Relationship of Coronary Artery disease with Carotid Artery Stenosis as assessed by Carotid Doppler Ultrasound

Introduction: Atherosclerosis is a systemic disorder that often involves multiple arterial beds such as carotid, coronary and peripheral arteries. The progressive simultaneous increase in the degree of carotid artery stenosis [CAS] with CAD [Coronary Artery Disease] has raised the valid speculations of a same mechanism of stenosis in both the arterial fields

Objective: The objective of this study was to correlate CAS severity with CAD severity by comparing Ultrasound measurements of CAS in study group subjects with evidence of significant CAD on coronary angiography and control group subjects with normal coronaries or non-significant CAD coronary angiography

Methodology: This case control study was conducted at Cardiology Department/Punjab Institute of Cardiology Lahore, Punjab, Pakistan from 1/2/2016 to 30/7/2016. In this study the Non Probability consecutive sampling technique was used. The Sample size was 86 with 43 case and 43 control population

Results: The average age of the patients was 53.45+/-10.16 years. The female to male ratio was 1:1.9. In this study 46 percent had normal carotid arteries with no evidence of atherosclerotic plaque. Clinically significant Carotid artery stenosis [>50 percent] was found in 0 percent of patients with normal coronaries and in 4.3 percent of patients with non-significant CAD. Similarly, clinically significant CAS was found in 10 percent, 20 percent, 50 percent, and 45.5 percent of patients with 1 VD, 2 VD, 3 VD and LMD, respectively. In this study there was the positive correlation between the CAS and CAD severity while comparing cases and control groups

Conclusion: The principle result of this study is that the degree of carotid artery disease is positively correlated to the severity of CAD

Frequency of Celiac disease in patients presenting with nutritional Anemia

Introduction: Celiac disease [CD] is a gluten sensitive enteropathy characterized by villous atrophy of the small intestine in genetically susceptible individuals. Anemia is frequently seen in celiac disease owing to greatly reduced iron, folic acid and B12 absorption

Objectives: To determine the frequency of celiac disease in patients presenting with nutritional anemias

Study design: Descriptive cross-sectional

study Setting: department of Internal Medicine, Services Hospital Lahore

Duration of study: Seven months from May 2017 to December 2017

Sample size: The calculated sample size is 100 cases

Sampling technique: Non-probability purposive sampling

Data collection procedure: 100 consecutive patients presenting with nutritional anemia were enrolled. Complete hematologic workup was done including blood complete picture [CP], peripheral smear, iron, folate and B12 levels. Anemia was defined as Hb<13 g/dL in males and <12 g/dL in females. Only cases with anemia secondary to iron, folate or B12 deficiency i.e. nutritional causes were included in the study Patients were then subjected to anti-tTG antibody testing. Jejunal biopsy was taken in all those cases which tested positive for anti tTG antibody. A diagnosis of CD was established upon positive histopathology findings All the data was recorded on a pre-designed proforma and analyzed by SPSS version 21.0

Results: The prevalence of Celiac disease was found to be 12 percent.10 out of 12 celiac disease cases were having IDA; 1 each showed dimorphic picture and concomitant B12 + folate deficiency respectively with none of the CD patients having folate or B12 deficiency alone

Conclusion: Celiac disease may be found in up to 12 percent of Pakistanis presenting with nutritional anemia. Hence, all those patients not responding to standard anemia treatment should be screened for celiac disease

Risk factors of heart failure after myocardial in farction

Objective: To find out risk factors of heart failure after ST Elevation Myocardial Infarction [STEMI] and to see the most commonly involved vessels in myocardial infarction responsible for heart failure

Methodology: This cross-sectional study was conducted from June 2013 to November 2013. 225 patients of heart failure [HF] following STEMI who came in the emergency department of the hospital were included. The selected patients were followed till the angiography reporting. Statistical analysis was done in SPSS version 16

Results: Mean age of patients was 51.42 +/-11.78 years. 49.0% patients were hypertensive, 37.3% patients were diabetic, 44.0% were smokers and 18.2% had positive family history. In this study, anterior wall MI was predominant and found in 30.7% patients. 46.7% patients had triple vessel disease [TVD]. There was 33.7% involvement of Left main stem [LMS]

Conclusion: Hypertension and smoking are most common risk factors of heart failure. The patients who present with heart failure are most who have involvement of triple vessel coronary artery disease. Left main stem [LMS] is most commonly involved vessel in these patients

Non-urgent visits to emergency department and comparison of urgency evaluation between patients and doctors

