Comparison of suprascapular nerve block and intra-articular injection in the treatment of frozen shoulder

The objective of this study was to compare the effect of supra scapular nerve block and intra articular injection to relieve pain and reduce disability in the patients of frozen shoulder. It was a quasi experimental study. The study was conducted at the department of Orthopedics, Pakistan Railway Hospital, Rawalpindi, fromAugust 2011 toSeptember 2012. Patients diagnosed as the cases of frozen shoulder in outpatient department of Orthopedics irrespective of their gender were included in the study. Forty patients and 50 shoulders were divided into two groups by randomization, one group received single suprascapular nerve block and second group received single intra-articular steroid injection. Both groups were advised for physiotherapy after injection. Patients' pain levels and ranges of movement were assessed over a period of twelve weeks. The study included 40 patients and 50 shoulders to a single suprascapular nerve block and intra articular steroid injection. The mean age of the patients was 49.4 + 9.97 and the range was 40-60 years. There were 16 females and 24 male patients. Post injection assessment of patients was done at two, six, eight and twelve weeks. There was a significant decrease in pain and marked improvement in range of movement with supra scapular nerve block than with intra articular injection. Patients' pain levels and ranges of movement were assessed over a twelve week period. Suprascapular nerve block produced a faster and more complete resolution of pain and restoration of range of movement than intra articular injection

C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

The acute-phase reactant C-reactive protein [CRP] has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction [STEMI]; group-3 comprised patients with Non-ST elevation myocardial infarction [Non-STEMI] and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. The CRP was elevated [>3 mg/L] among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP œ3 mg/L [P < 0.0001]. The mortality was significantly higher [P < 0.0001] in group-2 [8.9%] and group-3 [11.9%] as compared to group-1 [2.1%]. There was no cardiac event or mortality in Group-4. Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications

Craniosynostosis: early recognition prevents fatal complications

Background: Craniosynostosis is the premature fusion of cranial vault sutures. The overall incidence is 3–5/10, 000 live births. With multiple craniosynostoses, brain growth may be impeded by the unyielding skull. Most cases of single suture involvement can be treated with linear excision of suture. Involvement of multiple sutures or skull has usually required combined efforts of neurosurgeons and craniofacial surgeons. Methods: On the basis of visible skull deformity all patients were admitted in the Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Pakistan. Patients were examined for signs of raised ICP and other congenital deformities. The records of patients were maintained till follow up. Results: Twenty-seven children were included in this study from 2002 to 2009. Age range was 1–6 years, boys were 18 [66.6%], and girls were 9 [33.3%]. The common suture affected was coronal 12 [44.4%]. Two children with craniostenosis belonged to same family, and all presented with suture involvement. Three [11.1%] deaths occurred due to hypothermia [1], and blood loss [2]. Conclusion: Early diagnosis, expert surgical techniques and per- and postoperative care for bleeding and temperature regulation prevent mortality and morbidity. Keywords: Craniosynostosis, children, skull defects, suture

Sero-prevalence of Hepatitis B virus infection in Balochistan Province of Pakistan

The objective was to evaluate the sero-prevalence of hepatitis B surface antigen [HBsAg] and IgM antibodies to hepatitis core antigen in Balochistan Province of Pakistan. Design of the study: a cross-sectional, population-based study. Place and time of the study: The study was conducted in Balochistan from 1[st] January 2004 to 31[st] December, 2008. The screening areas included Barkhan, Eashani, Khuzdar, Kodi Zikriani, Kohlu, Rakhni and Turbat. A total of 15,260 subjects were enrolled; 11,900 [78%] agreed to undergo screening. Fresh serum samples were tested for the presence of hepatitis B surface antigen and IgM antibodies to hepatitis B core antigen. HBsAg was detected in 1166 [9.8%] while anti-HBc IgM was found in 117 [10.0%]. HBsAg positivity was seen in 875 [12.7%] males and 291 [5.8%] females. The prevalence of hepatitis B in Balochistan varies from 3.3% in Khuzdar to 17.0% in Kodi Zikriani. It is utmost important to educate the public, to take proper measures to control the spread of infection and vaccination in order to interrupt transmission of this threatening public health problem in Balochistan province of Pakistan

Changing spectrum of gallstone disease: an experience of 23 cases less than 10 years of age

