One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age / 대한고관절학회지

PURPOSE: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). MATERIALS AND METHODS: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). RESULTS: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. CONCLUSION: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

Gel dosimeters for radiotherapy: an introductory review

A major challenge in radiotherapy treatment is to deliver precise dose of radiation to the tumor with minimum dose to the healthy normal tissues. Recently, gel dosimetry has emerged as a powerful tool to measure three-dimensional [3D] dose distribution for complex delivery verification and quality assurance. Dosimeters currently in use are inadequate for clinical use as they measure one-dimensional [e.g. ion chambers] or two-dimensional [e.g. Radiographic films] dose distribution. There are basically two types of gel dosimeters i.e. Fricke and polymer gels. Fricke gel dosimeters are easy to prepare and are tissue equivalent but their use is limited because of dependence on oxygen concentration. Polymer gels are also sensitive to oxygen contamination however different formulations are used to solve this problem. The review summarizes improvements in gel dosimeter models and different gel compositions that had been proposed. These dosimeters act both as a phantom and detector, thus confirming the versatility of dosimetry technique. In this review imaging techniques most widely used for gel dosimeters. Magnetic Resonance Imaging, X-ray and Optical Computed Tomography shall be evaluated along with their limitations and sensitivity of gels

Clinical efficacy of Unani medicine Renax for treatment of Urolithiasis

Stone formation occurs most commonly in acute and chronic renal failure. A kidney stone is a solid lump made up of crystals that separate from the urine and build up on the inner surfaces of the kidney. The current study was conducted to investigate the clinical efficacy of Unani medicine Renax in comparison with allopathic medicine [Spironolactone + Furosemide] to treat urolithiasis. The study was conducted in District Dera Ghazi Khan, South Punjab region. This was case control, randomized, double blind clinical study. All patients were examined by the Physician and given either herbal or allopathic medicine for Urolithiasis. The patients were divided "into two groups" a control group and test groups. A Total of 24 patients were completely cured out of 50 by use of Renax while a total of 9 patients was cured out of 50 with allopathic medicine [Spironolactone + Furosemide]. This study validated the claim of traditional healer for use of Unani medicine in the treatment of urolithiasis

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

Effects of homoeopathic ultrahigh dilutions of Aconitum napellus on Baker's yeast-induced fever in rabbits / 中西医结合学报

<p><b>OBJECTIVE</b>To evaluate the effects of homoeopathic ultrahigh dilutions of Aconitum napellus in Baker's yeast-induced fever in rabbits.</p><p><b>METHODS</b>Rabbits were divided into 4 groups and each group contained 6 rabbits. Baker's yeast suspension (20%) was injected subcutaneously. After fever induction, paracetamol and homoeopathic ultrahigh dilutions (A. napellus 200c and 1 000c) were given orally. Rectal temperature was measured with digital thermometer hourly.</p><p><b>RESULTS</b>Fever was induced in all the rabbits after 4 hours of Baker's yeast administration. A. napellus 200c and 1000c significantly reduced the temperature (P < 0.05). In positive control, temperature decrease was more significant (P < 0.001).</p><p><b>CONCLUSION</b>The above findings indicate the effectiveness of ultrahigh dilutions of A. napellus in Baker's yeast-induced fever in rabbits. However, the effects were slower and less significant than standard medicine. Moreover, future research is required to know their mechanism of reducing temperature.</p>

In vitro enzymatic investigation of Ficus carica [Fruit]

The present study demonstrates the biological study of Ficus carica fruit. Methanolic extract of plant fruit was prepared and evaporated under reduced pressure by rota vapor and n- hexane, Chloroform, ethyl acetate and n-butanol soluble fractions were prepared separately from crude methanolic extract. These fractions were then screened for acetyl cholinesterase, butryl cholinesterase and lipoxygenase activities. n-butanol soluble fraction showed significant antiacetylcholinesterase activity [78.55+/-0.76%] with IC[50] of 55.8+/-0.37[micro]g/ml, ethyl acetate soluble fraction showed significant anti-butrylcholinesterase activity [70.35+/-0.85%] with IC[50] of 276.5+/-0.64[micro]g/ml and significant antilipoxygenase activity was shown by ethyl acetate soluble fraction [62.52+/-0.26%] with IC[50] of 380+/-0.08[micro]g/ml