Objective: To assess the proportion of non urgent patients presenting to the emergency department and to compare urgency evaluation between patients and doctors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Emergency department Combined Military Hospital [CMH] Jhelum, from November 2015 to December 2015

Material and Methods: All the patients presenting to the emergency department after working hours between 4-6 pm were documented for 16 consecutive working days. They were assessed as to the urgency of their condition by the doctor. The patients or guardians in case of children were also required to rate the level of urgency of their medical condition. The level of urgency was graded on visual analog scale from 0-10. A 5 and above score was labeled as urgent while a score of less than 5 was considered non urgent

Results: A total of 205 patients reported in 32 hours over 16 days, to the emergency department. Of these 31 [15.12%] were assessed as emergencies by doctors while 49 [24%] were thought to be emergencies by patients. The p-value for this difference was 0.021. The largest group of patients visiting the emergency department was pediatric and they comprised the largest group of non urgent visits to the hospital as well

Conclusion: Actual emergencies comprise a small proportion of visits to emergency departments while the main bulk consists of non urgent visits

Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Framingham risk score in impaired glucose tolerant population: a sub analysis of diabetes prevention and awareness program of Pakistan

Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score

Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD

Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years

Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD

Vildagliptin ameliorates biochemical, metabolic and fatty changes associated with non alcoholic fatty liver disease

Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia

Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment

Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters

Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia

Effects of vitamin D supplementation on physical activity of patients with heart failure

Objective: To see the role of Vitamin D supplementation on physical status of patients suffering from Congestive Heart Failure [dilated cardiomyopathy]

Methods: In this nonrandomized clinical trial, Forty three Patients with dilated cardiomyopathy who were not showing any significant improvements in physical performance on optimal treatment of heart failure were included. Vitamin D [200,000 IU] supplementation on weekly basis for a period of 12 weeks was added to heart failure treatment. And its effect was seen on 6 minutes' walk distance and Pro-BNP levels. SPSS version 19 was used for data analysis. Dependent sample t-test was used to see the significant effect of vitamin D supplementation on pre-intervention vitamin D levels, 6MWD and Pro-BNP. Taking p-value <0.05 as significant

Results: On clinical assessment most of the patients were in NYHA class II [65%], the percentages of NYHA Class I, III and IV was 19%, 9% and 7% respectively. The baseline mean vitamin D level of the study group was 16.59 +/- 3.54ng/ml and it raised to 31.97 +/- 3.64ng/ml after 12 weeks of supplementation with vitamin D, p value <0.0005. The mean distance travelled by the study group before the intervention was 806 +/- 380ft while it increased to 945 +/- 393ft after the intervention, p value of 0.008. The mean of pro-BNP level of the study group before the intervention was 1024 +/- 635 while it improved to 159 +/- 80 after the intervention with a significant p value <0.0005

Conclusion: Vitamin D supplementation decreases the severity of HF as reflected by reduction in serum pro-BNP levels and significant increase in six minutes' walk distance

Efficacy of N butryl cyanoacrylate in cases with isolated gastric varices due to liver cirrhosis

Background: Isolated gastric varices [IGV] are one of the major causes of upper gastro intestinal bleeding in cases with liver cirrhosis. They are difficult to manage and N butryl cyanoacrylate is one of the options

Objective: To determine the efficacy of N butryl cyanoacrylate in cases with isolated gastric varices due to liver cirrhosis

Methodology: This cross-sectional study was conducted at Endoscopy unit of Hamza Medicare Hospital, Rahim Yar Khan from 1st January 2015 to 31 th July 2016. The cases presenting with upper GI bleedy and history of liver cirrhosis [documented by presence of jaundice, ascites, hepatic encephalopathy, deranged LFTs, i.e. serum bilirubin, PT, albumin] irrespective of etiology and the child pugh class were included. The endoscopy was done by Olympus GIF-XQ140 and the site of bleeding varices were documented. The cases of isolated gastric varices of any type or severity were considered. Then glue comprising N butryl cyanoacrylate with lipoid solution in a ratio of 5:8 was injected into the varices in a dose of 2.5 to 5 cc and were then followed for next 5 days for any re bleeding episode and control of homeostasis. The cases, in which no such event was noted, were labeled as with positive efficacy. The data was entered and analyzed by using SPSS version 21

Results: In this study out of total 54 cases of IGV, there were 34 [62.96%] males and 20 [37%] females. The mean age was 58.50 +/- 15.54 years. There were 47 cases with hepatitis C and 7 has hepatitis B. Efficacy was seen in 52 [96.30%] out of 54 cases. Thirty-three out of 34 males and 19 out of 20 females has shown efficacy with p value of 0.80. The efficacy was better seen with age group of 15 to 35 years with cure in 5 [100%] out of 5 cases as compared to lower rate in others with p= 0.27. The cases with Child pugh class C contained the both failure cases with significant p= 0.04. There were one case each with hepatitis B and C with failure with p= 0.39