An overall increase in the incidence of paediatric cholelithiasis forms the basis of this study, which aims to investigate the overall changing clinical pattern of cholelithiasis. This is a retrospective observational descriptive study including twenty three [23] patients with gallstones admitted and operated during June 2006-June 2008 in surgical department of a teaching hospital. All the patients with sonological evidence of gallstones, less than 10 years of age with history of acute or chronic abdominal symptoms are included in the study population. After admission all the subjects were investigated and finally operated by open approach [21 patients] during the same admission. The details of all the patients were recorded on a proforma and statistical analysis done on SPSS version 12. Of the total study population, there were 19 [82.6%] males and 4 [17.39%] females with a mean age of 7 years and a range of 4-10 years. Ultrasound revealed gallstones in all the patients with a varying proportion of the walls of gallbladder. The commonest presentation was abdominal pain in the right upper quadrant, which was vague, and of mild to moderate intensity. In 21 [91.30%] patients, no specific underlying cause was found while two patients [8.6%] had haematological disorder as underlying cause for the gallstones. This study indicates an alarming increase in the incidence of idiopathic gallstones in children less than 10 years of age with a distinct male predominance

Treatment of tetanus; the use of continuous atropine sulphate infusion

[1] To find out the result of drug to what extent it reduces the need for sedatives. [2] to compare the results with other treatment. Prospective analytical. Tetanus ward D.H.Q. Hospital Faisalabad/ Six patients with Tetanus were studied. Adult male and females suffering from Tetanus. Patient with known peptic ulcer disease and benign prostatic hyperplasia. Six patients were given trial of Atropine infusions with continuous monitoring of pulse and blood pressure. Patients were provided conventional sedation along with Atropine infusion. The requirement of sedative drug was significantly reduced when the dose of Atropine was gradually increased. The patients remained mentally alert with marked reduction in muscle spasm, convulsion, no element of anxiety or agitation. Respiratory problems were minimized. One female expired probably due to septic shock from induced abortion. Atropine sulphate is cheaper drug, easily available, short half life, minimal side effect and much important in developing and under developed countries where ICU facilities are not available

Pericardial effusion in acute myocardial infarction: frequency and in-hospital course

To determine the frequency and in-hospital course of pericardial effusion in acute myocardial infarction in our population. Prospective observational study. The study was conducted in the Department of Cardiology and Medicine, Mayo Hospital, Lahore. One hundred consecutive patients presented within first 24 hours of first episode of ST elevation myocardial infarction [STEMI] were studied. Patients with known coronary artery disease [CAD], chronic renal failure, collagen vascular disease, cardiac surgery and metastatic disease were [PE] was considered to be present when separation between two pericardial layers persisted throughout the cardiac cycle. Among 100 patients who were enrolled, 27 developed PE. Frequency of baseline variable like age, gender, and risk factors for coronary artery disease including hypertension, smoking, and diabetes mellitus were same in patients who developed PE when compared to those who did not. Most of the PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and <10 mm]. Moderate PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and < 10 mm]. Moderate PE was detected in 18% [present all around and between 10-20 mm]. None of the patients developed large PE [>20 mm]. About 15% patients who were thrombolysed and 40% who could not be thrombolysed developed PE [p <0.01]. Frequency of PE was statistically highly significant [p <0.001] among patients with higher Killip class and lower ejection fraction at the time of presentation. Patients who developed PE had statistically significant longer hospital stay [p <0.001] and higher in-hospital mortality [p<0.05].Thrombolysis decreased the frequency of PE in acute STEMI. Development of PE during the course of acute STEMI has prognostic implications and early invasive strategy may be offered for patients who develop this complication

Colorectal carcinoma from Saudi Arabia Analysis of MLH-1, MSH-2 and p53 genes by immunohistochemistry and tissue microarray analysis

To document the incidence and role of p53 and DNA mismatch repair proteins in colorectal carcinomas, and to evaluate the relative frequency of major molecular pathways in colorectal cancers from Saudi Arabia. We collected the formalin fixed, paraffin embedded tissues from 154 colorectal tumors [83 patients from King Faisal Specialist Hospital and Research Centre and 71 from Saudi Aramco Dhahran Health Centre] between January 1989 and December 2003. We analyzed the p53 and mismatch repair gene expression [hMSH-2, hMLH-1] by immunohistochemistry in tissue microarray format. Expression loss of at least one mismatch repair gene was found in 33.8% of cases and significantly associated with the right-sided tumor location [p=0.0047]. The p53 positivity was observed in 57.5% of tumors, and was inversely linked to expression loss of mismatch repair genes [P=0.0102]. The strong confirmation of the previously established associations between tumor phenotype, and mismatch repair gene alteration provided strong evidence for the validity of our experimental approach. Together with the higher incidence of right sided location in Saudi [46.6%] than in Western colon cancers [34.9%], the observed high prevalence of mismatch gene expression loss in Saudi tumors argues for a higher importance of microsatellite instability in this population. If confirmed, it will be interesting to see whether an increased level of familial or sporadic microsatellite instability cases is causing this variation

