Institute of Dentistry [AFID], Rawalpindi [Pakistan] from January 2002 to December 2002. Patients and A total of 50 patients meeting the inclusion criteria were selected who had their first or second molars in unrestorable condition with intact third molars. The donor teeth were extracted after the preparation of recipient site. After endodontically treated in vitro the donor teeth were carried to the recipient site and immobilized. Postoperative variables were recorded and analyzed on SPSS version 10. The overall success rate after six months of the transplantation of third molars was 88% with complete root formation after endodontic treatment. All the patients[12%] who had complaints were more than 35 years of age. Third molars are good substitute for the unrestorable first or second molars and would be as effective as endosseous implants. The procedure is likely to have complications in the advanced age group

Clinical evaluation of restorative materials in primary molars

To carry out clinical comparison of glass ionomer with amalgam in restoring primary dentition of deciduous teeth. Design: An innovative and observational study carried out on pediatric patients. Place and Duration of Study: The study was carried out at the Armed Forces Institute of Dentistry, Rawalpindi. Subjects and Two hundred pediatric patients were randomly selected for the study. Each patient received one restoration of the glass ionomer and one of the amalgams regardless of the position occupied by the tooth in the jaw. After one-year review, results indicated that glass ionomer was viable, required less time in restoration, atraumatic and satisfactory alternate filling material to amalgam for restoring primary molars. The glass ionomer is a satisfactory alternate for predictable restoration of primary molar in pediatric patients, especially in compromised teeth with different grades of decay