Conclusion: N butryl cyanoacrylate has a high efficacy rate in shortterm relief for bleeding and Child pugh class C is significantly associated with lower success rate

Frequency of isolated gastric varices in cases with liver cirrhosis

Background: Liver cirrhosis, associated with upper gastrointestinal [GI] bleed, is one of the leading cause of morbidity and mortality. Esophageal and isolated gastric varices, both are common but the later is the more difficult to treat

Objective: to determine the frequency of isolated gastric varices in cases with liver cirrhosis presenting with upper gastrointestinal bleeding

Methodology: This cross sectional study was conducted at Hamza Medicare Hospital, Rahim Yar Khan from 1 January 2015 to 31 July 2016. The cases with upper GI bleeding due to liver cirrhosis [assessed by presence of ascites, splenomegaly and deranged liver functions like LFTs, PT] were included in this study. Sociodemographic data was collected like age, gender and other data like type of viral hepatitis and other examination to label for their child pugh class. The cases then underwent upper GI endoscopy with Olympus GIF-XQ140 and were assessed for presence of ulcers or varices from esophagus to stomach. The cases with varices of any size or type only in the gastric area were labeled as isolated gastric varices [IGV]. The data was entered and analyzed by SPSS version 21

Results: In this study there were total 662 cases of liver cirrhosis out of which 180 [27.19%] were females and 482 [72.81%] males. The mean age was 58.50+/- 15.51years. There were 495 [74.77%] cases with hepatitis C and 167 [25.23%] with hepatitis B virus. Isolated gastric varices. [IGV] were seen in 54 [8.17%] cases. All the cases were in GV1 class and all has size of more than 10 mm. IGV were seen in 34 [7.05%] males as compared to 20 [11.11%] females [p value= 0.53]. There was no significant association of GV with any age group with p= 0.17. There was significant association of IGV with child pugh class C [p=0.03]. There was no significant association with type of hepatitis with IGV [p=0.21]

Conclusion; Isolated gastric varices are common entity and every twelfth case of liver cirrhosis develops this. Child pugh class C is significantly associated with isolated gastric avarices

Effect of bupivacaine with and without intra peritoneal instillation on postoperative visceral pain after laparoscopic cholecystectomy

Background: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic gallstones disease. Open cholecystectomy results mainly in parietal pain while laparoscopic cholecystectomy causes visceral pain

Objective: To compare post-operative visceral pain at 24 hours in patients undergoing laparoscopic cholecystectomy with and without intra peritoneal instillation of bupivacaine

Methodology: Setting: Surgical Unit II, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Duration of Study: 1 July to 31 December 2015. Study design: Randomized controlled trial [RCT]. A total of 60 patients having symptomatic gallstones disease were included in this study. Patients were randomly divided into two groups. Thirty patients in group Awere treated with bupivacaine 0.5 % instillation. For the patients in group B, the dose was not instilled in the gall bladder fossa and right and left sub diaphragmatic spaces. Postoperative pain was assessed up to 24hours after surgery using Visual Analogue Scale [VAS]. The data was entered and analyzed by using SPSS version 16

Results: The mean age of the patients was 35 +/- 8 years in group A, and 37 +/- 8 years in Group B. Post operative pain at 24 hours was significantly low in group A than in group B [33.3% vs. 70%; p=0.004]

Conclusion: Intraperitoneal bupivacaine instillation after laparoscopic cholecystectomy reduces pain in the initial postoperative period. It is easy to administer with no adverse effects and may become a routine practice for this procedure

Outcome of closed titanium elastic nailing in paediatric tibial diaphyseal fractures

Background: Tibia fractures in skeletally immature patients are usually treated conservatively but sometimes operative treatment becomes essential

Objective: To determine the outcome of closed titanium elastic nailing in pediatric tibia diaphyseal fractures in terms of union and range of motion at knee and ankle joints

Methodology:Across sectional study was conducted at Orthopedics Department of Lahore General Hospital, Lahore. A total of 35 patients ageing between 6-12 years with unilateral, isolated, closed displaced diaphyseal fractures of tibia were included in this study. Patients were followed in outpatient department after 15 days for operative wound examination and then were followed after every 2 months to determine the progress in union and range of motion. The collected information was entered in PASWStatistics 18 and analyzed

