Outcome of peroneus brevis tendon transfer for augmentation of repair of old complete tear of achilles tendon

Background: Repair of complete tear achilles tenden is a challenge for orthopedic surgeons

Objective: To assess the outcome of peroneus brevis tendon transfer for augmentation of repair of the old tear of the Achilles tendon

Methodology: Study Design: Prospective case series study. Place of Study: Orthopaedic Complex, Quaid e Azam Medical College/ B. V. Hospital, Bahawalpur, Pakistan. Study duration: 1st October 2013 to 30th September 2017. A total of 52 patients [42 males and 10 females], age range 38 to 52 years who underwent repair of old tear of Achilles tendon augmented by peroneus brevis tendon transfer, were included. All patients were having closed rupture. Postoperative follow up evaluation was done for a period of 12 months by using modified Rupp score. Data analysis was done by using SPSS version 17

Results: 52 patients were operated of which 5 suffered minor skin complications which recovered subsequently. No patient suffered repeat tear of the repaired tendon. Subjective postoperative evaluation was done by modified Rupp score questionnaire while objective follow up evaluation was done on the basis of ankle range of movements, ability for raising over the tip toes and sensory/motor status over the foot. At 12 months follow up 25 [48%] patients has excellent, 16 [30.7%] patients has good, 7 [13.4%] patients has fair while 4 [7.10%] patients had poor functional outcome

Conclusion: The peroneus brevis tendon transfer for augmentation of repair of old tear of Achilles tendon achieved good to excellent functional outcome in majority of the patients

Comparison of karydakis technique with limberg flap procedure for sacrococcygeal pilonidal sinus disease in terms of hospital stay and work loss

Objective: To compare Karydakis technique with Limberg flap procedure for sacrococcygeal pilonidal sinus in terms of mean period of hospital stay and return to normal activity [mean number of days]

Study Design: Randomized controlled trial

Place and Duration of Study: Surgery department, Military Hospital /Combined Military Hospital Rawalpindi, Frontier Corps [FC] Hospital Quetta from July 2010 to July 2014

Material and Methods: A total of 150 patients [75 patients in each group] were recruited in this study by consecutive non-probability sampling. In group-A Karydakis technique was used while in group-B Limberg flap procedure was done. Data were analyzed using SPSS version 16 and by applying' t' test

Results: Comparison of mean period of hospital stay shows mean hospital stay 2.93 +/- 0.66 days in group-A and 3.97 +/- 0.71 days in group-B [p=0.001]. Similarly mean work loss was 13.13 +/- 1.15 days in group-A and 15.53 +/- 1.22 days in group-B. Significant difference was noted between two groups [p=0.001]

Conclusion: Karydakis technique, in treatment of pilonidal sinus disease is better in terms of short duration of hospital stay and less work loss. Karydakis procedure should be the preferred method in treatment of sacrococcygeal pilonidal sinus

Management of low anal fistula: fistulectomy alone versus fistulectomy with primary closure

Objective: To compare fistulectomy with primary closure of the wound and fistulectomy alone in the treatment of low anal fistula in terms of healing time

Study Design: Randomized control trial

Place and Duration of Study: Department of General Surgery Combined Military Hospital [CMH] Rawalpindi, from Nov 2006 to May 2007

Material and Methods: Total 60 patients of low anal fistula were enrolled in this study after informed consent and ethical approval. Patients were divided in two groups [A and B] each containing 30 patients. Patient of group A underwent fistulectomy alone whereas patients of group B underwent fistulectomy with primary closure of wound. All the patients were followed two weekly for 06 weeks. On each visit, healing was assessed by naked eye examination of epithelialization and noted on a Proforma. SPSS 17 was used to analyze the results. A p-value of <0.005 was considered statistically significant

Results: At 02 weeks after surgery, none of the patient in group A and 6.6% of group B patients showed wound healing, p-value was not significant i.e. 0.492. At 04 weeks after surgery, 23.3% of group A and 86.6% of group B patients showed wound healing p-value <0.001. At 06 weeks after surgery, 93.3% of group A and 100% of group B patients showed wound healing, p-value was not significant i.e. 0.492. Healing of wound was found more rapid in group B patients who underwent fistulectomy with primary closure of wound

Conclusion: Fistulectomy with primary repair was a better treatment as compared to fistulectomy alone in terms of healing time of wound

Efficacy of vacuum assisted closure in management of open wounds as compared to moist wound dressing-experience at CMH Rawalpindi

Objective: To compare the efficacy of vacuum assisted closure [VAC] therapy against regular moist wound dressings in reducing the surface area of open chronic wounds by at least 5 mm2 in terms of early closure of wound

Study Design: Randomized controlled trail

Place and Duration of Study: This study was conducted at general surgery department CMH/MH Rawalpindi from Jun 2011 to Dec 2011 over a period of 06 months

Material and Methods: A total of 278 patients [139 in each group] were included in this study. Group A received VAC therapy while moist wound dressings applied in group B

Results: Mean age was 54.9 +/- 7.2 and 53.4 +/- 8.9 years in group A and B, respectively [statistically insignificant [p=0.12]. In group A, 96 patients [69.0%] and in group B 92 patients [66.2%] were male while 43 patients [31.0%] in group A and 47 patients [33.8%] in group B were female the difference being statistically insignificant [p=0.608]. In group A, 63 [45.3%] patients showed significant reduction in the size of the wound while only 41 [29.5%] patients in group B had adequate wound healing at the end of 04 weeks, the difference being statistically significant [p=0.0064]

Conclusion: VAC therapy decreases wound size more effectively than moist wound dressing technique. It definitely reduces hospital stay and ensures early return to work

Doctor, the child has no pulse; where is the manual?

