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PURPOSE@#Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail.@*METHODS@#The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemoglobin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant.@*RESULTS@#There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X = 4.66, p = 0.031). At 6 months postoperatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant difference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016).@*CONCLUSION@#Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.
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Purpose:@#During fracture fixation, the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important. This study aims to find out whether "olecranon to 5th metacarpal head" (O-MH) measurement can be used to reliably predict the tibial nail length. @*Methods:@#This was a cross sectional study involving 100 volunteers. Measurements were done and recorded by two observers on two separate occasions. Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus (TT-MM). O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched. Statistical analysis was done to find out correlation between two measurements and influence of age, gender and body mass index on them. @*Results:@#Paired t-test showed no systematic error between the readings. Intraclass correlation coefficient showed strong agreement in inter and intra observer settings. Strong correlation was found between the TT-MM & O-MH measurements using Pearson's correlation coefficient test (r = 0.966). Hierarchical regression analysis showed age, gender and BMI have no statistically significant bearings on these measurements and their correlations. @*Conclusion:@#O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.
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Objective: The objective of this study was to compare the mean per operative and post operative blood loss using harmonic scalpel and monopolar electrocautry in modified radical mastectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Department of surgery PNS Shifa Karachi, from 25[th] Oct 2011 to 24[th] Apr 2012
Material and Methods: A total of 64 patients, undergoing Modified Radical Mastectomy [MRM] were randomly divided into two groups of 32 patients each, using random numbers table. Dissection in group A was done using Harmonic Scalpel [HS]. Group B underwent Monopolar Electrocautry [ME] for dissection and hemostasis. Mean per and post operative blood loss was calculated in milliliters
Results: Mean per operative and post operative blood loss using harmonic scalpel [group-A] was 121.19 +/- 5.63 ml while 603.35 +/- 8.04 ml loss was recorded in monopolar electrocautry group [group B]. A p-value was calculated as <0.001 which shows a significant difference between both the groups
Conclusion: The mean per and post operative blood loss using harmonic scalpel is significantly less than using monopolar electrocautry in modified radical mastectomy
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Objective: The objective of this study was to compare 5/0 polypropylene suture with 5/0 chromic catgut in small clean pediatric facial laceration repair in terms of cosmetic outcome
Study Design: Randomized controlled trial
Place and Duration of Study: Combined Military Hospital, Rawalpindi from 26[th] May 2012 to 25[th] Nov 2012
Patients and Methods: A total of 300 patients of both gender under 12 years of age, with small clean facial lacerations were selected and divided in two equal groups using random number tables. All the patients underwent suturing in minor operating theater of trauma centre CMH Rawalpindi as day care cases, under local anesthesia and aseptic measures. In group 1, polypropylene 5/0 suture was used where as in group 2 chromic catgut 5/0 was used for suturing
Aseptic dressing was applied. All patients were reviewed on 5[th] day [for stitch removal in polypropylene group] and 3 months post-operatively to establish cosmetic outcome which was determined by scar visual analog score both by parents of the child and consultant surgeon
Results: The mean VAS [visual analog score] as observed by Consultant surgeon was 79.14 and 78.63 for polypropylene and chromic catgut groups respectively
The mean VAS observed by the parents of the child for respective groups was 76.67 and 76.03. The significance value was 0.961 for parental VAS and 0.988 for surgeons VAS depicting insignificant difference in both suture groups
Conclusion: There is no long-term difference in cosmetic outcomes of both the sutures in the repair of facial lacerations in the pediatric population. No difference in complication rate of wound was observed. In addition, the parents of the children in absorbable suture group expressed satisfaction over prevention of psychological trauma of stitch removal
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This study was carried out to study elemental, nutritional, phytochemical and biological evaluation of Hypericum perforatum collected from Swat in 2010. The elemental analysis showed that Ca was highest [5600 micro g/g] in leaves and lowest [2500 micro g/g] in flowers. The potassium was highest [840 micro g/g] in fruit and lowest [80 micro g/g] in leaves. Magnesium was highest [260 micro g/g] in stem and lowest [200 micro g/g] in flowers. Sodium was highest [4900 micro g/g] in stem and lowest [4700 micro g/g] in leaves and flowers. Copper was highest [26 micro g/g] in stem and lowest [10 micro g/g] in leaves. Iron was highest [5000 micro g/g] in flowers lowest [1200 micro g/g] in stem. Zinc was highest [80 micro g/g] in flowers and lowest [46 micro g/g] in stem. Nickle, cadmium and Cobalt were <5 micro g/g for all plant parts. The nutritional analysis showed that the dry matter was in the range of [97.61%] in stem and [96.38%] in leaf, ash [5.43%] in flowers and [1.90%] in stem, crude protein [12.63%] in leaf and [6.15%] in stem, crude fibre [64.74%] in flowers and [13.0%] in leaf, ether extract [10.98%] in fruit and [1.88%] in stem and nitrogen free extract was [65.80%] in leaf and [10.98%] in flower, respectively. Hypericum perforatum did not show cytotoxic, insecticidal and antibacterial activity in vitro at different doses. The% activity was zero% in cytotoxic and insecticidal activities. However, H. perforatum plant parts revealed phytotoxic activity. The phytotoxic activity of leaf and fruit remained same [44.0%] at highest dose [500 micro g/ml]. The phytochemical screening showed the presence of mucilage, tannins, anthraquinones, saponins, fats and oils and proteins in all parts of the plant. Calcium oxalate was found in all parts except the fruit. Lignin and catechin was found in all parts except the leaf. Cutin was found only in stem and flower while chlorophyll was found only in stem and leaf. In various localities [Shartangaar, Panj Pali and Sharanko] of Swat fresh leaves were used while in Barani and Jaba fresh as well as dried leaves were used as stimulant, in fever, cough, diphtheria and as an anthelmintic only in Shartangaar
