Comparison of mean anterior knee pain between medial parapatellar tendon approach versus transpatellar tendon approach in tibial medullary nailing for treatment of tibial shaft fracture

Background: Tibial medullary nails are largely inserted by a transpatellar tendon approach or medial parapatellar tendon approach in fracture of shaft of tibia. One of the common complication of the tibial nailing is anterior knee pain

Objective: To compare the mean knee pain between Medical Parapatellar Tendon approach and Trans Patellar Tendon approach in Tibial medullary nailing for tibial shaft fracture. Methodology: Study Design: Randomized controlled trial. Study Duration: From 16th November 2015 to 15th May 2017. Settings: Department of Orthopedics, Bahawal Victoria Hospital, Bahawalpur. A total of 60 patients of closed or type I open fractures of tibial shaft, in 20-60 years of age, of either gender were included. Patients were placed randomly into two groups. In groups A patients, tibial medullary nailing was done by the Medical Parapatellar Tendon approach [MPT] while in group B, Tibial medullary nailing [TMN] was done by Trans patellar tendon approach [TPT]. Follow up was regular post-operatively and final knee pain was measured at the end of 2nd week. Data was analyzed by using SPSS version 16

Results: The mean age of patients in group A was 38+/-11years and in group B was 38+/- 9years. Out of these, 60 patients, 45 [75%] were male and 15 [25%] were females with ratio of 3:1. Mean knee pain in Group A [MPT approach] was 4.47 +/- 1.53 while in Group B approach] was 6.30 +/- 1.57 [p-value = 0.000]

Conclusion: Mean knee pain was less after Medical Parapatellar Tendon approach as compared to approach in Tibial Medullary Nailing for treatment of Tibial shaft fracture

Role of Saha's procedure in change of movement at shoulder joint in traumatic brachial plexus injuries

Background: Brachial plexus injuries are difficult to manage situation for surgeons

Objective: To assess the effects of saha's procedure on improving the range of movement of shoulder joint with brachial plexus injury

Methodology: We conducted a quasi-experimental study of twelve patients with absent or extremely weak shoulder abduction [motor grade 2 or less] due to traumatic brachial plexus injuries [C5-C6-C7/C5-C6 deficit], who had undergone surgical reconstruction of the flail shoulder by tendon transfer [Steindler elbow flexorplasty]. The etiology of shoulder weakness in all patients was traumatic brachial plexus palsy [C5-C6-C7/C5-C6 deficit] from 1[st] January 2011 to 31[st] December 2014. Shoulder abduction improved or not improved measured in term of range of motion at shoulder joint. Age, gender, preoperative strength [rated on a 0 to 5 scale for the trapezius], previous surgery, length of follow-up, other associated operative procedures, results and complications were recorded

Results: We operated on twelve patients and average age at which patients presented was 22.83 in which only one was female. The percentage years of C5-C6 and C5-C6-C7 were 86.66% and 13.33% respectively. Average time elapsed since injury was 23 months. We followed the patients on average of about 2 years. The Average increase [change] in the abduction range was 74.10

Conclusion: Saha's procedure is good and effective procedure in improving the range of motion [Change] at shoulder joint in traumatic brachial plexus injuries [C5-C6-C7/C5-C6 deficit]

Heerfordt-waldenstrom syndrome uveoparotid fever: review of the literature and a case presentation

Heerfordt-Waldenstr?m syndrome is also referred to as uveoparotid fever. In our patient physical examination showed bilateral parotid gland enlargement. Chest X-ray showed bilateral hilar lymph adenopathy. Biopsy specimen from the right parotid gland revealed scattered granulomas with focal central necrosis. Stains for acid-fast bacilli and fungi were negative. He was diagnosed as a case of Heerfordt- Waldenstr?m syndrome, a rare form of sarcoidosis in which the compression of the facial nerve results in palsy. He was treated with 60 mg of prednisone daily, and at follow-up after two weeks later, the swelling and uveitis was resolved

