Presentation and management outcome of tibial infected non-union with Ilizarov technique

Objective: To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications

Methods: This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine [NIRM], Islamabad and Civil hospital, Quetta over a period of 3-years

Results: There were 56 patients with 53[94.64%] males and 3[5.35%] females. The age range was 16-50 years with a mean of 32.58+/-9.98 years. According to ASAMI criteria, bone results were excellent in 37[66%], good in 10[17.85%], fair in 6[10.71%] and poor in 3[5.35%]. The functional results were excellent in 37[66%], good in 9[16%], fair in 7[12.5%] and poor in 3[5.35%]. The bone union rate was 98.21%

Conclusion: Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes

Presentation and management of neglected developmental dysplasia of hip [DDH]: 8-years'experience with single stage triple procedure

Objective: To document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure

Methods: It was a descriptive case series study, conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine [NIRM], Islamabad over a period of 8-years. It included children aged >1 and <9 years who underwent the triple procedure of open reduction, femoral shortening and Salter's osteotomy. Clinical evaluation was performed using McKay's criteria. Tonnis classification and Severin's scoring system were employed for the radiological evaluation

Results: There were 193 children with 213 DDH affected hips. The mean age was 3.31+/-1.6 years. The preoperative severity of the femoral head dislocation per Tonnis classification was Grade-I in 7.98%[n=17], Grade-II in 48.35%[n=103] and Grade-III in 43.66% [n=93] hips. The postoperative MacKay criteria was 'Good' to 'Excellent' in 193[90.61%] hips. The postoperative Severin's class was I in 113[53%] hips, II in 48[22.53%] hips, III in 43[20.18%] and IV in 9[4.22%] hips. The preoperative acetabular index ranged from 39 degree to 51 degree with a mean of 43.91+/-3.69 degree. The mean postoperative AI was 18.42+/-2.99 degree. The postoperative centre edge angle ranged from 21 degree to 26 degree with a mean 23.18 +/-1.35 degree

Conclusions: The single stage triple procedure offers the surgical remedy of choice with favourable results for managing neglected and late diagnosed DDH among children aged 1-8 years

Analysis of primary intrathoracic extrapulmonary hydatid cysts a rare clinical entity

To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions.Case series. Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1[st] July 2008 to 30[th] June 2011. All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability.Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 +/- 16.8 years range, [16-69 years]. Eight [80%] of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 [20%] mediastinal hydatid, 2 [20%] diaphragmatic, 2 [20%] pericardial, 2 [20%] oblique fissure, and 1 [10%] each in chest wall and pleural hydatid in our study. Albendazole [10 mg/kg] was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 +/- 15.4 months [range, 2-36 months].The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively

Effect of phenological stages on nutritional assessment of ten plant species in Tehsil Takht-e-Nasrati, District Karak, Pakistan

The proximate analysis of ten plant species from Tehsil takht-e-Nasrati, district Karak was conducted at three phenological stages using standard techniques. The species showed variable results. In the test species, the moisture content varied from 2.11-14.12%, 1.85-11.51 and 1.12-11.51%; the ash contents varied from 3.08-17.16%, 5.09-18.12% and 6.13-19.09%; the fibre contents varied from 2.14-11.09%, 2.43-12.31% and 2.78-13.01%; the carbohydrate contents varied from 54-85.1%, [50-84.1] and 47.1-81.1%; the fat contents varied from 1.06-5.46%, 1.09-5.98% and 1.56- 6.57%; the protein contents varied from 2.11-12.41%, 3.14-15.87% and 4.12-18.54%; the energy value varied from 305.12- 394.23 KCal/100g, 314.21-423.13 KCal /100g and 321.23-434.26 KCal /100g at vegetative stage, reproductive stage and post reproductive stage respectively. Proximate analysis of such plant species can help us to determine the health benefits achieved from their use in society. It is concluded that the poor livestock productivity in research area is partially due to insufficient amount of available poor quality forage that requires attention of the range mangers to improve the habitat and livestock breeds

Herpes simplex encephalitis presenting with normal CSF analysis

A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis [HSE]. MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis.