Autologous percutaneous bone marrow injection in long bone fractures with delayed and nonunion

Objective: to determine the outcome of bone marrow injection in fractures with signs of delayed union and nonunion in terms of clinical and radiological evidence of union

Study design: descriptive case series

Place and Duration of study: department of Orthopedics and Spinal Surgery, Ghurki Trust Teaching Hospital Lahore, from October 2014 to May 2015

Methodology: patients admitted with nonunion or delayed union were included in the study. After evaluation and taking informed consent bone marrow was taken from the iliac crest with the help of bone marrow biopsy needle and injected at the site of fracture with the aid of lumbar puncture [LP] needle under image guidance. Repeat injection was given at three month interval, if needed. Clinical and radiological evidence of bone healing was assessed at six weekly follow ups till six months

Results: a total of 80 patients were included. There were 48 males and 32 females. There were 42 tibial, 18 femoral, 11 radius/ulna and 9 humeral fractures. Sixty-two procedures under local anesthesia and eighteen under short sedation were performed. In 67 patients union occurred following injection. The mean healing time was 16 weeks

Conclusion: percutaneous bone marrow injection is an alternative treatment of choice for delayed union and nonunion for long bone fractures

Determination of lytic enzyme activities of indigenous Trichoderma isolates from Pakistan

Abstract This study investigated lytic enzyme activities in three indigenous Trichoderma strains namely, Trichoderma asperellum, Trichoderma harzianum and Trichoderma sp. Native Trichoderma strains and a virulent strain of Rhizoctonia solani isolated from infected bean plants were also included in the study. Enzyme activities were determined by measuring sugar reduction by dinitrosalicylic acid (DNS) method using suitable substrates. The antagonists were cultured in minimal salt medium with the following modifications: medium A (1 g of glucose), medium B (0.5 g of glucose + 0.5 g of deactivated R. solani mycelia), medium C (1.0 g of deactivated respective antagonist mycelium) and medium D (1 g of deactivated R. solani mycelia). T asperellum showed presence of higher amounts of chitinases, β-1, 3-glucanases and xylanases in extracellular protein extracts from medium D as compared to medium A. While, the higher activities of glucosidases and endoglucanses were shown in medium D extracts by T. harzianum. β-glucosidase activities were lower compared with other enzymes; however, activities of the extracts of medium D were significantly different. T. asperellum exhibited maximum inhibition (97.7%). On the other hand, Trichoderma sp. did not show any effect on mycelia growth of R. solani on crude extract.

Assessing of oxidative stress related parameters in diabetes mellitus type 2: cause excessive damaging to DNA and enhanced homocysteine in diabetic patients

Oxidative stress and reactive oxygen species [ROS] have been documented subsist to the pathogenesis of many diseases including diabetes mellitus. The strength of both parameters could be estimated by measuring oxidative stress marker thiobarbituric acid reactive substances [TBARS], its related parameters and the antioxidants glutathione peroxidase and superoxide dismutase [SOD] in plasma of DM patients. Lipid peroxidation was measured as TBARS and presented as malondialdehyde, total cholesterol [TC], low-density lipoprotein [LDL], triglyceride [Tg], the antioxidants [vitamin A [beta-carotene], vitamin E, vitamin C, glutathione peroxidase [GPx] and superoxide dismutase] levels. The results showed that these parameters, commonly, were declined appreciably in diabetic individuals as compared to the healthy individuals. In most cases, age and gender were appeared to involve in having greater values of diabetes marker. Further, increased level of lipid peroxidation and random behaviour of antioxidant potential also associated with Diabetes. For that reason these biomarkers might be of great important to diagnosis DNA damages of diabetic patients