effect of environmental pH on the setting of Mineral Trioxide Aggregate

One of the materials used for repairing root-end fillings is mineral trioxide aggregate [MTA]. MTA has been reported to remain soft when placed in perforations with a high degree of inflammation. The purpose of this study was to evaluate the effect of environmental pH on the setting and micro structure of MTA. In this interventional study, tooth-colored MTA [Pro Root, Dentsply, USA] was mixed according to the manufactures instructions. The mixture was placed into cylindrical polycarbonate tubes. The specimens were randomly divided into four groups of 9 and were subjected to a pressure of 3.22 Mpa - 6kg applied for 1 minute in a custom-made condenser device. Each of the 9 specimens were then stored at room temperature and saturated humidity in four plastic plates containing buffer solutions of butyric and propyonic acid with a pH of 4.4, 5.4, 6.4 and 7.4, for 4 days. The Vickers hardness test was performed on each specimen. The microstructures of the specimens were analyzed using a scanning electron microscope after sectioning the specimens with a scalpel. Data were subjected to one-way ANOVA. The lowest and highest pH values were 4.4 and 7.4, respectively. A statistically significant difference was observed between all four groups [p<0.05]. Unreacted MTA particles scattered in a non uniform matrix were seen in specimens stored in pH 4.4 solutions whereas cases kept in a pH 7.4 environment had distinctive crystalline structures embedded in a more uniform matrix. The results indicate that the acidic pH of inflamed tissues can adversely affect the setting of MTA

effect of intra canal fluids on the apical seal of root canal fillings using AH26 and rosen sealers

One of the main objectives of root canal treatment is to achieve a suitable and 3-dimensional seal in order to prevent tissue fluids and microorganisms from re-entering the root canal system. The aim of this study was to determine the effect of intracanal moisture on the apical seal during root canal obturation using Rosen and AH26 sealers. Sixty-four teeth were chosen according to the inclusion criteria: mature apices, straight canals, no intra/extra-resorption or calcification. The root canals were prepared and randomly divided into six groups, after removing the crowns. Two different sealers, AH26 and Rosen, were chosen and the teeth were filled using the lateral condensation technique in three different settings: dry canal, presence of blood and 2/5% hypoclorite in the canals. All specimens were immersed in methylene blue solution, rinsed throughly and dried. The roots were cut longitudinally into two halves. For dye volumetric measurements, all samples were immersed in 65% nitric acid and the volume of the penetrated dye was measured by a spectrophotometer. Two-way ANOVA was used to compare the leakage of the dye in the study groups. The amount of dye leakage was significantly lower in the AH26 groups [P<0.001]. There was no significant difference between the three clinical settings in the AH26 and Rosen groups [P=0.857]. If the basic obturation principles are carefully administered during root canal filling, intracanal moisture could not affect apical seal, especially when AH26 is employed as a sealer instead of Rosen

Endemicity of malaria in Quetta

To determine the endemicity of malaria in Quetta and to evaluate the malarial disease index [DI]. Also, the various modes of presentation of malaria by the prevalent species were also assessed. A cross-sectional study. The study was conducted from January 1994 to December 1998, at the Department of Medicine, Sandeman Provincial Teaching Hospital, Quetta through the courtesy of Malaria Control Program Balochistan. A total of 2.63,018 subjects were included in the study of which there were 151210 [58%] males and 111808 [42%] females. The age range was 10-60 years. After detailed history and clinical examination, finger prick method was used for thick and thin peripheral blood smears for the diagnosis. Out of the total of 2.63,018 subjects who were screened, the positive smears were detected in 91679 [34.85%]. Malarial disease index [DI] was 0.35. P. falciparum was detected in 28166 [30.72%], P. vivax in 61313 [66.87%] and mixed infection in 2200 [2.39%]. Only two symptoms were significantly associated with malaria: fever was present in 62% of P. falciparum, 53% of P. vivax and 65% of mixed infection. Chills were present in 47% of P. falciparum, 41% of P. vivax and 49% of the mixed infection. Other symptoms including vomiting, headache, bodyaches and diarrhoea had a weaker association. Balochistan is a highly endemic malarious area. The high prevalence of infection associated with low prevalence of disease in Quetta shows epidemiologically stable malaria and that in this community malaria transmission is more endemic than epidemic

CT scan in evaluation of cardiac masses

To evaluate the usefulness of CT scan in Cardiac tumor A descriptive study with convenient sampling. We studied seven cases referred to us for work up of cardiac masses, the contrast enhanced CT scan was able to identify and give the extent in five of these patients. Two patients were negative on CT scan but were confirmed to have a mass in the cardiac chamber by echocardiography. While CT was able to identify the thrombotic mass extending into the heart in two of the patients which remained inconclusive on echocardiography. CT is better modality for the extent of the lesion and echocardiography is better as an initial modality to screen the cardiac chambers