Subject(s)
Phytochemicals , Nutrition Assessment , Plant Extracts , Anti-Bacterial AgentsABSTRACT
Oral Squamous Cell Carcinoma [OSCC] is usually preceded by precancerous lesions. These lesions appear white or red clinically [Leukoplakia and Erythroplakia respectively] and show dysplastic epithelial changes on histopathological examination [Abbas et al, 2007]. If p53 alterations [gene mutations and protein expression] in premalignant lesions are detected and treated in their early stages, it might help in prevention of progression to cancer [Patton et al, 2008]. Aim was to determine the frequency of p53 gene mutation and protein expression in oral epithelial dysplastic lesions. This was a descriptive study carried out at the Armed Forces Institute of Pathology [AFIP], Rawalpindi and was of one year duration from 8[th] May 2010- 5[th] May 2011. Thirty cases of oral epithelial dysplasia [OED] were retrieved from the record files. Some fresh /frozen sections were also included. Gene p53 mutation was detected in these cases by PCR-SSCP Analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh /frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases andproteinp53 expression was recorded. Mutations of the p53 gene were detected in 20% of the dysplastic lesions. Immunohistochemical staining ofmarkerp53 was positive in 60% of the cases. Gene p53 mutation and protein expression was not coexistent
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Objective of this study was to determine the effectiveness of cefuroxime prophylaxis in controlling the postoperative wound infection in clean inguinal hernia mesh repair surgery and to compare single day and multiple [two] days antibiotic prophylaxis by means of hospital stay and cost effectiveness. Two hundred forty patients of inguinal hernia were studied. Patients were divided into two groups A and B comprising of 113 and 127 patients respectively. Group A was treated with three IV doses of cefuroxime 750 mg t.i.d starting from 30 min before surgery and then oral therapy of 250 mg cefuroxime b.i.d for 5 days was given. Group B received total six IV doses of cefuroxime 750 t.i.d and then shifted to oral therapy for four days. Resultant observations were analyzed by Chie square test. In group A, 6 [5.3%] and in group B 10 [7.87%] patients developed surgical site infections. Mean hospital stay of group A and group B was 2.14 and 2.21 days respectively. Overall cost effectiveness of group A is almost two times less than Group B. from our study, it is concluded that the risk of post-operative wound infection in inguinal hernia mesh repair surgery can be effectively managed by one day t.i.d treatment of cefuroxime which has the benefit of patient compliance and less hospital stay of patient as well as is cost effective thus decreasing the work load on medical and paramedical staff as well the hospital
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A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis [HSE]. MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis.
Subject(s)
Humans , Female , Adult , Herpesvirus 1, Human , Acyclovir , Cerebrospinal Fluid , Magnetic Resonance Imaging , Polymerase Chain ReactionABSTRACT
Pubic pain is a common symptom in athletes and in soccer players.Its cause can be difficult to determine. We report a case in a 14-year-old boy who presented with bilateral adductor muscle abcesses following a trivial injury to the groin. The etiology, radiological findings and treatment, along with literature review are discussed. The main causes of pubic pain after sports are thought to be sports related microtrauma to the pubic rami or symphysis and lesions of the oblique, rectus or adductor muscles or their tendons1, 2. Osteitis pubis refers to a painful inflammation of the periosteum, bone, cartilage and ligamentous structures of the anterior half of the pelvis. Pubic osteomyelitis is an uncommon entity, accounting for less than 1% of all cases of Heamatogenous osteomyelitis. We report a case of bilateral adductor muscle abcess six week after a trivial injury in sports
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The study aimed at observing the difference in predicted and recorded Vital Capacity in young Pakistani adults. Female students [n=46] and male students [n=30] belonging to age group 18-20 years, height 150-190 Cm, and with no history of smoking or respiratory ailment participated in the study. Predicted Vital Capacity was calculated by using the formula based on age and height. Vital Capacity was recorded on Students' Spirometer of 9 L capacity. A statistically significant difference between predicted and recorded Vital Capacity [p<0.05] for both female and male medical students was observed. In females, recorded Vital Capacity values were 22% less than predicted values, and in males they were 23% less than the predicted value. Vital Capacity is dependent on other factors besides age and height. Therefore recorded values 77-78% of predicted should be considered normal. The incorporation of weight in prediction equation would result in better estimation of Vital Capacity in Pakistan for different age groups
Subject(s)
Humans , Male , Female , Spirometry , Students , Students, MedicalABSTRACT
To find the association of tumor size with grade of tumor and its extra capsular extension. A review of record of all renal biopsies performed at pathology department King Edward Medical University over a period of two years was done. It was found that large sized tumors tend to have a higher grade and this correlation was found to be statistically significant [P=0.02]. A significant correlation was also seen between the size of tumor and extra capsular extension [P=0.001]. It was concluded patients presenting with larger renal tumors, who subsequently underwent nephrectomy and histopathological analysis were diagnosed with a higher grade. This relation implies that these patients with larger tumors will in turn have poorer prognosis