Outcome of bipolar hemi arthoroplasty: analysis of using lateral and posteriolateral approach

Objective: To find the outcome of bipolar hemiarthroplasty using posteriolateral and lateral approaches

Study design: Descriptive case series

Place and Duration of study: Departments of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2016

Methodology: Patients of either sex and of age above 40 year, who presented in Emergency Department with femoral neck fractures, were included in the study. Data included basic demorgraphic profile, Harris hip scoring, duration of surgery, hospital stay and blood loss

Results: A total of 200 patients were included in the study. There were 77 [38.5%] males and 133 [61.5%] females. Male to female ratio was 0.58:1 with mean age of 58.2 +/- 6.02 year. Mean follow up was 14.2 +/- 2.5 months. In 134 [67.0%] patients there was history of fall, 41 [20.5%] presented with fracture after low energy vehicle accident, 20 [10.0%] presented after high energy vehicle accident. Duration of surgery and blood loss were less in posteriolateral approach. The complication rate and Harris hip scoring was similar in both the approaches

Conclusions: Outcome of surgery in terms of infection, mobility and pain as well as dislocations were similar in both the approaches. The posterior approach was superior in terms of short duration of surgery and less blood loss

Outcome of shish kabab osteotomies fixed with SIGN NAILI in osteogenesis imperfecta. our experience at Ghurki Trust Teaching Hospital, Lahore, Pakistan

Objective: To evaluate the results of shish kabab osteotomies fixed with SIGN NAIL in long bone deformities of patients suffering from osteogenesis imperfect

Methods: This study was carried out on 12 patients who presented in OPD or Emergency Department with deformities of long bones. Detailed history, examination and investigations including X-ray AP and Lateral view of involved bone were done. All these cases were treated with Shish Kabab Osteotomies and SIGN NAILunder spinal or general anaesthesia. These cases were followed up for up to average of 20 months [range 06 months -6 years ] and results of the nail were observed in terms of union, rehabilitation and complications

Results: It was found that 8 [66.7%] were male and 4 [33.3%] were females with a mean age of 14.83 +/- 5.24. 5 [41.7%] patients having age 10-15 years and 7 [58.3%] were between 16-20 years. Total 21 surgeries performed. 3[25.0%] had surgery on unilateral femur,2 [16.7%] on unilateral tibia, 3[25.0%] on both unilateral tibia and femur,3 [25.0%] had surgery on bilateral tibia and 1[13.3%] with bilateral tibia and femur. The parents of all patients had a first degree consanguineous marriage. The mean hospital stay were 4.17 +/- 1.75 days. All osteotomies sites heal within 06 months, better bone densities, 1 Having recurrence of deformity and no fracture were found. Only two patients using walkers while remaining need no support for walking

Conclusion: Sign Nail along with shish kabab osteotomies in deformities of osteogenesis imperfecta is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and osteotomies site healing response is good as well as decrease risk of fracture

Burden of advance stage gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy Jamshoro Sindh

Objectives: In Pakistan gynaecological cancers are among the leading causes of women's morbidity and mortality posing huge financial burden on families, communities and state. Due to lack of national cancer registry exact facts and figures are unknown therefore this study was planned to find out prevalence, age, site and stage of presentation of gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy [NIMRA], Jamshoro

Methods: A retrospective, cross sectional study was conducted from 1[st] January 2011 to 31[st] December 2011 at NIMRA Jamshoro. All cases of genital tract cancers were evaluated, required data was entered on predesigned performa and results were analyzed manually

Results: Out of 2401 total registered cancer cases, 231 [9.6%] patients were suffering from gynaecological cancer making it third most common cancer. Ovary was commonest site followed by cervix and uterus. More than 60% cases presented in advanced stage, mostly during 4[th] and 5[th] decade of life

Conclusion: Gynecological cancer was among top three cancers at one of the busiest public sector cancer institute in Sindh province and significant number presented in advance stage making treatment difficult and expensive. There is urgent need for development and implementation of an effective health policy regarding cancer prevention and treatment