Ilionguinal neurectomy in open inguinal hernia mesh repair

To evaluate the long-term impact of ilioinguinal neurectomy on the incidence of postoperative neuralgia and paraesthesia following the tension free Lichtensteins hernia repair. Case Descriptive Study. DHQ Hospital, Faisalabad [January 2003 - January 2005]. A total of 200 patients having unilateral inguinal hernia were included in the study. After a detailed history, patients were subjected to standard Lichtenstein inguinal hernioplasty. All patients underwent elective ilioinguinal neurectomy at the time of hernioplasty. Postoperative pain and paraesthesia were recorded and categorized on a mild, moderate or severe scale. Patients were followed 1 month, 6month and 1 year postoperatively. The incidence of chronic pain was 9% at 1 month and 6% at 6 months and 1 year postoperatively. None of the patients developed severe persistent pain in inguinal region. The incidence of post operative paraesthesia showed a continuous decli ne. It was 32% at 1 month, 24% at 6 month and 19% at 1 year of follow up. The paraesthesia was never severe or bothersome at the end of the follow up period. Routine ilioinguinal neurectomy significantly reduces the chronic post-hernioplasty inguinal pain. Moreover it is safe to perform and well tolerated by the patients

Perceptions and practices of mothers regarding child feeding

Perceptions and practices of mothers regarding child feeding vary depending upon their education, socioeconomic and cultural background. The objective of current study was to see the perceptions and practices of nutrition in mothers of malnourished children. It was also aimed to ascertain malnutrition due to poverty versus ignorance. It was a retrospective study. A total 200 malnourished children from children OPD, aged 6 months to 3 years were included in this study. History was taken regarding breast feeding, weaning, ORS preparation and care of children. Physical examination was carried out to assess the nutritional status and grade of malnutrition. Weaning age at enrollment of 18 [9%] children was 4 months, 9 [4.5%] children was 5 months, 105 [52.5%] children was 6 months, 34 [17%] children was 7 months while weaning age of 34 [17%] children was 8 months. Children being inadequately fed on food were 178 [89%]. Hundred percent children had history of an illness in the past. One hundred and sixty three [81.5%] of the mothers had heard about ORS but did not know how to prepare it. Only37 [18.5%] of the mothers had full knowledge about preparation of ORS. It was concluded that poverty alone is not the only factor in causing malnutrition. Ignorance is an important factor in child malnutrition. Nutritional education should be given to the mothers to eradicate malnutrition in the children

Vesicovaginal fistula [VVF]: a prospective analysis

Vesico vaginal fistula disease is as old as antiquity, VVF has a profound effect on the patient's emotional well being. The main object of our study was to find out the etiology, success of repair, in our set up. A total of 26 patients were included in our study, with the mean age of 30 years, all were almost illiterate [88.56%], Multiparous [57.69%], with the height more than 151cm [53.84%]. The cause of injury noted for birth trauma was, Obstructed labor [42.30%]. The time interval for the presentation of the patient for the treatment in 61.54% was 2-10 month. The success rate noted was 92.30%

Ultrasound screening for fetal abnormalities

The aim of the study was to review the recent trends in the incidence, risk factors, pattern, diagnosis and management of various congenital anomalies in our population. This cross-sectional, observational study included sixty pregnant women aged 20-35 years. Mode of delivery was decided after considering all these aspects. Total eight [13.3%] fetuses had congenital malformations. The follow-up of these ladies revealed that 26 [43.3%] were lost on follow-up, so the incidence of congenital malformations at birth was found to be 5.8%

Clinical and ultrasound correlation in first trimester abortion

To compare the diagnostic accuracy of clinical and ultrasound evaluation in first trimester abortions and assess the impact of ultrasound on patient management. Non-interventional comparative study conducted on 100 patients, selected on simple random basis from Gynae Outpatient Department. Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore Materials and All the patients with symptoms of first trimester abortion were evaluated clinically and by ultrasound to formulate a diagnostic and management plan. Both Modalities were compared for diagnostic accuracy, positive and negative correlation in different types of abortions. 34% of the patients were at 10 weeks of gestation, 28% were unsure of dates, 17% were at 11 weeks of gestation, 13% of the patients were at 9 weeks of gestation, 5% were at 6 weeks while 3% were at 7 weeks of gestation. Clinical diagnosis was made in 42% of cases; in 39% definite diagnosis was possible with combined clinical and ultrasound evaluation while in 19% no diagnosis was established with either modality In 89% of the cases the diagnosis was made on single ultrasound scan, while 11% required a repeat scan. Correlation between two modalities was present in 81% of the cases. Positive correlation was obtained in 59% and negative correlation was seen in 22%. The correlation was not possible in 19% of cases. Ultrasonography is an essential tool in diagnosis of early pregnancy failures especially where clinical evaluation is inconclusive