Frequency and risk factors of hepatitis B and C in Afghan patients presenting to tertiary care hospital in Peshawar

To document the frequency and risk factors of Hepatits B and C in Afghan patients presenting to a tertiary care hospital in Peshawar. Descriptive study. Rehman Medical Institute [RMI], Peshawar from 1st January, 2012 to 31st December, 2012. A total of 2166 Afghan national were included in the study who underwent surgery in RMI through consecutive, non-probability sampling. Hepatits B surface antigen [HBsAg] and anti-HCV antibody tests were performed by ELISA method. All patients who were positive for either of the two or both were investigated by a researcher-administered questionnaire to find the risk factors for seropositivity of hepatitis. Out of a total of 2166 patients, 104 patients [4.8%] were found to be positive. Seventy-eight patients [75%] were HepBsAg positive while 24 patients [23%] were anti-HCV antibodies positive while 2 patients were positive for both viruses. Re-use of unsterilized syringes [23%] and history of previous surgery [19.2%] were the most common risk factors whereas no risk factor could be identified in 15 patients [14%]. Seventynine patients [76%] were newly diagnosed at time of test while 25 patients [24%] were known cases of either HBV or HCV. Only one patient had clinical/laboratory features of chronic liver disease while no patient had underwent Hep B vaccination or had hepatocellular carcinoma. A high seroprevalance of HBV and HCV was found in this study. Reuse of unsterilized syringes, history of previous surgery and tattoos piercing were found to be the most common risk factors

Stabilization of open femoral fractures with the sign intramedullary nail: treatment protocol and early clinical results

Objective: to evaluate the effectiveness of SIGN-Nail [Surgical Implant Generation Network[registered sign]] for the treatment of open femoral fractures

Study design: case-Series

Place and Duration of study: department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from September 2010 to June 2012

Methodology: patients with open fractures of femur were included in the study. Femoral IM nailing was done using SIGN [Surgical Implant Generation Network[registered sign]] nail with standard SIGN-technique with hand reaming without using bone-grafting or image intensifier. Patients were evaluated for infection, radiographic parameters, range of movements, time to weight bearing [partial and complete] and complications or revision surgery, if needed

Results: there were a total of twenty-two [21 male and 1 female] patients in this series. The mechanism of injury was gunshot in 12, bomb blast in 4 and road traffic accident in 6 cases. Seventeen [77%] patients had Gustilo Type IIIa fracture, 3 [14%] patients had Type IIIb fracture and two [9%] patients had Type II fracture. The average time from injury to surgery was 13.8 days [range 2 to 35 days]. Two patients developed surgical site infection. The frequency of infection in Type IIIa fractures was 5.8% [1/17] and in Type IIIb fractures 33% [1/3]. In follow up all patients had greater than 90 degrees flexion at the knee joint. Twenty patients [91%] were full weight bearing at 4 months. Two revision surgeries were done. Bone grafting plus exchange nailing was done in both the patients to achieve union

Conclusion: use of SIGN-nail is an effective treatment modality in treating open fractures of femur with excellent fracture healing

Clinical presentations of acute leukemia

To document the clinical presentation and epidemiology of various types of acute leukemia with their respective referral source at a tertiary level centre in Peshawar. An observational study. Department of Pathology, Hayatabad Medical Complex [HMC], Peshawar, from January 2011 to May 2012. A total of 618 bone marrow biopsy reports were reviewed. All biopsy reports labeled as acute leukemia were reviewed for age, gender, address, referring unit, diagnosis on bone marrow examination, presenting complaints, duration of illness and findings of clinical examination. Ninety-two patients were diagnosed as suffering from acute leukemias [15%]. ALL was most prevalent [46%], followed by AML [38%] and undifferentiated acute leukemia [16%]. Males were affected more compared to females [60% vs. 40%]. ALL and AML were predominant in pediatric [64%] and adults [77%] patients respectively. Patients from Afghanistan accounted for 33% of all cases followed by Peshawar [14%]. Fever [77%], pallor [33%] and bleeding disorders [23%] were the main presenting complaints. Enlargement of liver, spleen and lymph nodes together was associated with ALL compared with AML [p = 0.004]. ALL-L1 and AML-M4 were the most common sub-types. Fever, pallor and bleeding disorders were the main presenting complaints. Enlargement of liver, spleen and lymph nodes was more frequently associated with ALL compared to AML

Management of acute pancreatitis: experience of a tertiary care hospital in Peshawar