Results: The minimum age was 6 and maximum was 12 years. There were 19[54.3%] males and 16[45.7%] females. According to Hammer classification of fracture healing, at 2nd week post operative all patients has Grade-V. At 2nd Month follow up 12[34.28%] patients has Grade-II and 23 [65.72%] patient has Grade-III fracture healing. At 4th month follow up 30[85.71%] patients has Grade-I and 5[14.2%] patients has Grade-II union. At 6th month follow up all 35[100%] patients has Grade-I fracture healing

Conclusion: Treatment of diaphyseal fractures of tibia in children with closed elastic intramedullary nailing is a rapid and effective method in terms of bone union and range of motion of the ankle and knee joints

Comparison of outcome of fractures of inferior pole of patella

Background: Fractures of patella are common and it constitutes about significant proportion of all skeletal injuries resulting from either direct or indirect trauma

Objective: To evaluate the outcome of inferior pole fractures of patella treated with tension band wiring and resection of avulsed fragment and re-attachment of ligament to patella

Methodology: This was an comparative study, carried out in Department of Orthopaedic surgery of Lahore General Hospital, Lahore from 16[th] June 2012 to 15[th] June 2014. A total of 20 patients were included in this study. These patients were randomly divided into two groups. In Group-A patients were treated with open reduction and internal fixation with tension band wire and in Group-B patients were treated by resection of the avulsed fragment and reattachment of the patellar ligament to the patella. Patients were followed up for surgical site infection and functional outcome at 1[st], 7[th], 15[th], day one month, three months and six months post operatively. Final outcome was assessed by using Bostman criteria. Data entry and analysis was done by using SPSS version 17

Results: Mean age of all 20 patients was 34.20 +/- 12.13 years. Although both treatment groups had statistically same rate of surgical site infection from 1[st] day till 15[th] day post operatively. From 1[st] month till 6[th] months follow up time period none of the patients had surgical site infection in both treatment groups. At 1[st] month and 6[th] month post operatively in Group-B outcome was statistically better as compared to Group-A patients. But at 2[nd] month outcome of patients was statistically same in both treatment groups

Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had good outcome according to the Bostman criteria as compared to open reduction and internal fixation with tension band wire

Frequency of thymoma in thymectomy specimens in myasthenic patients

This study was carried out to determine the frequency of thymoma in different age groups and sexes in thymectomy specimens in Myasthenia Gravis patients. Observational study. The study was carried out in General Surgery Department at PIMS over a period of three years from 2009-2012. PIMS is a tertiary care centre where large population of Islamabad and Surrounding territory, including AJK, Gilgit Baltistan, Hazara division, Peshwar and nearby districts of Punjab gets treatment. A total of 30 patients selected at random, were included in this study. Patients were of different age groups, above 12 and under 52 years of either sex. Patients with poor medical control of disease with no contra indication for surgery. Patients with operable mediastinal mass [thymoma] were included. Generalized myasthenia gravis was diagnosed in patients. Pre-operative plasmaphoresis was carried out in all patients. Transsternal approach was used in all cases although now video assisted thoracoscopic thymectomy is becoming popular. Intraoperative findings were noted with emphasis on gross appearance and an information by histopathological report [frozen section]. In our study 17 % thymectomy specimens turned out to be Thymoma. Male to female ratio was 3:2. Age range was 12 years to 52 years. All patients undergoing thymectomy for Myasthenia Gravis don't have thymoma. Moreover all Thymomas are not associated with Myasthenia Gravis. Ages between 3[rd] to 5[th] decade are affected by thymoma and gender difference is very little

Frequency of thyroid dysfunction during TFT in interferon and ribavirin therapy in patients with chronic hepatitis C

Objective: To determine the frequency of thyroid dysfunction among patients of chronic hepatitis C [HCV] infection receiving combination of interferon-alpha and ribavirin therapy

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from September 2012 to March 2013 over a period of six months

Patients and Methods: In this study, 170 diagnosed patients of chronic HCV [confirmed by anti-HCV and HCV RNA-positive] presenting to medical OPD with normal thyroid functions were recruited. All patients fulfilled inclusion and exclusion criteria. They were prescribed IFN-alpha 2b [3 million units subcutaneously 3 days a week] and oral preparation of antiviral drug ribavirin [800 to 1200 mg daily in divided doses according to weight]. At the end of 12 weeks of combination antiviral therapy, their thyroid profile was worked up. Serum TSH, free T4 and T3 levels were determined by chemiluminescence technique in chemical pathology lab of the hospital. Statistical analysis was done on SPSS 17