Police encounters in Karachi - an autopsy based study

Background and Objective: A unique study conducted in Karachi with actual facts and figures based on autopsy findings of killings in Police encounters during last three years, also highlighting the number of killings which occurred during last three years along with age group, parts of body involved in such deaths along with areas of Karachi, so as to give an overall picture of these encounters. More over the root causes of these encounters, along with recommendations to improve the prevailing law and order situation in Karachi enabling people to per sue their daily routine without any fear or threat to life and property

Methods: The study is an autopsy based descriptive cross-sectional study conducted at Mortuaries at Civil hospital, Jinnah Postgraduate Medical Center and Abbasi-Shaheed Hospital of Karachi. The duration of study is based on three years, from 1st Jan 2011 to October 31st 2014. Records were gathered from the office of the Police Surgeon, Karachi and each post mortem report was scrutinized by the authors who are senior Forensic Experts themselves. All cases of police encounters that were brought for autopsy were included in the study while any case which was not autopsied was excluded. Aside from this custodial deaths have been excluded in the study

Results: Total number of encounter deaths autopsied during the period of study are 260, with 135[51.92%] autopsied at JPMC, 95[36.54%] at Abbasi Shaheed Hospital and 30[11.54%] at Civil Hospital Mortuary. Identity of deceased was known in 108 cases [41.54%] and 152[58.46%] remained unidentified. Majority of cases were between 25-30 years [n=135, 51.92%], next in order of frequency were 31-35 years [n=46, 17.69%] and least in 36 and above years [n=37, 14.23%]. On autopsy the pattern of frequency of body parts involved is ; bullet injuries in chest and abdomen in 110 cases [42.31%], only chest in 74 cases [28.46%], head in 17 cases [6.54%] and abdomen in 25 cases[9.62%].District wise Malir was venue of most of the encounter deaths 115[44.23%], followed by District South with 44 [16.92%] deaths, District East with 35[13.46]. A comparison between 2013 and 2014, showed that the frequency of Police encounters has increased from 19.23% i.e. from 50 deaths in 2013 to 57.69% i.e.150 deaths in 2014, up to October 31[st] 2014

Conclusion: The word life has not been defined in the Constitution of Islamic Republic of Pakistan, but it does not mean nor can it be restricted only to vegetative or animal life or mere existence from conception to death. Life includes all such amenities and facilities which a person born in a free country is entitled to enjoy with dignity, legally and constitutionally. So it is the duty of the state to provide safety to public. Although it is a good attempt to clean the city from notorious elements in the city of Karachi, but the main thing is that law enforcing agencies carry it without political discrimination and in cases of police encounters the action should be justified to rule out extra judicial killings. Speedy trial of those apprehended in courts of law and protection to witnesses will be of great help

Power doppler ultrasonography guided and random prostate biopsy in prostate cancer diagnosis - a comparative study

To compare the diagnostic accuracy of power Doppler-guided targeted prostate biopsy and random sextant biopsy in the diagnosis of prostate cancer. The prospective study was carried out at the Allama Iqbal Medical College and Jinnah Hospital, Lahore, Pakistan, from January to December, 2012, and comprised clinically suspected cases of carcinoma prostate. Power Doppler-guided biopsies using automatic biopsy gun were obtained from the suspected targeted site. One to three cores per suspected site were obtained. Subsequently random sextant biopsies were performed in the same sitting. Six cores were obtained from 6 random sites using the same gun. Biopsies from both sources were processed for routine haematoxylin and eosin stainstained sections for histopathological examination. Of the 50 patients in the study, 30[60%] were diagnosed with power Doppler-guided biopsy as malignant, whereas random sextant biopsy could pick up 22[44%] cases. For benign prostatic hyperplasia, random sextant biopsy labelled 28[56%] as benign, whereas only 20 [40%] were labelled as benign with power Doppler-guided biopsy. Discrepancy in the results between the two procedures was observed in 14[28%] cases, and of them, 11[22%] were labelled as malignant on power Doppler-guided biopsy while histopathology of sextant biopsies labelled these as benign. The sextant biopsies rendered a specificity, sensitivity, negative predictive value, positive predictive value and diagnostic accuracy of 60.71%, 86.36%, 85%, 63.33% and 72% respectively. Random sextant biopsy in combination with power Doppler-guided targeted biopsy increases the rate of detection of prostate cancer whereas both procedures in isolation have low sensitivity and specificity for cancer detection