We provide excellent and safe anesthesia care. How do we get better? The editorial below provides a glimpse in an approach of a perpetual quest of improvement. It dares us that if we feel that we have reached at a comfort zone and things have stabilized, that is the time to find a new horizon

MID-shaft clavicle fractures; surgical management

To study the time to union and complications after open reduction and internal fixation of mid-shaft clavicle fractures. Retrospective. Midlands Orthopedic/ Sports Injury Clinic, Bahawalpur. 2003 to December 2012. The medical record of the patients operated for mid-shaft clavicle fractures was searched to find out the time to union and occurrence of complications during this period. The time to union was 4.6 months and there were two complications. A prominent implant had to be removed and one non-union required additional bone grafting procedure. This small series shows that the rate of complications is low and a larger study is needed to expand the indications for operative fixation of clavicle fracture safely

Discrepancy in abo blood grouping

Discrepancies in blood typing is one of the major reasons in eliciting a transfusion reaction. These discrepancies can be avoided through detailed analysis for the blood typing. Here, we report a subgroup of blood group type-B in the ABO system. Donor's blood was analyzed by employing commercial antisera for blood grouping. The results of forward [known antisera] and reverse [known antigen] reaction were not complimentary. A detailed analysis using the standard protocols by American Association of Blood Banking revealed the blood type as a variant of blood group-B instead of blood group-O. This is suggestive of the fact that blood group typing should be performed with extreme care and any divergence, if identified, should be properly resolved to avoid transfusion reactions. Moreover, a major study to determine the blood group variants in Pakistani population is needed

Risk factors for typhoid fever in children in squatter settlements of Karachi: a nested case-control study

Typhoid fever remains a major public health problem in developing countries such as Pakistan. A great majority of cases occur in children living in poor sanitary conditions in squatter settlements in large cities. We conducted a case-control study to identify risk factor for typhoid fever in children under the age of 16 years residing in squatter settlements of Karachi. We enrolled 88 typhoid fever patients, diagnosed by positive blood culture or Typhidot[R] test, between June 1999 and December 2001. Simultaneously, we enrolled 165 age-matched neighborhood controls. Multivariate analysis done through conditional binary logistic regression analysis technique showed that increasing number of persons in the household [odds ratio [OR] = 1.9; 95% confidence interval [CI] 1.2-3.1], non-availability of soap near hand washing facility [OR = 2.6; 95% CI 1.1-6.3], non-use of medicated soap [OR = 11.2; 95% CI 1.3-97.6] and lack of awareness about contact with a known case of typhoid fever [OR = 3.7; 95% CI 1.6-8.4] were independent risk factors of the disease. Health education with emphasis on hand washing may help decrease the burden of typhoid fever in developing countries

Incidence of acute respiratory infections in children 2 months to 5 years of age in periurban communities in Karachi, Pakistan

To measure the incidence of acute respiratory infections and burden of respiratory pathogens in children aged two months to five years. Four periurban communities in Karachi were selected for the study. The children, identified with fever and cough during community surveillance at regular intervals, were referred to especially established study clinics. These children were diagnosed to have no pneumonia, pneumonia and 'severe pneumonia' as per IMCI guidelines. To identify the causative organisms, children with pneumonia and severe pneumonia were investigated with oropharyngeal swabs and blood culture. Acute respiratory infection was seen in 5884 children during 1st February 2002 to 31St January 2003. Of these, 1097 children had pneumonia and severe pneumonia, with an incidence 440.3/1000 children per year for Acute Respiratory Infections and 82.1/1 000 children per year for pneumonias. Haemophilus influenzae, Streptococcus pneumoniae and Klebsiella pneumoniae were isolated from 10.9%, 3.7% and 8.5% of oropharyngeal swabs respectively. Extrapolating from the results of this study, the total number of cases of pneumonias in children aged less than five years in Pakistan is estimated to be 213,116 per year due to H. influenzae, and 71,864 per year due to S. pneumoniae. Incidence of acute respiratory infections in children varies in different communities and is a common cause of morbidity

effects of mefenamic acid on hematocrit of the lizard, uromastix hardwickii

Mefenamic acid is an analgesic, antipyretic and anti-inflammatory agent. In addition induces several hematological disturbances. Present study was conducted to determine the alterations in blood PCV of the lizard Uromastix hardwickii after the administration of 7.1 mg / ml; 10.5 mg / ml and 14.0 mg / ml mefenamic acid per individual per day for 12 days to 3 test groups. The mean values of PCV were 15.5 +/- 0.81%, 14.5 +/- 0.25% and 12.0 +/- 0.25% for 3 test groups respectively in comparison to 23.5 +/- 0.40% for control. Thus a significant dose dependant reduction in mean PCV per cent following the administration of mefenamic acid for 12 days indicates the extra vascular hemolysis due to destructive change in the red cell membrane through autoantibody mechanism

effects of mefenamic Acid on the osmotic fragility of lacertilian erythrocytes

Osmotic fragility of red cells is increased by the use of mefenamic acid. The use of this analgesic induces hemolytic anemia. Study of osmotic f agility of RBCs of control and test was observed following administration of 7.1 mg, 10.5 mg and 14 mg/day mefenamic acid to each lizard. Increased osmotic fragility was observed with increase in the amount of dose on day 6 and day 12