Carpal tunnel syndrome

Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. The symptoms of CTS include pain, paraesthesia and hypoesthesia in the hand, in the area innervated by the median nerve, and often occurs or worsens during the night or early morning, waking the patient up. Physical examination and nerve conduction studies are used to diagnose this condition. Early diagnosis and treatment of CTS are important because any delay can cause irreversible median nerve damage. To highlight the role of physical examination and nerve conduction study in the diagnosis of CTS. Setting: Kuwait teaching Hospital Peshawar. June 2008 to June 2010. Methods: Fifty patients of carpal tunnel syndrome were studied. All patients who reported numbness and/or tingling in the median nerve distribution in the hands at least twice weekly during the preceding four weeks were enrolled to undergo clinical examination and nerve conduction tests. Following the clinical examination the symptomatic persons underwent bilateral nerve conduction tests. Out of these twelve patients were males and thirty eight were females with a ratio of 1:3.1. The age range was between 20 to 60 years. CTS was bilateral in 22 patients [44%], right-sided in 23[46%] patients and left-sided in 5[10%] patients. In addition to the clinical presentation, electrophysiology has been proposed as the standard of care for diagnosing CTS with a recommendation that it should be performed in all cases

Comprehensive nutrients analysis of rhizomes of Polygonatum verticillatum

The current study was undertaken to estimate the concentration of micronutrients [Zn, Fe, Pb, Cu, Ni, Cd, Cr, Co, Sb and Mn], macronutrients [Na, Ca and K] and essential life nutrients [proteins, fats, carbohydrates and ascorbic acid] along with ash, fiber and moisture contents. Atomic absorption spectrophotometer was employed for the analysis of micronutrients while flame photometry for macronutrients. For proximate analysis [proteins, fats, carbohydrates, ash, fibers and moisture], Association of Official Analytical Chemists methods [AOAC] were used and titration method for ascorbic acid determination. It is evident from the results that the crude extract and its fractions accumulate significant concentrations of both micro and macro nutrients. The significant quantities of essential life nutrients like proteins, fats, carbohydrates and ascorbic acid along with ash, fiber and moisture contents were also found in extracts. It is concluded that the extracts of rhizomes accumulated significant quantities of life indispensible nutrients and validated the ethnobotanical uses of the plant as tonic and energizer

Comparison of left coronary artery diameter among diabetics and non-diabetics

To compare the left coronary artery diameter between diabetic and non-diabetic patients undergoing coronary angiography. This was a hospital based cross sectional comparative study. After obtaining an informed consent, 139 patients each in diabetic and non-diabetic groups were selected by non-probability purposive sampling method. Coronary angiography was done through femoral approach using Seldeinger technique and standard views were taken. Quantitative analysis of digital angiograms was performed. Data analyzed using SPSS version 11.0. Independent t test was applied to calculate mean coronary artery size between diabetic and non-diabetic patients. A p-value of less than 0.05 was considered significant. Out of 278 patients included in the study, 139 [50%] were diabetics and 139 [50%] were non-diabetics. Males were 168 [60.4%] as compared to females 110[39.6%]. Mean age was 52.82 + 7.115, and mean body surface area was 1.8004 +.11094. There was significant difference in coronary diameters of LAD [p value 0.000], LMS [p value 0.008], and distal Cx coronary arteries [p value 0.000] between the two groups. In this study, left coronary arteries and its branches were found to be narrower in diabetic patients than in non-diabetics

Effectiveness and safety profile of cyclosporin A in rheumatoid arthritis

To describe the effectiveness and safety profile of Cyclosporine A in the treatment of Rheumatoid Arthritis. The study was conducted in the department of Medicine, Khyber Teaching Hospital from Sep 98 to Aug 99. 'There was three months recruitment period i.e. July to September prior to the actual treatment phase. Those patients that fulfilled the criteria of the American College of Rheumatology for Rheumatoid Arthritis were included in the study. A total of 25 patients with Rheumatoid Arthritis [RA] completed the study. Patients started on Cyclosporine A were followed for a period of one year. Outcome was assessed in respect of functional grade and joint score during the study and at the end of one year and was graded as very good, good and poor. Sixty percent patients showed very good to good response to Cyclosporine treatment, as they were in functional class I and showed more than 80% reduction in joint score. The other 40% had poor response as they were in functional class 2 or more and had less than 80% reduction in joint score. Mild hypertension was seen in 2 [8%] patients. Two [8%] patients developed hypertrichosis. One patient with severe gingival hyperplasia eventually dropped out of the study. None of the patients showed elevation of serum creatinine level above 30% of the baseline values at any time during treatment. The study shows that Cyclosporine A is an effective agent in active and potentially disabling RA. It has a good safety profile when used in recommended doses

Clinical audit of treatment of acute watery diarrhoea in paediatrics unit, Hayatabad medical complex, Peshawar