Minimal invasive plate osteosynthesis of close fractures of distal tibia

Background: The limited soft tissue, subcutaneous location and poor vascularity render the tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive plate osteosynthesis [MIPO] technique may minimise damage to soft tissues and the vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. This descriptive study was conducted to assess the outcome of patients treated with MIPO technique for distal tibial fractures. Methods: Seventy three cases of multifragmentary fractures of the distal tibia admitted in Bahawal Victoria Hospitals, Bahawalpur between April 2009 and October 2010 were included in this study. Patient's outcome in terms of period of radiologic union of the fractured segments and period of full weight bearing capacity were accessed. Results: There were 66 males and 7 females of mean age 43 years. The mean follow-up period was 13 weeks. [Ranging from 9–16 weeks]. All patients were fully weight bearing at 16 weeks [ranging 9–16 weeks] showing radiological union. There were two superficial infections treated successfully using oral antibiotics and no failures of fixation. There were no cases of rotational malalignment. Conclusion: MIPO is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incisions is technically demanding but decreases surgical trauma to soft tissues. Keywords: Distal tibial fractures, Minimally invasive plate osteosynthesis, MIPO

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy

To measure levels of ionized calcium, total calcium and albumin corrected calcium in patients with different malignant disorders for the diagnosis of hypercalcaemia of malignancy. A case control comparative study. The study was carried out in the Department of Pathology, Army Medical College Rawalpindi, Armed Forces Institute of Pathology and Department of Oncology CMH, Rawalpindi from March 2003 to December 2003. Ninetyseven patients of various malignant disorders, admitted in the Department of Oncology, CMH, Rawalpindi, and 39 age and gender-matched disease-free persons [as control] were included in the study. Blood ionized calcium [Ca++], pH, sodium [Na+] and potassium [K+] were analysed by Ion selective electrode [ISE] on Easylyte[R] auto analyser. Other related parameters were measured by colourimetric methods. Blood Ca++ levels in patients suffering from malignant disorders were found significantly high [mean +/- SD: 1.30+017 mmol/L] as compared to control subjects [mean +/- SD: 1.23+0.03 mmol/L] [p<0.001]. The number of patients with hypercalcaemia of malignancy detected by Ca++ estimation was significantly higher [38%] as compared to total calcium [8.4%] and albumin corrected calcium ACC [10.6%] [p<0.001]. There was no statistically significant difference in other parameters e.g. phosphate, urea, creatinine, pH, Na+ and K+ levels in study subjects and controls. Detection of hypercalcaemia can be markedly improved if ionized calcium estimation is used in patients with malignant disorders

Monitoring of progression in diabetic nephropathy by use of protein: Creatinine index

To assess the progression of nephropathy in diabetic patients by using protein: creatinine index in spot urine sample as compared to 24 hours urinary protein excretion rate. Comparative cross-sectional study. One hundred and fourteen patients, 45 male and 69 female, aged 18 to 67 years having proteinuria of more than 150 mg/day were included this study. Quantitative measurement of protein in the spot and 24h urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acidic medium, on Microlab 200 [R] [Merck]. Estimation of creatinine was done on Selectra [R]-2 [Merck] by Jaffe's reaction. The urine protein: creatinine index was calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] and multiplying by 10. The protein: creatinine index in spot urine sample showed a reliable method of monitoring of progressive diabetic nephropathy as compared to 24 hours urine protein excretion rate. A significant correlation [r = 94] was found between the protein creatinine index and standard 24 hours urinary protein excretion in these patients [p< 0.001]. The index showed a significant negative correlation [r = 0.46] with glomerular filtration rate in progressive renal insufficiency in poorly controlled diabetics. The protein: creatinine index is quick and reliable method of estimation of proteinuria, to be used for monitoring of nephropathy leading to renal insufficiency in poorly controlled diabetics

Frequancy of different species of cockroaches in tertiary care hospital and their role in transmission of bacterial pathogens

To identify different species of cockroaches in tertiary care hospital of Rawalpindi and evaluate their role in the transmission of bacterial pathogens as carrier agents. Three species of cockroaches namely Periplaneta americana [American cockroach], Blatta orientalis [Oriental cockroach] and Blattella germanica [German cockroach] were identified. They were collected from nine sites of the hospital viz. Medical ward- 16, Medical ward-2, Medical ward- 10. Children medical ward, Gynecology and Obstetrics ward, Children surgical ward, Female surgical ward, Skin ward and Cook house. A total of 100 cockroaches were collected from various sites of a tertiary care Hospital from Oct-Dec 2004. American cockroaches were the most common in all the sites accounting for 73% followed by Oriental cockroaches 18% and German cockroaches 9%. Thirteen types of bacteria were isolated which included Enterococcus spp 13.4%, Proteus spp 11.5%, Citrobacter spp 11.3%, Klebsiella pneumoniae 12.8%, Escherichia coli 9.7%, Enterobacter spp 8.0%, Pseudomonas spp 8.0%, Bacillus spp 6.9%, Pseudomonas aeruginosa 5.7%, Serratia marcescens 4.7%, Providencia spp 3.4%, Staphylococcus spp 2.3% and Klebsiella oxytoca 1.8%. The prevalence of Periplaneta Americana was highly significant and Enterococcus spp was the most common bacterial isolate in the hospital environment. Cockroaches appear to be potential source of spread of infection in the hospitals. Effective measures need to be taken to tackle this issue