To document the frequency, age, gender, etiology, mortality and morbidity of patients suffering from acute pancreatitis [AP] and managed at a tertiary care hospital. This prospective, descriptive, institution-based study was conducted in Department of Surgery, Rehman Medical Institute [RMI], Peshawar [Pakistan], from June 2010 to June 2013. All patients with acute pancreatitis admitted to our institute were managed with a set protocol. Consecutive, non-probability sampling was done. Data were collected from all patients by a single investigator using a researcher-administered questionnaire, which included patient demographics, various risk factors, treatment options, complications and mortality. A total of 47 patients were included in the study; 28 female and 19 male patients. Out of 47 patients 35 [74%] were of Afghan origin, while 12 [26%] were Pakistani. Majority of patients [57%] were between 20-40 years of age. Gall stone pancreatitis [GSP] was the cause of AP in 13 [28%], dyslipidemia in 9 [19%], and traumatic AP in one patient, while in 24 patients [51%] it was idiopathic. Ten [21%] patients developed pseudocyst. Out of a total of 47 patients, 3 [6%] expired. Patients suffering from acute pancreatitis and presenting to our hospital had a predominance of females. Majority of patients were between ages of 20-40 years. Idiopathic pancreatitis was the most common type followed by GSP. Mortality and morbidity in this study was low in comparison to other local studies

Effectiveness of procedure for prolapse and hemorrhoids in immediate postoperative period

To document the early outcome of stapled hemorrhoidopexy, the procedure for prolapsed and hemorrhoids [PPH]. Descriptive case series. Rehman Medical Institute [RMI], Peshawar; from May 2012 to May 2013. A total of 24 patients requiring surgical treatment for prolapsing hemorrhoids of degree II and III were included in the study. Outcome measures were postoperative pain, bleeding, sepsis, urinary retention, relief of preoperative symptoms, operation time and length of hospital stay. Mean age of patients was 46.8 year. All surgeries were performed under spinal anesthesia. Mean surgical time was 22.5 minutes. The average distance between the stapling line and the dentate line was 2.6 cm. Postoperative pain at rest and during defecation was mild to moderate after PPH. Healing time was shorter after PPH and no patient had perioperative or postoperative bleeding. Postoperative pain was mild to moderate in majority of patients. There were no intraoperative or postoperative complications. PPH was a safe procedure and resulted in swift recovery and earlier return to work

Supracondylar humeral fracture in children: management by percutaneous lateral-entry pin fixation

This case series was conducted at the Department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from January 2007 to June 2008 to assess the outcome of two percutaneous lateral-entry pins in the operative management of supracondylar humeral fractures. The study included management of Type II and III displaced supracondylar humeral fractures according to Wilkins's modification of Gartland's classification system in 193 patients. The fractures were fixed with two percutaneous lateral-entry pins. Seventy-two children had Type II fracture and One Hundred and Sixty-five children presented with Type III fracture according to Wilkins's modification of Gartland's classification system. A comparison of perioperative and final radiographs showed no loss of reduction of any fracture. There was no hyperextension, loss of motion, cubitus varus, iatrogenic nerve palsies and no patient required additional surgery. Six patients had pin tract infection. Follow up rate was 81.5% Results were evaluated by Flynn's Criteria, 93.3% Excellent/good results were obtained. In this case-series, the use of lateral-entry pins was found to give excellent/very good results. It is an effective treatment option for unstable supracondylar fractures of humerus in children. This method provides the greatest skeletal stability and prevents neurovascular complications in children, as in other techniques, hence giving excellent results

Malignant fibrous histiocytoma of hand - a case report

Malignant Fibrous Histiocytoma [MFH] is one of the most common soft-tissue sarcoma of late adult life. The common sites of involvement include the extremities especially the lower extremities, retro peritoneum and head and neck. Hand is an uncommon site of presentation. These tumors follow an aggressive course and recur unless widely excised. We present a case of an 18-year old female with MFH of second metacarpal of left hand

Involvement and barriers to research amongst students of Khyber Medical College

To find the involvement in research amongst students of Khyber Medical College and to identify reasons for not doing research. A cross-sectional study was performed in which medical students [n=160] from different years of study were asked to fill a questionnaire. Stratified random sampling was done as 20 male students and 20 female students from each year answered the 10-question. Total positive score was calculated. One-hundred and sixty students completed the survey. There were equal male and female respondents [80 each]. The students were from 2[nd], 3[rd], 4[th] and final year. Among the respondents, only fifteen [9%] were involved in a research project; one hundred and thirty students [81.2%] believed that research is easy if proper guidance is given. One hundred and one students [63%] thought that research could enhance understanding of the subject. Most students disagreed with the idea that research could only be done by intelligent students [139, 86.8%]. One hundred and forty students [87.5%] replied that they are interested in doing research, provided proper guidance is given. In this study, we found out that very few students of Khyber Medical College are involved in research. Lack of awareness regarding importance of research and lack of guidance for undertaking research were identified as main barriers for doing research. The concerned authorities need to take steps to encourage students and should involve teachers to streamline the process