To look into the treatment given to children with acute watery diarrhea by Trainee Medical Officers at the time of admission and to compare it with the standard treatment protocol as recommended by World Health Organization for the treatment of acute watery diarrhoea. This was a retrospective study conducted in Department of Pediatric Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar from June 15 to August 15, 2008. Treatment charts of children admitted with acute watery diarrhoea were studied for demographical findings, degree of dehydration and other clinical findings and treatment given at the time of admission. The data was statistically analyzed by SPSS version 10. Eighty children were included in the study. The age range was from one month to five years with mean age of 25.5 months. The majority were in the range of 1 to 3 years with male to female ratio of 1.4:1. Majority [68.75%] had bowel movements more than 6 times/24 hours. Blood in the stool was present in only five cases [6.25%]. Thirty-five [44%] and 12 [28%] were presented with some and severe dehydration respectively at the time of admission. Analysis of drug treatment [antibiotics, anti-protozoal, anti-emetics, stool hardeners, probiotics] showed that 65 [81.25%] children received appropriate treatment as per recommendations of World Health Organization. All children were discharged uneventfully. Continuous training and supervision of the Trainee Medical Officers is required to implement standard treatment of acute watery diarrhoea according to laid down World Health Organization guidelines. Such activities will help to reduce inappropriate use of drugs and wrong treatment for diarrhea

Surgical interventions in multidrug-resistant tuberculosis: retrospective analysis of 27 patients treated at a tertiary level care center

To assess the results of surgery for Muttidrug- Resistant Tuberculosis [MDR-TB]. Retrospective analysis was done in 27 cases of multidrug- resistant tuberculosis in whom some surgical interventions were carried out at department of Thoracic surgery, Lady Reading Hospital Peshawar between the years 2002 to 2007. There were 18 male and 9 female patients in the age group of 14-54 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections [pneumonectomy [n=07], bitobectomy [n=08] and lobectomy [n=10]], while primary thoracoplasty with apicotysis was done in two patients. Post operatively 2[nd] line anti tubercular chemotherapy was prescribed for 24 months. There was one early and one Late death. Postoperative complications were seen in three cases. One patient developed bronchopleural fistula with empyema. At a mean follow-up of one year bacteriological cure was achieved in 24 patients. Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality in multidrug- resistant tuberculosis. Morbidity and drug compliance remain as problem areas

Glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 patients of type 2 diabetes mellitus

To assess the glycemic status, income, self-monitoring, compliance, education and pattern of pharmacotherapy in 100 type 2 diabetes mellitus patients. Material and This descriptive observational study was carried out at Medical A Unit, Khyber Teaching Hospital Peshawar. A total of 100 type 2 diabetic patients were included through non-probability sampling. Glycosylated hemoglobin of each patient was determined and questions were asked about income, self-monitoring of glycemic status, education and compliance of the patients. Majority of the patients [78%] had poorly controlled diabetic mellitus. Most of the patients [42%] were poor and their monthly income was less than 5000 rupees. Only 57% of the patients monitored their blood sugar once a month. No patient was using glycosylated hemoglobin for assessment of his or her glycemic status. Majority of the patients [82%] were illiterate. Oral hypoglycemic agents were used by 81% of the patients. Most of the patients had poorly controlled diabetes mellitus. Majority of the patients were poor and illiterate and there was poor self-monitoring. Most of the patients were using oral hypoglycemic drugs

great role of Seabuckthorn combating desertification, land sliding and soil control with Seabuckthorn

Seabuckthorn [Hippophae rhamnoides L.] is multipurpose plant whose fruits, seeds, leaves and bark can be exploited, its fruit contains very rich nutrients and bio-active substances [both in its juice and oil] which have been widely used in making food, beverages, medicines and cosmetics. Seabuckthorn is also useful to control the land slidings and soil erosion

trial myxoma: a ten years experience at the NICVD

A trial myxoma is a rare disease. This is a ten-year retrospective study carried out between January 1991 and December 2000. Our goals were to find out the incidence and long term results of this disease. 52 patients were identified with this condition during this period. The majority of patients were females 41 [78.8 percent] compared to males 11 [21.2 percent]. The mean age was 35 years [28-50 years]. The diagnosis was confirmed at 2D echocardiography surgical treatment entailed excision of the myxoma under CPB. All specimens were sent for histology. Complete excision of the myxoma was achieved in all patients. The incidence of malignancy was very small i.e.: 2 patients [3.84 percent]. The hospital mortality was 5.8 percent. The commonest complication was bleeding 11. 5 percent. There was no recurrence at 2 years follow up. Atrial myxoma is a curable disease. Once treated surgically, it has excellent long term prognosis