Role of distant flaps in soft tissue defects of the hand

To evaluate the role of different distant [groin, hypogastric] flaps in soft tissue defects of the hand. Design and Observational case series from Jan. 2002 to Jan. 2005.Bahawal Victoria Hospital, Bahawalpur.32 patients, 28 males and four females with large skin defects on hand due to agricultural machine injury 16], road traffic accidents [8], blast injuries [6] and electric burns [2].In 18 cases groin flap while in 14 cases hypogastric flaps were employed to cover the defects. Results: Two flaps were lost completely, partial flap loss occured in one, marginal necrosis in three, while infection was noted in one case.Distal flaps are useful for the coverage of the soft tissue defects of the hand when applied with proper. indications

Hospital waste management in a tertiary care army hospital

This direct observational descriptive study was carried out in a tertiary care army hospital from 5th December 2003 to 19th December 2003 to assess its prevailing practices of health care waste management and to estimate hospital waste generated per bed per day. Presently the waste is being segregated and collected in different colour coded receptacles only at the nursing stations and carried in open unhygienic trolleys. The sanitary workers were not using protective devices while handling waste in the hospital. The waste generation was calculated by placing coloured receptacles in selected zones and constant observation for seven days each as mentioned above. Results showed that total waste generation was about 3.434 kg/bed/day [out of which 0.309 kg was infectious, 0.103 kg sharps and 3.022 kg non- infectious] and that final disposal of infectious and non-infectious waste was getting mixed-up while loading in the municipality carriage system. The awareness of sanitary workers regarding colour coding was fair but not up to the mark and they were also unaware of potential hazards of health care waste while handling it. Eighty one percent of sanitary workers were vaccinated against tetanus and typhoid but none of the 86 workers were vaccinated against Hepatitis B. Two single chambered, brick made, gas fired so called [incinerators] with enormously low temperature are being used for burning which are emitting smoke and obnoxious gases directly into the atmosphere, affecting the health of the people and environment. Liquid waste is thrown down the municipal sewerage system without any prior treatment, which is adding up to the water pollution. The study concluded that although some basic steps have been taken towards the effective waste management but still there is a long way to go. Several recommendations have been made to stream line the waste segregation, collection, transportation and final disposal along with the improvement in the awareness of sanitary workers about the potential hazards of health care waste and to get 100% vaccination against tetanus, typhoid and hepatitis B. In the end it is also recommended that national guidelines on hospital waste management must be practically implemented without any further delay

Split thickness skin grafting; change of 1[st] dressing of donor area

Objectives: 1] To compare the result of early [7[th] day] with late [14[th]] dressing. 2] To establish protocol for the change of 1[st] dressing of donor area after STSG Design: A comparative [case control] study. Setting: Surgical unit B V Hospital Bahawalpur. Period: From 2001 to 2003

Material and Methods: All the patients who under went STSG due to any reason were included in the study. Patients were divided into two randomized groups. In one group dressing of donor area was changed at 7[th] postoperative day while in other group, 1[st] dressing was changed on 14[th] postoperative day. The two groups were compared in speed of healing; postoperative pain, cosmetic result and patients satisfaction

Results: Total 31 patients [13 in group A and 18 in group -B] were included in study, 22 were male and 9 were female. Ages between 4 to 65 years with an average of 32.2 years. Diseases causing morbidity were burn [7 patients], Diabetes [5 patients] infection [12 patients], Cutaneous malignancies and others miscellaneous causes [7 patients]. Postoperative result have shown that in group- B [case] ] there was a maximum healing [16 out of 18 patients] as compared to group -A [control]. [5 out of 13 patients]. In group B only in 1 patient healing was delayed beyond 2 weeks and in one patient there was some degree of infection. In case of group A in 6 out of 13 patients healing was delayed beyond two week and in 2 patients there was infection of the wound. Many patients were not happy with cosmetic results as the donor area showed varying degree of hyperemia, scaring and discoloration, yet results were found to be more satisfactory and acceptable in group -B. Patient's satisfaction was good in case of group -B [13 out of 18 patients] as compared to group -A [7 out of 13 patients ]. Postoperative pain was a common problem in both groups

