Autologous blood injection for lateral epidcondylitis of elbow

Objective: to determine the outcome after autologous venous blood injection in patients with lateral epicondylitis of elbow

Study design: descriptive case series

Place and Duration of study: Ayub Teaching Hospital Abbottabad and Saidu Teaching Hospital Swat, from August 2014 to March 2015

Methodology: patients having lateral epicondylitis of elbow were selected from the outdoor department.Two ml of autologous venous blood was drawn from the contralateral antecubital fossa of the patient and slowly injected into the site of maximum tenderness. Patients were advised to continue their normal daily activities and followed up at 2nd, 4th, 8th and 12th weeks post-procedure for assessment of intensity of pain using VAS pain score and Nirschl staging

Results: there were 38 males and 61 females with ratio of 1:1.6. The mean age was 40.91+/-8.21 year. The mean pre-injection Visual Analogue Score [VAS] and Nirschl score were 6.9+/-1.2 and 6.0+/-0.9. At follow up it decreased to 0.9+/-1.0 and 1.5+/-1.1 respectively

Conclusion: autologous blood injection is an effective way to treat patients of epicondylitis of elbow especially in refractory cases

Early results of Ponseti technique for idiopathic congenital talipes equinovarus

Clubfoot or congenital talipes equinovarus is one of the most common congenital anomaly affecting the lower limb. The exact cause is unknown and a number of theories have been postulated to explain its origin. Congenital talipes equinovarus affects both sexes and may be unilateral or bilateral. Clubfoot is sometimes associated with Arthrogryposis multilex congenital, spina bifida, meningomyelocele and muscular dystrophies. This study was conducted to determine the early results of ponseti technique for idiopathic congenital talipes equinovarus. Observational [Follow-up] Study. This study was conducted at orthopedic B-Unit of Ayub Teaching Hospital Abbottabad from 1[st] April 2009 to 30[th] September 2009. Thirty [30] patients from either gender with age from birth to 06 months of age attending the outpatient department of Orthopedic B-Unit of Ayub Teaching Hospital Abbottabad were included in the study. The patients were ranged in age from birth to 06 months of age, with 17 male [56.7%] and 13 female [43.3%]. In our series on follow up, fore foot adduction was detected in 06 cases [20%] and 02 cases had equines relapse [6.7%] and 03 patients had residual equines [10%] while bilateral residual equines was detected in 01 patient [3.3%] and 01 patient had recurrence of deformity [3.3%] for which posteromedial release was done. We concluded that the Ponseti method is a reliable, simple, effective and safe method for the treatment of idiopathic clubfoot deformity

Alkaline phosphatase as a screening test for osteomalacia

Vitamin D deficiency remains common in children and adults in Pakistan despite adequate sunlight exposure. Diagnosis in adults is usually delayed and is made following pathological fractures that result in significant morbidity. The objective of this study was to see whether Serum Alkaline Phosphatase levels could be used as a screening test for osteomalacia. The Study was conducted at Fatima Hospital, Baqai Medical University, Gadap, Karachi, between July 2002 and June 2005. Serum calcium levels are commonly used to screen patients suspected of osteomalacia, and raised serum alkaline phosphatase [SALP] is considered a diagnostic finding. We used SALP to screen patients who presented with back or non-specific aches and pain of more than six months duration. Three hundred thirty-four [334] patients were screened of which 116 [35%] had raised SALP. Osteomalacia was diagnosed in 92 [79.3%] of these 116 either by plain radiographs, bone biopsy or isotope bone scan. Fifty-four [53.4%] of the 101 cases had a normal level of serum calcium. Osteomalacia is likely to be missed if only serum calcium is used to screen patients. Serum Alkaline Phosphate should be used as the preferred method for screening these patients

Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Thyroid abnormalites in patients with chronic hepatitis-C

To determine the frequency of thyroid dysfunction in patients with chronic hepatitis-C. Case-series study. Department of Medicine, outpatient department of Internal Medicine at Aga Khan University Hospital Karachi. From April 25[th] till October 25[th] 2008

Thyroid disorders in Peshawar Pakistan-one year experience

This study reports on 124 cases of thyroid disorders from Peshawar treated with radioiodine during 2008. The aim of this study was to analyze the cancer registry record of patients from the district of Peshawar in order to obtain an insight about thyroid disorders for use in proposrng future health plans. The patient data has been collected from the Institute of Radiotherapy and Nuclear Medicine [IRNUM] Peshawar. Patients with thyroid disorders were confirmed by clinical examination, thyroid scintigraphy [Thyroid scan], blood tests [T[3], T[4], TSH] and histopathalogy tests and then treated with radioiodine. Of all 124 patients with thyroid disorders [Median age; 45.5 years. Range: 16-77 years] 20% were male and 80% were female. The final diagnosis was Toxic Multi Nodular Goiter [TMNG] in 56 [45.1%] cases, Diffuse Toxic Goiter [DTG] in 30 [24.2%] cases, Thyrotoxicosis in 14 [11.3%] cases while 7 [5.7%] patient showed thyroid carcinoma. All these patients were treated with radioiodine. For females, the most affected age group was 11-40 years with 31.3% cases of the total female cases followed by 21-30 age groups. No strict predominance has been observed in any age group of males. This preliminary study will provide an insight to the thyroid disorders and its treatment with radioiodine in Peshawar. Insufficient health care facilities, poor educational market [especially] in the rural areas are the most important probable factors leading to thyroid disorders. This study may be used as a base line for future planning strategies for improving the health standards in Peshawar