Multiple myeloma in younger age

A Multiple Myeloma [MM] is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory

Patients experiences and satisfaction from surgical out patient department of a tertiary care teaching hospital

To find out patients experiences and satisfaction from the Surgical Out Patient Department [OPD] of Civil Hospital, Karachi. This cross-sectional study was done in surgical OPD of Civil Hospital, Karachi from January to March 2008. Patients were asked questions regarding general condition of the OPD, administrative procedure, waiting time, consultation time, doctors attitude and ethical behaviour, their professionalism, overall satisfaction, future reutilization and recommendation to others apart some demographic information. Total 490 patients were interviewed after taking verbal consent. More than three fourth of the patients agreed with good atmosphere [administrative procedure, receptionist attitude, waiting room] of the OPD department, but only 64[13.1%] said that inside the hospital the surgical OPD sign was clearly visible. Mean waiting time was 47.47 +/- 15.29 minutes [Range: 15-150]. Three hundred one[61.4%] patients were examined and treatment advised by Residents only while 189[38.6] patients received treatment by Consultants. Mean consultation time was 6.03 +/- 3.34 minutes [2 - 20] and 246 [50.2%] patients said that consultation time was adequate. From only 287 [58.6%] patients consent was taken before examination but patients privacy was maintained while examining 306 [62.4%] patients. Sixty five [13.2%] patients experienced subsequent visit problem with other units. Four hundred seventy three [96.5] patients said they will utilize the OPD in future and 461 [94.1%] said they will recommend it to other. Overall patient's experiences and satisfaction from Surgical OPD were fair to good. We have highlighted number of areas in which improvement can be made to increase the quality of care and patient satisfaction

Priapism

Priapism is a rare urological emergency. Mostly idiopathic in origin, but in our setup use of illicit drugs for sexual gratification is the main etiology. Early presentation and prompt detumence effects the final out come. In this case patient presented 48 hours after initiation of priapism therefore, in spite of all measures patient suffered from erectile impotency

Diurnal fluctuation of the heat fluxes over the Northern Arabian Sea

The sea surface hourly meteorological parameters that were recorded at five time series stations under the North Arabian Sea Environment and Ecosystem Research [NASEER] programme [1992-1994] were used to study the heat fluxes including; momentum, latent, sensible and moisture heat fluxes as well as the net heat gain and total heat loss over the northern Arabian Sea. The study is the part of research on the formation and distribution of northern Arabian Sea water mass. The momentum or wind stress fluxes during the January 1992 and December 1994 were quite large in both the components of eastward [0.188 N m -2] and northward [0.148 N m -2]. During the August 1992, the east and north components were negative indicated direction of momentum from southwest with values under 0.1 N m-2. The data recorded during the March of 1993, have the visible diurnal variational pattern. The average of sensible heat fluxes during January 1992 was 76 Wm -2, while in the August of 1994 was 71 Wm -2. The results of evaporation indicated the similar pattern of diurnal variation as observed for the data of latent heat fluxes. During the January 1992 cruise, minimum evaporation is computed in the early morning and maximum after 1100 hours. However, during the December 1994, minimum evaporation was observed after sunrise and maximum near to sun set. The mean of the Net Heat Gain during the January 1992 was 138 Wm -2 while, in the August 1992, mean of the area was computed as 96 Wm -2. The Net Heat Gain values depicted that in the entire area of observation, heat was lost from sea surface to the atmosphere