Conclusions: Healing is improved, speedy and well tolerated in case the 1[st] dressing is changed on 14[th] day

Treatment response in HCV related chronic hepatitis

To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. Design: A descriptive study. Place and Duration of Study: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. Material and Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction [PCR] between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response [ETR]. Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response [SVR]. The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor [Roche] for qualitative detection of HCV RNA. Out of 229 cases tested for end-of-treatment response, 198 [86.5%] had no detectable HCV RNA [responders] and 31[13.5%] were PCR positive [non-responders]. Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions

Relationship between disease activity indices and colonoscopic findings in ulcerative colitis

Ulcerative colitis previously thought to be a western disease has a world wide distribution with increasing incidence even in Pakistan. The clinical presentation is highly variable and is characterized by periods of symptomatic flare-ups and remissions. This study was designed to seek relationship between disease activity indices and colonoscopic findings in ulcerative colitis including extent, macroscopic and microscopic grade of disease. This is a review article

Adverse effects of smoking in the flyers of Pakistan air force

This study was carried out to assess the adverse effects of smoking on pilots at PAF Base Sargodha. 73 Aircrew were included in the study. 28 pilots, 28/73 [38.35%] were found to be smokers. 57% of pilots reported high frequency of upper respiratory tract problems per year. 100% reported altered taste sensation. 78% reported dyspepsia/heartburn. The study recommends that all aircrew who smoke must quit smoking as it affects almost all body systems

Antibiotic resistance in campylobacter jejuni in Rawalpindi and Islamabad. A preliminary study

To determine the antimicrobial resistance in Campylobacter jejuni isolated from stools of children suffering from diarrhoea/dysentery in our setup against the antimicrobials commonly used as empirical therapy. Study: A prospective cross sectional descriptive study. Place and duration of study: Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi from 29 August to 29 November 2002. Patients and methods: The study was carried out on eighteen isolates recovered from one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production, resistance to cephalothin and sensitivity to nalidixic acid. Sensitivity testing was carried by Modified Kirby Bauer disc diffusion technique on lysed horse Blood Agar against ampicillin [10 ug], erythromycin [15ug], tetracycline [10ug], chloramphenicol [30ug], trimethoprim/ sulphamethoxazole [1.25ug/23.75ug], nalidixic acid [30ug] and ciprofloxacin [5ug]. One isolate [7.14%] was resistant to ciprofloxacin, three [16.66%] to chloramphenicol and four [22.22%] to nalidixic acid, five [27.77%] to erythromycin, seven [38.88%] to tetracycline, sixteen [88.88%] to trimethoprim/sulphamethoxazole and ampicillin respectively. The susceptibility pattern reflects variable susceptibility with maximum resistance to ampicillin and trimethoprim/sulphamethoxazole. Four isolates were resistant to nalidixic acid

Carpal tunnel syndrome

This is a retrospective study of 635 patients suffering from carpal tunnel syndrome [CT Sydrome], who were referred to department of Physical Medicine and Rehabilitation of Combined Military Hospital, Rawalpindi. In this article we have presented our nine years experience [Jan 1987 to Dec 1995] of incidence, symptoms, signs, clinical diagnosis and electrophysiological studies. Nerve conduction studies [NCS] were performed with MS6 system [MEDELEC] using surface electrodes. Concentric needle electromyograph [NEMG] was performed using NEUROPACK electromyographic model MEM-7102 K. Out of 635 patients studied, CT syndrome was four times more common in women. It most commonly affected in the fourth or fifth decade. Most frequent symptoms were paraesthesia, numbness affecting the flexor aspect of the thumb, index and middle finger with or without pain. Phalen's manoeuvre was positive in 394 patients [62%] and Tinel's sign was positive in 476 patients [75%]. CT Syndrome most commonly affected the dominant hand in 255 patients [40%], bilateral in 224 patients [35%] and left sided in 156 patients [25%]- Nerve conduction studies [NCS] using surface electrodes and concentric needle electromyography [NEMG] were very useful in confirming the diagnosis