Thoracic impalement injury: A survivor with large metallic object in-situ / 中华创伤杂志(英文版)

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

effect of low dose aspirin on bleeding in patients undergoing minor oral surgical procedures

Objective: To evaluate the safely of oral surgical procedures without stopping low dose aspirin. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Rawalpindi, from Mar 2008 to Mar 2009

Material and Methods: Seventy patients taking aspirin 75 to 150 mg daily and requiring minor oral surgery were included. Patients were randomly divided into two groups, group A [control group] who stopped taking aspirin and group B [intervention group] in which aspirin was not stopped. Their bleeding time [BT] and platelet count were assessed before surgery. Suturing and pressure pack were used to control bleeding. Data were entered in SPSS version 10

Results: Out of 70 patients, 48 [68.57%] were male and 22 [31.43%] female. The mean age was 58.83 +/- 10.94 years. The mean bleeding time was 2.23 +/- 0.013 minutes for group A, and 2.71 +/- 0.12 minutes for group B. The difference was statistically significant [p=0.01]. Severe bleeding was noted in 2 patients from group A and 3 patients from group B, but local haemostatic measures were sufficient to control bleeding

Conclusion: The patients on low dose aspirin can safely undergo routine minor oral surgical procedures, without alteration in their regular therapeutic aspirin regimen

E-learning among medical students: comparison between medical colleges of two metropolitan cities in punjab

Background: Information and communication technology is a new approach to the teaching and learning process, now widely accepted as a necessary tool for attainment of developmental goals. From traditional blackboard and lectures, education has moved to e-learning. E-learning is a flexible term that refers to the improvement in knowledge and performance through use of computer and internet technologies

Objective: To compare the e-learning in medical students of medical colleges of two metropolitan cities of Punjab

Methodology: This cross sectional survey was conducted for the final year MBBS students of King Edward Medical University, Lahore [KEMU] and Khawaja Muhammad Safdar Medical College, Sialkot [KMSMC] from 1st January to 30th June 2017. A 5 domained validated questionnaire was used. Students were included by non-probability convenient sampling. A questionnaire was emailed to 210 study participants. A total of 145 students [69% response rate] from both the colleges responded to the questionnaire. Data was entered in SPSS 20 for statistical analysis. Independent sample t-test was applied where data was normal while Mann Whitney U test was applied where data was not normally distributed

Results: In this study, a total of 145 students participated. The mean scores for perceived usefulness for e-learning, ease of e-learning, e-learning stressor and e-distance use of e-learning was statistically same in KEMU and KMSMC students. However, the score for intention to adopt for e-learning had statistically higher mean in students of KEMU. [p-value = 0.004]

Conclusion: Medical students from both the institutions of metropolitan cities recognize the uses of e-learning in medical education and are perceptive to adopt it

Improvised laparostomy pack to manage laparostomy for injuries due to improvised explosive devices [ieds]

causing contamination of peritoneal cavity. This necessitates multiple peritoneal toilets and relook surgeries. Surgical management is to perform laparostomy to avoid life threatening complication, like abdominal compartment syndrome and fulminant sepsis. "Peshawar pack" is a three-layer temporary abdominal dressing pack for managing laparostomy. It is prepared in operation room and applied on patients with ease. Patients with abdominal injuries due to blasts of IEDs, managed with Peshawar pack during June 2014 to June 2016, were studied to determine the effectiveness and practical utility of Peshawar pack. Data was analysed by SPSS version 22. Total numbers, means +SD and frequencies with percentages were described. In fifty-five patients selected for the study, effective drainage of peritoneal cavity and control f peritoneal sepsis was achieved in all cases. Mobilisation out of bed was possible in 38 cases [70%] within 3-5 days and evisceration during mobilisation occurred in 02 cases [3.6%]. There was no case of iatrogenic gut injury. Complete fascial closure in staged manner was achieved in 53 cases [96%]. Peshawar pack is a simple, practical, and effective method for laparostomy care in abdominal injuries due to blast of IEDs

computational structural analysis of functional attributes of hypodermin A and B proteins: a way forward for vaccine development