Formulation and clinical evaluation of topical dosage forms of Indian Penny Wort, walnut and turmeric in eczema

Eczema is characterized by itching, lichenification, scaling, oedema and erythema. Current management strategies include corticosteroids, which are limited due to side effects. Many herbal remedies are used traditionally but unfortunately have not been validated in controlled clinical trials. Three popular traditional treatments of eczema include Indian pennywort, Walnut and Turmeric. In this study three topical formulations [micro emulsion, gel and ointment] were prepared from extracts of Indian pennywort, Walnut and Turmeric. These formulations were monitored for stability for a period of three months. Controlled clinical trials were conducted on 360 eczema patients. Clinical parameters observed were degree of erythema, oedema, scaling, itching and lichenification. Effects of each formulation on these clinical parameters were compared with placebo formulations. Micro emulsion formulations in all cases proved to be more effective in reducing semi quantitative scores of erythema and oedema. Itching was relieved more by gel formulation. The ointment showed more efficacy towards scaling and lichenification. Comparison of the effects of placebo and the specific formulations was performed by chi-square statistics and found to be highly significant. In summary it is concluded that all the formulations could be used as promising source for treatment of eczema

Antipyretic activity of hydro-alcoholic extracts of Moringa oleifera in rabbits

Pyrexia and inflammation are indicatives of various disorders. Modern medicines are available for treatment of pyrexia, but they have few side effects. Several studies are ongoing Worldwide to search natural antipyretic agents with better efficacy and fewer or no side effects. This study was aimed at evaluating the antipyretic activity of Moringa oleifera bark in rabbits against E. coli induced pyrexia. Rectal temperature was recorded with digital thermometer at 0 h and E.coli suspension was injected. After 1 h again rectal temperature of the animals was recorded and hydro-alcoholic extract were administered to the treatment groups and paracetamol hydro-alcoholic 50 mg/kg orally to the positive control group. Then rectal temperature was recorded at the interval of one h for 4 h. After the drug administration [at h 1], the decrease in body temperature with the dose of 25mg/kg[-1] during next four h ranged between 1.9-2.6 [degree sign]F as compared to the negative control. At the dose of 50mg/kg[-1] the decrease in temperature was 1.9-3.0 [degree sign]F. The decrease in body temperature at the dose of 100mg/kg[-1] was high, which ranged from 2.3-3.1oF as compared to negative control. Paracetamol, a standard drug, also significantly lowered the temperature but Moringa oleifera at the concentration of 100mg/kg[-1] lowered the body temperature significantly as compared to the negative as well as positive control. Moringa oleifera bark has marked antipyretic activity in animal models and this strongly supports the ethnopharmacological uses of Moringa oleifera bark as an antipyretic plant

Antimicrobial and toxicological studies of Ochthochloa compressa plant

The present study demonstrates the biological activity of Ochthochloa compressa, since extensive literature survey has shown no documented biological activity of this plant. Ethanolic extract of whole plant was prepared and evaporated under reduced pressure by rota vapor

The crude extract was further fractionated into n- hexane, dichloromethane, ethyl acetate and n-butanol soluble fractions

These fractions were screened for antifungal, phytotoxic, cytotoxic and antibacterial activities

Dichloromethane soluble fraction showed significant phytotoxicity whereas n-hexane, ethyl acetate, and n-butanol soluble fractions showed non-significant phytotoxicity

Similarly, ethyl acetate soluble fraction was the only fraction, which showed significant cytotoxic activity

There was no antibacterial but moderate antifungal activity was shown by these fractions against selected strains of bacteria and fungi. This is the first report on the biological activity of O. compressa

