The 2nd Metacarpal Cortical Index as a Simple Screening Tool for Osteopenia

Background@#Osteopenia is a known risk factor for sustaining skeletal fractures. Prevention of fragility fractures has obvious clinical and economic advantages, however screening all patients using a dual energy X-ray absorptiometry (DXA) is controversial not only because of the cost implications but also because it would potentially involve exposing a percentage of normal patients to unnecessary radiation. We wished to assess whether a simple hand X-ray measuring the 2nd metacarpal cortical index (2MCI) could be used as a simple screening tool for identifying patients with osteopenia. @*Methods@#We retrospectively collected the radiographic data of 206 patients who had a simple radiograph of the hand and a DXA scan within one year of each other from our picture archiving and communication system database. The 2MCI was calculated for all patients. As data was parametric, a Pearson’s correlation was performed to assess association between Tscores and 2MCI. Further analysis involved the construction of receiver operating characteristic (ROC) curves to identify a 2MCI index, which would give the most appropriate sensitivity and specificity values for identifying the presence of osteopenia. @*Results@#A statistically significant and moderate correlation between DXA T-scores and 2MCI values was found (r=0.54, n=206, P<0.001). Further ROC curve analysis of normal and osteopenic subjects identified that a 2MCI of 41.5 had a sensitivity of 100% and specificity of 53% for detecting osteopenia. @*Conclusions@#Our results support the use of the 2MCI as a simple screening tool for identifying patients with osteopenia.

The 2nd Metacarpal Cortical Index as a Simple Screening Tool for Osteopenia

Background@#Osteopenia is a known risk factor for sustaining skeletal fractures. Prevention of fragility fractures has obvious clinical and economic advantages, however screening all patients using a dual energy X-ray absorptiometry (DXA) is controversial not only because of the cost implications but also because it would potentially involve exposing a percentage of normal patients to unnecessary radiation. We wished to assess whether a simple hand X-ray measuring the 2nd metacarpal cortical index (2MCI) could be used as a simple screening tool for identifying patients with osteopenia. @*Methods@#We retrospectively collected the radiographic data of 206 patients who had a simple radiograph of the hand and a DXA scan within one year of each other from our picture archiving and communication system database. The 2MCI was calculated for all patients. As data was parametric, a Pearson’s correlation was performed to assess association between Tscores and 2MCI. Further analysis involved the construction of receiver operating characteristic (ROC) curves to identify a 2MCI index, which would give the most appropriate sensitivity and specificity values for identifying the presence of osteopenia. @*Results@#A statistically significant and moderate correlation between DXA T-scores and 2MCI values was found (r=0.54, n=206, P<0.001). Further ROC curve analysis of normal and osteopenic subjects identified that a 2MCI of 41.5 had a sensitivity of 100% and specificity of 53% for detecting osteopenia. @*Conclusions@#Our results support the use of the 2MCI as a simple screening tool for identifying patients with osteopenia.

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

BACKGROUND: The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury. METHODS: We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF. RESULTS: There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06). CONCLUSIONS: Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation.

Diagnostic accuracy of modified CT severity index in assessing severity of acute pancreatitis

Objective: To determine the diagnostic accuracy of modified CT severity index in assessing the severe acute pancreatitis keeping APACHE II as gold standard

Study Design: Cross-sectional [validation] study

Place and Duration of Study: Department of Radiology, Allied Hospital, Faisalabad, from February to August 2014

Methodology: A total of 120 patients of either gender aged 20-60 years with epigastric pain radiating to back and having sonographic findings [decreased or heterogeneous pancreatic echogenicity, pancreatic enlargement, peripancreatic fluid collection], supportive of acute pancreatitis were taken. CT with intravenous contrast was performed on 128-slice scanner within 24 hours of presentation. Slice thickness was 3 mm in region of pancreas. Modified CT severity index was calculated. Score above 5 was graded as severe pancreatitis. APACHE II score of >11 considered as gold standard was also calculated within 24 hours of admission

Results: Mean age of the patients was 39.03 +/- 8.71 years. Most of the patients were females 73 [60.8%]. Out of 120 patients, 43 [35.83%] patients had severe acute pancreatitis. Sensitivity, specificity, positive predictive value and negative predictive value of modified CT severity index in assessing the severe acute pancreatitis were 100%, 87%, 81.13% and 100%, respectively. The diagnostic accuracy was yielded as 91.67% considered APACHE II as gold standard

Conclusion: Modified CT severity index had high diagnostic accuracy in assessment of severe acute pancreatitis and can be used reliably in early prediction of complications of severe acute pancreatitis

Outcome of stapled haemorrhoidectomy versus open milligan morgan haemorrhoidectomy at allied hospital

Objective: to compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's haemorrhoidectomy at Allied Hospital

Study Design: simple comparative study

Place of Study: Surgical Unit 1, Allied Hospital Faisalabad

Duration of Study: January 2011 to September 2012

Sample size: 50 patients

Material and Methods: fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of twenty five each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan- Morgan haemorrhoidectomy [MMH]. The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale [VAS]. Bleeding was measured as mild, moderate and profuse. Other postoperative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables

Results: a majority of patients[combined in both groups] had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled and open groups [34 vs 36 minutes]. In Group A 23 [92%] patients were discharged in 24 hrs while 2 [8%] patients were discharged after 24 hrs. In Group B 9 [36%] patients were discharged in 24 hrs and 16 [64%] patients were discharged after 24 hrs. In group A 19 [76%] patients were having mild bleeding, 5 [20%] moderate bleeding and 1 [4%] profuse bleeding. In Group B 7 [28%] patients were having mild, 16 [64%] moderate and 2 [8%] profuse bleeding. In Group A 15 [60%] patients were having mild pain, 7 [28%] moderate and 3 [12%] severe pain on visual analogue scale. In Group B 4 [16%] patients were having mild pain, 15 [60%] moderate and 6 [24%] severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group

Conclusion: there was a significant difference between stapled haemorrhoidectomy and Milligan Morgan's for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different

Three port versus four port laparoscopic cholecystectomy

Objective: The objective of this study is to compare the outcome of three vs four port laparoscopic cholecystectomy and detect safety of three port laparoscopic cholecystectomy [LC] as routine procedure

Study Design: Simple comparative study

Setting: One year starting from June 2010 to May 2011. Sample size: 100 patients

Methods: All patients were divided into two groups. Group A: three port laparoscopic cholecystectomy was done. Group B: Conventional four port laparoscopic cholecystectomy was done. Outcome is determined in terms of postoperative pain [determined by visual pain scale] and complications [bleeding, infection, bile duct injury]

Results: 35 patients in Group A had low pain score and 15 were high pain score. In group B, 24 had low pain score and 26 high pain score. In group A only 10 patient needed nalbuphine as compared to 35 patient in group B. Both groups have almost same operating time [48.5min A and 48min B]. Hospital stay is same [48h]. Complications like port site bleeding [2 patient in A and 4 in B], wound infection [2 in A and 3 patients in B], abdominal pain [3 in group A and 4 in group B] of three port laparoscopic cholecystectomy are comparable with four port cholecystectomy. No patient in both groups suffered bile duct injury

Conclusion: The three-port technique is as safe as the standard four-port for LC. The main advantages of the three-port technique are that it is less painful, safe, less chances of wound infection and leaves fewer scars

Rabies: a highly fatal but preventable disease

Rabies is a highly infectious viral disease of central nervous system caused by rabies Lyssa virus type-1. It is also known as hydrophobia and is transmitted to human being mostly by the rabid carnivorous animals

Objectives: 1-To understand the pathogenesis of the disease rabies and be able to manage this problem most effectively. 2- To be able to avoid preventable deadly complication of this disease. 3- To give awareness about right treatment and remove wrong concepts among the public about this highly fatal disease

Conclusion: treatment. Rabies can be managed effectively with various modalities like wound management, vaccination and use of Rabies immune-globulins [RIG] as active and passive immunization according to the category of the exposure

Prognosis and outcome: With tissue or cell cultured vaccine the results are good while nerve tissue vaccines have too many disadvantages and are of uncertain efficacy. Failure to use RIG in category iii bite is often a reason for failure of therapy

Thyroidectomy with safe vocal cord functions

To compare the prevalence of vocal cord dysfunctions due to recurrent laryngeal nerve [RLN] injuries in thyroidectomy with and without identification of RLN. A prospective comparative study. The study was conducted in the Department of Surgery, Allied Hospital Faisalabad from October 1[st], 2008 to September 30[th], 2009. With an informed and explained consent, the study was conducted on two groups of patients who had thyroidectomy for the treatment of primary goitre. Patients were distributed on alternate basis irrespective the type of goitre into groups A and B for [thyroidectomy with identification of RLN] and [thyroidectomy with out identification of RLN] respectively. Patients of both groups were compared for the prevalence of post- operative vocal cord dysfunctions in association with recurrent laryngeal nerve injuries. Groups A and B had 52 and 53 patients respectively. Post-thyroidectomy vocal cord functions were remained safe in all the patients of group A. However, 3 [5.66%] patients of group B showed altered vocal cord functions in post operative follow up. Prevalence of RLN injuries in Group A and B remained 0% and 3 [2.97%] respectively. Out of three RLN injuries in group B, 2[1.98%] were transient and 1[0.99%] was permanent. Preservation of vocal cords functions and recurrent laryngeal nerves in thyroidectomy is more likely with the exposure and identification of RLN up to larynx

Role of adjuvant topical oxygen therapy [Topox] versus conventional methods in the management of non- healing infected wounds

Objectives: To compare the role of adjuvant topical oxygen therapy versus conventional methods in the management of non-healing infected wounds

Study Design: Simple comparative study

Setting: The study was carried out in one year duration from January 2010 to December 2010 in Surgical unit-1 Allied Hospital Faisalabad

Sample Size: 60 patients

Methods: Total of 60 patients was divided into two groups. In one group [A] topical oxygen therapy was given along with conventional measures for management of wound. In second group [B] only conventional methods were used for wounds

Results: 60 cases included in this study,30 in group A and 30 in group B. From patients of group A, 16[53.3%] showed clinical improvement in first week and 25[83.3%] showed clinical improvement in second week. While in group B 5[17%] and 11[36.7%] showed clinical improvement in first and second week respectively.5[17%] patients in group A developed granulation tissue in first week and 19[63%] in second week. While in group B 2 [7%] developed granulation tissue in first week and 8[27%] in second week. From group A 10[33.3%] and 24[80%] patients showed complete wound healing in second and third months respectively. In group B 3[10%] patients showed complete wound healing in two months and 12[40%] in three months.1[3.3%]patient in group A deteriorated in first week and 2[7%] in second week.8[27%]patients from group B deteriorated in first week and 4[13.3]in second week

Conclusion: Use of TOPOX along with conventional method is more safe and effective in the management of nonhealing infected wound than conventional methods alone