Hypodermosis is a parasitic disease of cattle. The pathogenicity of the disease is attributed to Hypodermin proteins [Hypodermin A, Hypodermin B and Hypodermin C]. Studies suggest that Hypodermin proteins may be defined as Serine proteases and collagenases. The structure of both proteases Hypodermin A and Hypodermin B were modeled using the Swiss-model server followed by its validation using Procheck, Errat and Verify-3D. Afterwards, both Hypodermin A and Hypodermin B were docked against collagen in order to study its interaction with respective Hypodermin proteins. The structure of both Hypodermin A and Hypodermin B showed more bent towards hydrophobic nature, as more beta sheets were present in them. Both structures were also superimposed to check out similarities and differences present between them. Serine, Aspartic acid, Histidine, Glutamic acid and Lysine are found as interacting residues that are involved in hydrogen bonding with collagen. The interactions are found in the active domain region of Hypodermin proteins. The interacting residues were present in the active region of the hypodermin proteins thus validating the docking studies. This study may help in the drug development against hypodermosis with least side effects

Knowledge, attitude and practices of women towards breast self-examination in rural area of Lahore, Pakistan

Introduction: A breast self-exam is the routine examination done by females of their own breasts to find any abnormal growth or changes that are alarming and need medical consultation to treat. It is seen that more than 10 percent to20 percent breast cancer is detected by breast self-examination. It is important for females to do BSE regularly to prevent breast cancer

Setting: Study was conducted in a rural area of Lahore, Pakistan

Study design: Cross sectional descriptive study was conducted

Population: Data was collected from 135 women of rural area of Lahore

Sampling: Data was collected from convenient selected sample of 135women of rural area of Lahore

Methodology: The instrument use for the data collection was adopted questioner and convenient sampling technique was used

Results: 19.3 percent of the study participants knew about the Breast self-examination while 28.9 percent have knowledge about breast cancer. Only 24.4 percent knew about the Breast self-examination whereas 35.6 percent know that only doctors can examine the breast. As regard interval of breast self-examination, 34.1 percent of the study participants had knowledge, while 46 percent were not having knowledge. On other question that BSE must be done between days 7 until day 10 after menstrual cycle 20 percent of the study participants had knowledge, while 80 percent were not aware of this. BSE should be done in front of a mirror 40 percent had knowledge and 60 percent had no knowledge. The above table reveals that only 19.3 percent study participants had knowledge regarding Breast self-examination, while 80.7 percent percent were not aware of it. Similarly, need to assess any changes in color, size and shape of Breast only 24.4 percent had knowledge and 75.6 percent had no knowledge about it. The knowledge of breast self-examination was also very low among the participants and only 19.3percenthad knowledge about it

Conclusions: knowledge, attitudes, and practices towards breast self-examination are poor among the women of child bearing age in the rural area of Lahore

syndrome of diabetic amyotrophy: a preventable disaster?

Diabetic amyotrophy is a disabling syndrome that frequently has a difficult or delayed clinical recognition. It is characterised by lancinating pain followed by muscle weakness, usually in the hip and thigh. The disease predominantly occurs in elderly patients and causes significant morbidity. Although a detailed history and neurologic examinations are helpful, electrodiagnostic testing yields accurate diagnosis in most of the cases. Herein, we chronicle the case of a young patient who developed profound diabetic amyotrophy within five years after the onset of type 1 diabetes mellitus. Furthermore, this report highlights the preventive as well as therapeutic role of strict glycemic control, warranting population-based monitoring and education of patients for diabetic amyotrophy, especially in Pakistan

Optimization of antibacterial activity of ethanolic extracts of eucalyptus tereticornis and nigella sativa: response surface methodology

The screening of plants for medicinal purposes represents an effort to discover newer, safer, and possibly more effective drugs. Design of the present study was made aiming to the optimization of the antibacterial activity of ethanolic extracts of Eucalyptus tereticornis [leaves] and Nigella sativa [seeds] against bacteria belongings to both Gram-positive [Bacillus subtilis and Staphylococcus aureus] and Gram-negative [Escherichia coli] spectrum by using response surface methodology. 20 g powder of each E. tereticornis [leaf] and N. sativa [seeds] were mixed with 200ml of ethanol at room temperature, and then it was centrifuged at 4000 rpm for 10 min to separate the supernatants, and allowed to dry in order to obtain ethanol free extracts. A fresh bacterial culture of 100microl of test microorganism was inoculated onto media and spread homogeneously. The antimicrobial activity of ethanolic extracts showed that all the concentrations tested were effective against the test microorganisms. The diameters of zones of inhibition exhibited by S. aureus PCSIR-83 were in the range of 0-28mm, E. coli PCSIR-102 [0-28mm] and B. subtilis PCSIR-05 [15-26mm]. The combination of N. sativa [15mg/micro l] and E. tereticornis [20mg/micro l] were found most effective at pH 9.0 and temperature 35°C. Our results clearly indicate that Gram positive bacteria showed more sensitivity than Gram-negative bacteria