Accuracy requirements in radiotherapy treatment planning

Radiation therapy attempts to deliver ionizing radiation to the tumour and can improve the survival chances and/or quality of life of patients. There are chances of errors and uncertainties in the entire process of radiotherapy that may affect the accuracy and precision of treatment management and decrease degree of conformation. All expected inaccuracies, like radiation dose determination, volume calculation, complete evaluation of the full extent of the tumour, biological behaviour of specific tumour types, organ motion during radiotherapy, imaging, biological/molecular uncertainties, sub-clinical diseases, microscopic spread of the disease, uncertainty in normal tissue responses and radiation morbidity need sound appreciation. Conformity can be increased by reduction of such inaccuracies. With the yearly increase in computing speed and advancement in other technologies the future will provide the opportunity to optimize a greater number of variables and reduce the errors in the treatment planning process. In multi-disciplined task of radiotherapy, efforts are needed to overcome the errors and uncertainty, not only by the physicists but also by radiologists, pathologists and oncologists to reduce molecular and biological uncertainties. The radiation therapy physics is advancing towards an optimal goal that is definitely to improve accuracy where necessary and to reduce uncertainty where possible

Role of community radio FM-93 Hunza during the Attabad lake crisis

The Attabad lake disaster took place on 4[th] January, 2010 in Northern Areas of Pakistan near China border when a massive landslide slid the Attabad village into the river Hunza. The debris blocked the water flow in the river and created a large barrier lake. The level of the water in the lake continued to increase at an alarming speed thus causing a great threat to the people of areas. There was a great need to establish communication links with the people of the area for rescue activities. To cope with the situation, Radio Pakistan set-up FM-93 Baltit Fort Hunza radio station on emergency basis. The study was carried out to evaluate the role of the community radio station that it played during the crisis situation. Survey method was used to collect the data. The population consisted of all the sixty-five thousand people affected by the crisis while sample size was two hundred subjects. The results showed that 85% subjects agreed with the supportive role of the radio station while 15% did not agree. Therefore, it was concluded that the community radio FM-93 Hunza played an effective role in addressing the issue

Antimicrobial activities of rhizomes of Polygonatum verticillatum: attributed to its total flavonoidal and phenolic contents

The current study was undertaken to evaluate the rhizomes of Polygonatum verticillatum against various pathogenic bacteria and fungi. Broad spectrum antibacterial activity was demonstrated by the crude extract of the plant and its subsequent solvent fractions; predominantly against Gram-negative bacteria. MICs of the extracts against Escherchia coli, Salmonella typhi and Shigella flexeneri were in the range of 1.5-40 micro g/ml, 03-06 micro g/ml and 03-40 micro g/ml, respectively. The only sensitive Gram-positive bacterium was Staphylococcus aureus with MICs in the range of 75-80 micro g/ml. The fungicidal activity was limited to Microsporum canis and Fusarium solani and the MICs were in the range of 350-360 micro g/mL and 190-290 micro g/ml respectively. The various fractions of rhizomes contained significant concentration of total flavonoidal and total phenolic contents that could be responsible for the current findings

Use of traditional herbal medicines in the treatment of eczema

Use of traditional herbal medicines is very common in Pakistani society. It is more prevalent in villages and Cholistan desert areas where medical facilities are less available, so generally people rely on herbal treatments for their diseases. Mostly herbal remedies are very effective and have fewer side effects. In this review some commonly used herbal remedies for treatment of eczema are discussed. Unfortunately, research on herbal drugs in terms of controlled clinical trials in humans is scanty. Hopefully, clinical research in the herbals opens new avenues in therapeutics

