Dyspepsia; frequency of common upper gastrointestinal endoscopic findings in elderly patients with iron deficiency anemia

The most common single cause of anemia worldwide is Iron deficiency. It results from other underlying diseases and to look for its cause is very crucial and is of far greater importance than restoring the iron stores and hemoglobin levels. To determine the frequency of common upper gastrointestinal endoscopic findings in elderly patients with iron deficiency anemia presenting with dyspepsia. Cross sectional descriptive study. Department of Medicine, Khyber Teaching hospital, Peshawar. March, 2011 to September, 2011. 116 patients, all the patients with iron deficiency anemia presenting with dyspepsia were subjected to upper gastrointestinal endoscopy to detect common findings as gastric erosions, peptic ulcer and gastric carcinoma. Data was analyzed with SPSS 10.0. On upper gastrointestinal endoscopy, normal findings were noted 30 [25.86%] patients and abnormal findings were noted in 86 [74.14%] patients including 45 [38.79%] patients with gastric erosions, 30 [25.86%] patients with peptic ulcer and 11 [9.48%] patients were found with gastric malignancy. Upper gastrointestinal lesions are common in elderly patients with iron deficiency anemia presenting with dyspepsia and must be screened by gastrointestinal endoscopy

Chronic gout and hyperuricemia; treatment with febuxostat versus allopurinol

To assess the urate-lowering efficacy and safety of Febuxostat versus Allopurinol in subjects with hyperuricemia and gout. Randomized controlled trial. Department of Orthopaedic and Trauma Surgery Mardan Medical Complex Teaching Hospital Bacha khan Medical College Mardan from February 2012 to March 2013. Fifty patients of chronic gout and hyperuricemia fulfilling the inclusion criteria were divided into two equal groups by random method having 25 patients each and received either a fixed dose [80 mg] of Febuxostat [Group A] or Allopurinol [Group B] 300mg once daily for 16 weeks. The primary end point was the percentage of patients reaching serum urate level <6.0 mg/dl [360 micro mol per liter] at final visit. The secondary end points include reduction in the incidence of gout flares and adverse drug reactions. There were 16[64%] males and 9[36%] females with mean age 44.92 years in group A while group B had 15[60%] males and 10[40%] females with mean age 46.24 years. At final visit Febuxostat group had mean uric acid level of 4.72 mg/dl +/- 1.56 SD while Allopurinol group had mean serum uric acid level of 6.34 mg/dl +/- 1.82 SD with majority of patients [84%, n=21] in group A achieving serum uric acid level of < 6 mg/dl [360 micro mol/l] while only 60 percent [n=15] of the patients in group B had serum urate level of < 6 mg/dl.[P= <0.05]. Gout flare was reported in 12% [n=3] of group A patients and 36% [n=9] in group B patients. Adverse drug reactions were reported in 12% [n=3] of group A patients while 24% [n=6] in group B. Febuxostat lowerd serum uric acid levels more potently than Allopurinol while having minimal gout flares and side effects

Local steroid injection or carpal tunnel release for carpal tunnel syndrome - which is more effective?

To compare the effectiveness of local steroid injection [LSI] and carpal tunnel release [CTR] operation for the treatment of carpal tunnel syndrome [CTS]. This is a prospective randomized clinical trial conducted at Khalifa Gul Nawaz Teaching Hospital and District Headquarters Teaching Hospital, Bannu from Feb. 2009 to Sept. 2011. Patients having CTS irrespective of gender, age and ethnicity, were included in this study. They were randomly assigned to two treatment groups by lottery method, LSI group, and open CTR group. Follow-up was done for a total period of 12 weeks. A standardized symptoms questionnaire, the 'Global Symptom Score' [GSS] was used for baseline assessment as well as for outcome measurement. It rates symptoms on a scale from 0to 50, where '0' indicates no symptoms and '50' indicates the most severe symptoms. Data were analyzed with SPSS 10. Results: Out of total 40 patients, there were 11[27.5%] males and 29[72.5%] females. The age of the patients ranged from 24-66 years [mean age 45.35 +/- 11.65]. In 15 cases the age was <40 years and in 25cases the age was >40 years. Out of 40 patients, 20 were assigned to LSI group and 20 to CTR group. The baseline mean GSS for LSI group was 34.80 +/- 8.15 and for CTR group 35.45 +/- 7.43. Two weeks after treatment, mean GSS for LSI group was 11.60 +/- 6.90 and for CTR group 12.50 +/- 7.28. Four weeks after treatment, mean GSS for LSI group was 9.85 +/- 6.39 and for CTR group 7.30 +/- 5.68. Twelve weeks after treatment, mean GSS for LSI group was 22.10 +/- 6.90 and for CTR 5.45 +/- 6.90. This trend shows that LSI has temporary effect on GSS in CTS whereas CTR has long-lasting effect. LSI gives only transient relief in CTS, whereas CTR operation provides long-lasting relief as shown in this short series of 40 patients with short-term follow-up of 12 weeks