Improvised laparostomy pack to manage laparostomy for injuries due to improvised explosive devices [IEDs]

Splinters of improvised explosive devices [IEDs] cause multiple intestinal perforations and random pattern visceral injuries causing contamination of peritoneal cavity. This necessitates multiple peritoneal toilets and relook surgeries. Surgical management is to perform laparostomy to avoid life threatening complication, like abdominal compartment syndrome and fulminant sepsis. "Peshawar pack" is a three-layer temporary abdominal dressing pack for managing laparostomy. It is prepared in operation room and applied on patients with ease. Patients with abdominal injuries due to blasts of IEDs, managed with Peshawar pack during June 2014 to June 2016, were studied to determine the effectiveness and practical utility of Peshawar pack. Data was analysed by SPSS version 22. Total numbers, means +SD and frequencies with percentages were described. In fifty-five patients selected for the study, effective drainage of peritoneal cavity and control of peritoneal sepsis was achieved in all cases. Mobilisation out of bed was possible in 38 cases [70%] within 3-5 days and evisceration during mobilisation occurred in 02 cases [3.6%]. There was no case of iatrogenic gut injury. Complete fascial closure in staged manner was achieved in 53 cases [96%]. Peshawar pack is a simple, practical, and effective method for laparostomy care in abdominal injuries due to blast of IEDs

Comparison between extra oral and intraoral surgical procedures for the management of mandibular angle fractures

Objective: To evaluate and compare the treatment outcomes of isolated mandibular angle fractures managed by open reduction and internal fixation using intra oral and extra oral approaches. Study Design: Randomized control trial. Place and duration of Study: Department of oral and maxillofacial surgery, Liaquat University Hospital Hyderabad, from May 2011 to Nov 2011

Patients and Methods: The patients who presented with isolated mandibular fracture were selected according to inclusion criteria. The diagnosis was made by standard history, clinical examination and radiographic investigations. The patients were randomly divided into two groups, A and B. Group A patients were managed by extra oral approach and group B patients were managed using intra oral approach. The patients were prescribed antibiotics for one week and follow up was carried for four weeks. Nerve damage, limited mouth opening, infection, mal-occlusion, hypertrophic scar and aesthetic dissatisfaction were immediate and late post operative complications observed and documented

Results: Road traffic accident [RTA] was the main etiologic factor [66.66%]. Marginal mandibular nerve damage was noted in 20% cases treated with extra oral approach [group A]. Post operative esthetic dissatisfaction was present in 60% patients [group A] as compared to 6.66% of the patients [group B]. The rate of mouth opening compromise and mal-occlusion were also higher in the patients treated with extra oral approach compared with intra oral approach, although statistically not significant

Conclusion: The intra oral approach for mandibular angle fracture management is an effective and comparatively better technique as compare to the extra oral approach

Outcomes of laparoscopic cholecystectomy in acute cholecystitis

Objective: To study the morbidity and mortality of early laparoscopic cholecystectomy in acute cholecystitis by comparing its results with laparoscopic cholecystectomy in chronic cholecystitis and simple cholelithiasis

Study Design: Quasi-experimental study

Place and Duration of Study: Pakistan Naval Ship [PNS] Shifa Hospital Karachi and Combined Military Hospital [CMH] Lahore Pakistan, from Nov 2009 to Jan 2013

Material and Methods: Total 398 patients with symptomatic gall stone disease were included in the study after exclusion of patients with upper abdominal surgery, perforated gallbladder with abscess formation, cardiopulmonary disease, equipment failure and those with choledocholithiasis. Cholecystectomy was performed using a three port technique in most of the cases. On the basis of per-operative findings regarding degree of inflammation of gallbladder, all patients were divided into three groups irrespective of duration of symptoms i.e. acute cholecystitis group, chronic cholecystitis group and no inflammation group. The collected data included age, sex, diagnosis, history of previous surgery, co-morbidities, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications. Statistical comparison was performed using the chi square test. Statistical significance with value of p was less than 0.05 was considered significant

Result: Out of 398 patients, 31.2% had acute cholecystitis, 10.1% had chronic cholecystitis and 58.8% had no inflammation of gall bladder. Complication rates and conversion rates were higher in chronic cholecystitis group as compared to acute cholecystitis group and no inflammation group. Similarly, mean hospital stay was also highest in chronic cholecystitis group

Conclusion: Early laparoscopic cholecystectomy was found safe in acute cholecystitis in expert hands and should be performed in all cases of acute cholecystitis rather than delayed interval cholecystectomy

Optimal primary surgical management of infected pseudoaneurysm in intravenous drug abusers: ligation or reconstruction?

Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015

Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure

Results: All patients who underwent ligation and excision procedures did well initially. One [3.2%] patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five [16.1%] patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero

Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization

Diagnosis of hepatitis C in pregnant mothers and its transfer pattern in neonates

Hepatitis is the most common liver diseases in the Pakistan caused by blood-borne infection of HCV. Viral transmission is frequent through blood contact. Vertical transmission is transfer of disease from mother to infant. The women who are infected with hepatitis C virus RNA are at high risk of infecting their babies. Actual transmission occurs during labor and at time of delivery when blood of both mother and neonate is in contact with each other. Vertical transmission rate is lowered when mother is HCV RN Anegative. The project was designed to determine the percentage of transmission and prevalence of Hepatitis C virus from mother to neonates. Assessment of the quantitative analysis of RNA levels in mother blood and viraemic status from the early postpartum period onwards of children born to HCV-infected mothers. For the diagnosis of hepatitis C in mothers, blood samples of fifty HCV pregnant women between 23-41 years old were taken. The blood samples were centrifuged at 8,000 rpm and serum was separated and stored at 4°C. The values of the Alanine Aminotransferase was determined at 2nd and 3rd trimester of pregnancy. After extraction HCV-RN Awere transcribed and amplified by PCR. The samples were further authenticated through the Agarose Gel Electrophoresis system and bands were obtained. Nested reverse transcription PCR [RT-PCR] was conducted for the quantitative analysis of HCV-RNA. The results showed that in 66% cases, the mothers had high level of ALT at 2[nd] trimester of pregnancy. Their ALT level was decreased in the 3[rd] trimester of pregnancy. PCR results showed that 40% pregnant women had quantity of HCV-RNA in the range of 1000-10,000 lU/mL and in 18% women were above 100000 The results of spectrophotometer showed that 80% infants had the antibodies against HCV-RNA while only 20% of the neonates did not have antibody right after birth. The 29% babies got HCV-RNA in their serum and became positive for HCV-RNA?

Rate and reasons of conversion of laparoscopic cholecystectomy to open cholecystectomy? A prospective analysis of 450 consecutive laparoscopic cholecystectomies

Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy [OC] in 450 patients who underwent laparoscopic cholecystectomy [LC] by the same surgeon in tertiary care teaching hospitals

Study Design: Descriptive study

Place and Duration of Study: The study was conducted initially at Pakistan Navalship [PNS] Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013

Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was filled which included the demographic data of the patients, indications for cholecystectomy, histories of previous abdominal surgery, their comorbidities [if any], operating time, intraoperative findings, complications, post-operative hospital stay and rate and reasons for conversion to open cholecystectomy [if required]

Results: Out of 450 consecutive patients for whom LC was attempted by a single surgeon, 7 patients [1.6%] were converted to OC. There were 380 female and 70 male patients [F: M ratio 5.4:1]. Their mean age was 44.6 +/- 13.5 years, ranging from 9-82 years. All patients who required conversion to OC were females. The mean operating time was 38.9 +/- 16.2 minutes [range 15-120 minutes]. The reasons for conversion included cystic artery bleeding2, liver bed bleeding1, common hepatic duct injury1, cholecystoduodenal fistula1, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle1 and cystic duct avulsion1

Conclusion: The overall rate of conversion to OC was 1.6%. Laparoscopic cholecystectomy is a safe procedure with very little chances of conversion to open even in acute cases, when performed by an experienced surgeon

Incidence of intestinal tuberculosis in patients presenting in emergency with intestinal perforation- a review of 1000 patients

Objective: The present study was undertaken to document the presentation of intestinal tuberculosis in patients with intestinal perforation that present to the emergency department of Nishtar Hospital Multan

Study Densign: Observational / Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Nishter Hospital, Multan. from 2007-2015

Materials and Methods: A proforma was filled which was approved by hospital ethical committee. 1000 patients who were admitted in in A and E department Nishtar Hospital,Multan with intestinal perforation were included in this study

Histopatology specimen were sent. Results were labeled as either presence or absence of intestinal tuberculosis