Effect of pregnancy on the disease activity in ulcerative colitis

To study the effects of pregnancy on the disease activity in ulcerative colitis. This experimental study was conducted at department of Medicine at Sultan Qaboos University Hospital Oman from July 2002 to December 2004. A total 60 diagnosed cases of ulcerative colitis proven on colonoscopy and biopsy and fairly well controlled disease at the time of enrollment were included in the study. Those who conceived and delivered during the study period were inducted as experimental group [total 30 patients], and those who did not conceive during the study period were inducted as control group [total 30 patients]. Out of total 60 patients, 30 patients who were included in the study group, 24 remained well with mild exacerbation requiring only increased dose of mesalamine, four patients had moderate disease exacerbation requiring oral steroids along with mesalamine. Two patients had severe exacerbation that was controlled on parental steroids. Among control group, 25 had mild exacerbation, 4 had moderate exacerbation and 1 had severe exacerbation during the study period. The eventual out come was good in all patients. It is thus concluded that a planned pregnancy when the disease is well controlled minimizes the risk of complications in patients of ulcerative colitis and also has got favorable outcome of pregnancy

analysis of depth dose characteristics of photon in water

Photon beam is most widely being used for radiation therapy. Biological effect of radiation is concerned with the evaluation of energy absorbed in the tissues. It was aimed to analyse the depth dose characteristics of x-ray beams of diverse energies to enhance the quality of radiotherapy treatment planning. Depth dose characteristics of different energy photon beams in water have been analysed. Photon beam is attenuated by the medium and the transmitted beam with less intensity causes lesser absorbed dose as depth increases. Relative attenuation on certain points on the beam axis and certain percentage of doses on different depths for available energies has been investigated. Photon beam depth dose characteristics do not show identical attributes as interaction of x-ray with matter is mainly governed by beam quality. Attenuation and penetration parameters of photon show variation with dosimetric parameters like field size due to scattering and Source to Surface Distance due to inverse square law, but the major parameter in photon interactions is its energy. Detailed analysis of photon Depth Dose characteristics helps to select appropriate beam for radiotherapy treatment when variety of beam energies available. Evaluation of this type of characteristics will help to establish theoretical relationships between dosimetric parameters to confirm measured values of dosimetric quantities, and hence to increase accuracy in radiotherapy treatment

Mild skeletal class III malocclusion treated non-surgically with a combination of compensation mechanics and fixed orthodontic appliance: a case report

A 15 years old patient came to Dental Centre, Islamabad, with chief complaint of anterior cross bite and all unaesthetic smile. Extra oral examination showed a prognathic mandible, deficient midface, low smile line and a concave lateral profile. There was reverse overjet of'2.5mm and reverse overbite was 6mm, which was corrected to 2mm and 3.5mm respectively. Treatment was successfully completed with a non-surgical protocol in 16 months

Screening for diabetic retinopathy: a comparative study between hospital and community based screening and between paying and non-paying patients

Prevalence of diabetes and diabetic retinopathy varies in the population considering the background and financial status. A total of 79, 194 people more than 40 years, were screened for diabetes both in the community and eye hospital setting. Initial screening was carried out by urine dipstick followed by random blood sugar examination. A value >/= 140 mg/dl of blood sugar was considered positive for diabetes. All the diabetics were then examined for any evidence of diabetic retinopathy through indirect ophthalmoscopy in a dilated pupil by a midlevel ophthalmologist. Health education campaign at public, patient and professional level was also conducted. The results of screening were analyzed for three distinct groups; rural population, hospital based free patients and hospital based paying patients. The prevalence of diabetes was found to be 9.12%, 10.34% and 18.57% in rural community, poor hospital and affluent hospital groups respectively. The prevalence of diabetic retinopathy in the total screened population in these three subgroups was 1.92%, 2.52% and 4.42% respectively, while this prevalence in the diabetic population was 21.05%, 24.39% and 23.80% respectively. The cost per person screened was $2.6-3.4, while the cost per diabetic identified was $26-28 and the cost per patient of diabetic retinopathy identified was $108-135. The prevalence of diabetic retinopathy was two times more in the affluent hospital patients as compared to poor hospital patients or rural population. For each known diabetic, there were four previously undiscovered diabetics in the rural population, and two previously undiscovered diabetics in hospital based population