Hypothyridism in patients with chronic hepatitis-C

To determine the frequency of clinical and subclinical hypothyroidism in patients with chronic hepatitis-C. Case-series study. Department of Medicine, outpatient department of Internal Medicine at Aga Khan University Hospital Karachi. From April 25th till October 25th 2008. A total of 73 patients were enrolled in the study. Data was entered and then analyzed using Statistical Packages for Social Sciences [SPSS] Version 14. Results are given for quantitative variables such as age are presented as means +/- Standard deviation and percentages are presented for hypo and hyperthyroidism. Stratification on age, gender, ALT levels and gender is undertaken to control for effect modification. Out of total of 73 patients 8 patients [11% of total patients] were found to be suffering from hypothyroidism. Out of these 8 patients 2 patients were males [6.9% of total male patients] and 6 patients were females [13.6% of total female patients]. Known duration of chronic hepatitis C infection in most of the patients suffering from hypothyroidism was 6-12 months [6 patients], however rest of 2 patients had known duration of chronic hepatitis C greater than 13 months. Looking at the ages of the patients in the study group with hypothyroidism showed that half [4 out of 8] patients were in the age group 35-43 years, however 2 patients were younger to the former group and were in the 25-34 age group, and remaining 2 patients were over the age of 44 years

Outcome of modified open surgery in tennis elbow

Tennis elbow is a common disorder of upper extremity. It can be treated conservatively in majority of the patients but some resistant cases eventually need surgery. This descriptive study was conducted at Department of Orthopaedics, Ayub Teaching Hospital, Abbottabad, from January 2002 to June 2006. Sixteen patients had surgical release of the extensor tendon origin along with excision of the lateral epicondyle ridge. These patients did not respond to conservative treatment i.e. rest, non- steroidal anti inflammatory drugs [NSAIDS], local steroid injections and physiotherapy. Patients were followed up to six months. Outcome was graded as excellent, good and poor according to pain relief and function of the hand. Sixteen patients [17 elbows] were studied, Thirteen were female [81.25%] and three were male [18.75%]. Fifteen patients [93.75%] had unilateral Tennis Elbow, while one had bilateral involvement [6.25%]. In unilateral disease, right side was affected in eleven patients [68.75%] and left side in four [25%]. Excellent outcome was noticed in eleven patients [68.75%] and good result in five patient [31.25%]. Open surgical technique of releasing extensor tendon origin along with excision of lateral condylar ridge of the humerus is new and simple procedure and yields excellent and good result in patients with resistant Tennis Elbow

Modified French osteotomy for cubitus varus deformity

To evaluate the outcome of Modified French Osteotomy for correction of cubitus varus deformity. Descriptive quasi-experimental study from Feb. 2000 to Oct. 2003. Dept. of Orthopaedics and Trauma, Post-Graduate Medical Institute, Hayatabad Medical Complex, Peshawar. All children, aged 3-12 years, with cubitus earns deformity were included in the study. Pre-operative clinical as well as radiological assessment of upper extremities were done in all cases. Modified French osteotomy was done to correct the deformity. All patients were followed for seven months. Physical examination for the range of motion, scar and post-operative complications were assessed. Antero-posterior and lateral radiographs of the elbow were obtained, and the carrying angles and lateral condylar prominence index were measured and recorded. Out of the total 30 patients, 26 were male and four female. Left side was involved in 24 cases and the right side in six. The average age at the time of osteotomy was seven years [range 3%-12 years]. The average pre-operative carrying angle was 25.2° [range 18-30°] and the post-operative angle 8.7° [range 5-13° valgus]. The average preoperative range of motion was 122.6° [range 105-135°] and the post-operative range 123.86° [range 90-135°]. The average pre-operative lateral condylar prominence index [LCPI] was 175.56 [range 128-232] and the post-operative lateral condylar prominence 156 [range 100-240]. Based on Bellmore criteria, 25 patients showed excellent, three good and two a poor result. Modified French technique of supracondylar osteotomy has excellent results in the management of cubit vs varus in terms of cosmesis, radiological findings and fewer complications

Bilateral protrusion of femoral head into the pelvis in neglected osteomalacia

Osteomalacia is a metabolic bone disease in a mature individual, caused by lack of vitamin D or its active metabolites, on account of a number of factors. Osteomalacia is common in females and in countries with less sun shine. It typically presents with body aches, weakness, alongwith signs of bone tenderness and proximal myopathy. Diagnosis is made on the basis of clinical presentation and investigations; serum calcium, phosphorus, serum alkaline phosphates, 24 hour urine for calcium and phosphorus and skeletal radiology