Results: 1000 patients, complying with the inclusion criteria were included in the study. The mean age of the patients was 45 +/- 5 years. 289 [ 28.9%] were in the age group of 20-30 years of age.312[31.2%] were in the age group 31-40 years.243 [24.3] were in age group [24.3%]. 156 [15.6%] were from age group 51-60

Regarding age, majority of the patients 532 [53.2%] were females, and 468 [46.8%] were males

Duration of symptoms ranged from 1 day to >3 days. 312 [31.2%] had symptoms for 1-2 days. 432 [43.2%] had symptoms for 2-3 days and 256 patients had symptoms for more than 3 days. All had histological evaluation

Conclusion: 23% patients were found to have tuberculosis

Glycyrrhiza glabra L. [Liquorice]

Medicinal plants are being used for treating various diseases. According to World Health Organization 80% of the world population depends on indigenous medicinal plant remedies. Herbal medicine employs fruits, vegetables, as dry materials or their extracts for the treatment of different diseases and health maintenance. Glycyrrhiza glabra [Liquorice] has been used in Europe since prehistoric times. It is well documented in written form starting with the ancient Greeks. Glycyrrhizin is the major active constituent obtained from liquorice roots, one of the most widely used in herbal preparations for the treatment of liver complaints. The plant is used as anti-inflammatory, spasmolytic, laxative, anti-depressive, anti-ulcer and anti-diabetic. The present review focuses Glycyrrhiza glabra distribution, ethno botany, ethno pharmacology, chemical constituents, medicinal uses, cultivation and trade. Plant requires a lot of attention as it has been reduced in population due to over-use in Baluchistan. The plant conservationists should consider this herb as priority species and should start its cultivation on the commercial scale to fulfill the requirements of the local markets and pharmaceutical industries as well as reduce the pressure on the wild plants

Transpharyngeal approach for Eagle syndrome - case report and literature review

Symptomatic elongation of styloid process or mineralization of stylohyoid ligament is referred to as Eagle's syndrome, which usually presents as a vague head and neck pain radiating to jaws, pharyngodynia, difficulty in swallowing, dysphagia, otalgia, and sensation of foreign body in throat leading to wide range of differential diagnosis. Instead of many hypothesis and studies, the exact etiology of styloid process and role of ectopic calcification are unknown. History and physical examination plays a pivotal role in diagnosis and is confirmed by radiological investigation. Treatment modalities include both conservative and surgical management by intraoral and extra oral approaches

Demographic and clinical characteristics of 100 consecutive patients with diabetic foot presented in Nishter hospital Multan

Objective: To study the incidence of infected diabetic foot among diabetic admissions on the surgical floor

Study Design: Quasi-experimental study

Place and Duration of Study: This study was conducted at the Surgical Unit-IV, Nishtar Hospital Multan from June 2013 to March 2016

Materials and methods: The study on diabetic foot management was carried out involving 100 patients with septic foot complications in diabetics

Results: Out of 100 patients, 59 [59%] were male, 41 [41%], were female, 76 [76%] patients were admitted through emergency, 18 [18%] through outpatient department and only 6 [6%] patients were referred from physicians. Family history of diabetes was found in 45% of the patients in both parents. As regards age, most of the patients i.e. 50 [50%] patients were in age group 61-70 years. In 25 [25%] patients left foot was involved, right foot was involved in 55 [55%] patients while in 20 [20%] patients both feet were involved. As regards management of patients, 15 [15%] patients were taking insulin, 30 [30%] were on OHA, 30 [30%] were controlled by diet and remaining 20% had no treatment. Planter infection and infection on dorsal aspect was seen in 30% patients respectively

Conclusion: No aspect of regimen of therapy for diabetics is more important than the proper care of his feet

Assessment of availability of essential human resource for health for EmONC services in public sector of Pakistan

Objective: To assess availability and establish the current situation of essential human resource shortage for provision of emergency obstetric and new born care in public sector health facilities

Study Design: Observational / descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Department of Public Health, Contech School of Public Health, Lahore from January 2013 to December 2013

Materials and Methods: A robust surveys were conducted by stratified sampling technique by taking 100% samples. 20% sample of basic health units was taken to assess the availability of essential human resource for health to meet the progress of Millennium Development Goal 4 and 5

Results: Situation of availability of essential human resources at district and tehsil level for provision of maternal and newborn health services was found only 33% at district head quarter hospitals and 3% at tehsil headquarter hospitals. This is an escorting cause of not reducing maternal and child mortality as per target

Conclusion: Study results suggest accelerated provision of essential human resource for health to provide emergency obstetric and new born care to reducematernal and neonatal mortality in the country