Role of percutaneous autologous bone marrow grafting in non-union tibia

To evaluate the efficacy of percutaneous autologous bone marrow grafting in patients with tibial diaphyseal non-union. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching Hospital, Bache Khan Medical College Mardan, from March 2011 to October 2012. Fifteen patients [mean age 41.6 year] with tibial non-union were treated with a single percutaneous autologous bone marrow injection. The bone marrow was aspirated from the anterior iliac crest and injected at fracture site. The procedure was carried out under general or spinal anesthesia. The patients were followed up after every four weeks and the rate of healing was assessed clinically as well as radiologically. Union Scale Score was used to assess the progress of union. A score of six or more was considered as sound union. Majority [73.3%, n=11] of the patients achieved a solid union after an average period of 14 weeks [range 12-20 weeks]. Four [26.6%] patients however could not achieve union. The average time duration between the procedure and injury was 37 weeks [range 36-40 weeks]. The average pre injection Union Scale Score was 2 [0-3]. The mean Union Scale Score at the end of study was 5.8 [0-7] and in united cases it was 6.4 [6-7]. Percutaneous autologous bone marrow injection provided an effective safe and easy bone grafting in non-union tibia

Efficacy of plaster casting versus external fixation in comminuted distal radius fractures

To compare the outcomes of plaster casting and external fixation in comminuted distal radius fractures. This prospective study was conducted at District Headquarter Teaching Hospital and Khalifa Gul Nawaz Teaching Hospital Bannu from February 2009 to September 2010. A total of 30 adult patients having comminuted distal radius fractures were included in this study. They were classified according to AO/ASIF-Classification. The patients were randomized to plaster casting and external fixation by lottery method. Follow-up of each case was done for a total duration of 12 weeks. Radiographic assessment and clinical evaluation was conducted during each visit. Any complications arising during this period were recorded. The outcomes were assessed at the end of 12 weeks. For grading the results, Green and O'Brien clinical scoring system was used. Out of 30 patients, 15 were treated with plaster casting and 15 with external fixation. The mean age of patients in plaster casting group was 49.80 years +/- 16.05 SD and in external fixation group 51.47 years +/- 15.01 SD. According to AO-Classification, there were 8 type- A, 10 type- B and 12 type- C fractures. Radiographic evaluation at 12 weeks in plaster casting group showed mean values of volar tilt 2.8667°, radial height 6.0000 mm, radial inclination 14.2000° and articular step-off 1.5200 mm. In the external fixation group, mean value of volar tilt was 5.7333°, radial height 8.2000 mm, radial inclination 18.8000° and articular step-off 1.0467 mm. Clinical evaluation based on Green and O'Brien scoring system showed 4 excellent, 3 good, 4 fair and 4 poor results in plaster casting group and 5 excellent, 6 good, 2 fair and 2 poor results in external fixation group. External fixation is an acceptable surgical solution for the treatment of comminuted distal radius fractures as compared to cast immobilization

Hematoma block local anesthesia for closed reduction of Colles-type fractures

To describe the outcome of hematoma block local anesthesia for closed reduction of Colles-type fractures in emergency care setting. This descriptive study was conducted at Khalifa Gul Nawaz Teaching Hospital and District Headquarters Teaching Hospital Bannu, from February 2009 to August 2010. A total of 70 patients having Colles-type fractures were recruited for this study. Closed reduction and plaster casting was performed under HB in Accident and Emergency Department. Pre-and post-reduction radiographic assessment was done. A questionnaire about pain perception was administered to patients. It included a visual analogue scale as well. Fractures requiring re-manipulation were noted. Any local or systemic complications of anesthesia were recorded. Patients were sent home 3 hours after reduction. Follow-up of the patients was done up to 12 weeks. Out of 70 patients, 30 were males and 40 were females. They were in the age range of 20-80years. On assessing their pain perception with VAS, during closed reduction under HB, 36 patients had no pain, 24 had mild pain, 6 were feeling moderate pain, and 4 were feeling severe pain. 12 patients required remanipulation for improper reduction. 2 patients developed carpal tunnel syndrome, 3 developed reflex sympathetic dystrophy and one developed localized infection at the site of infiltration. No systemic complications of anesthesia were noted. HB can be used effectively for closed reduction of Colles-type fractures, especially in a district hospital which lacks advanced anesthesia and intensive care facilities