Results: Out of 170 patients, 83 [48.82%] were females and 87 [51.18%] were males with the age ranging from 22-46 years [mean +/- SD: 33.86 +/- 5.32]. After 12 weeks of antiviral therapy, thyroid functions were normal in 156/170 [91.76%] patients, whereas in 14/170 [8.24%] cases thyroid dysfunction was observed. Out of those patients having thyroid dysfunction, 10/14 [71.42%] were hypothyroid whereas 4/14 [28.58%] had hyperthyroidism

Conclusion: Managing patients of chronic HCV with combination antiviral therapy comprising IFN-alpha 2b and ribavirin can cause thyroid dysfunction. These patients should be monitored before and during treatment to avoid complications and poor compliance

Outcome of tissue sparing conservative surgery in blast injuries to limbs

Background: Blast injuries are common in countries affected by conflict

Objective: To evaluate the outcome of conservative surgical intervention in the blast injuries of limbs in civilian population

Methodology: Study Design: Cross sectional study. Place and Duration of Study: Department of Orthopedic Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] September 2011 to 31[st] March 2013. Fifty patients suffering from blast injuries to upper and lower extremities in civilian population regardless of age and sex were enrolled. Those patients who already had been treated after injury at some other centers were excluded from the study. Only clinical evaluation was used to check the vascular status and viability of the remaining attached tissues. Patients were operated either under general or regional anesthesia. Repeated debridement's followed by skin coverage in the form of split thickness skin graft or rotational flaps were the treatment option for soft tissues and exposed bone respectively. Post operative antibiotics were given for a period of one week at least. Rehabilitation exercises were continued up to six months after discharge from the hospital. The data was entered and analyzed by using SPSS version 15

Results: Mean age of the victims in this study was 22 years. Twenty nine patients had some sort of traumatic amputation at presentation resulting from original injury. Original injuries occurred were as follows; loss of limb below knee 7[14%], loss of limb at ankle region 05[10%], mid foot amputations 08[16%], and hemi foot amputation in 05[10%]. In upper limb injuries pattern was as follows; 01[2%] mid palmer amputation, 02[4%] two fingers amputation, and 04[8%] had soft tissue involvement of hand. Infection rate was 22% in patients who did not have wound dressing by the primary physician while it was 10% in patients who had wound dressing by primary physician before presenting to this institution, the collective infection rate was 32%

Conclusion: Conservative wound debridement, early skin coverage, preserving maximum soft tissues and bone results in functionally and cosmetically better limb in blast injuries

Short term outcome of clubfoot correction by Ponseti method

Background: Congenital Talipes Equino Varus [CTEV] is a common complex congenital deformity of the foot. Treatment still continues to challenge the skills of the pediatric orthopedic surgeon as it has a notorious tendency to relapse, irrespective of whether the foot is treated by conservative or operative means

Objective: To evaluate the short term outcome of Ponseti method of serial manipulation and casting in Congenital Talipes Equino Varus [CTEV] in children up to 6 months of age

Methodology: A descriptive case series study was carried from 16[th] February to 15[th] August 2012 in the department of orthopaedic surgery, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. A total of 200 feet were included in this study. The first cast application corrects the cavus deformity by aligning the forefoot with the hind foot, supinating the forefoot to bring it in line with the heel, and elevating the first metatarsal. One week after application, the first cast was removed, and after about 2-3 minutes of manipulation, the next toe-to-groin cast was applied. Manipulation and casting continued weekly for the next 5 to 6 weeks

Results: Mean age of patients was 3.9 +/- 1.7 months. Ninety one patients [62.3%] were male while remaining 55 patients [37.7%] were female. Left foot deformity was seen in 48 [33%] patients, right foot deformity was found in 34 [23%] patients and 64 [44%] patients were suffering from bilateral deformity. Percutaneous tenotomy of Tendo-Achilles was performed in 167 patients [83.5%]. Out of 200 feet, correction was achieved in 177 feet [88.5%] with zero Pirani score

Conclusion: Ponseti's method is simple, easy to learn, effective and reproducible method for correction of Congenital Talipes Equino Varus [CTEV] deformity in children

Antioxidant and nutraceutical value of wild medicinal Rubus berries

Nutritional quality and antioxidant capacity of three edible wild berries [Rubus ellipticus Smith, Rubus niveus Thunb, Rubus ulmifolius L.] from Lesser Himalayan Range [LHR] were evaluated. Their edible portion was assayed for moisture, fats, ash, carbohydrates, proteins, fibers, essential minerals [Ca, P, Mg, K, Na, Cl, S, Mn, Zn, Fe, Cu, Se, Co, Ni] and DPPH free radical scavenging activity was applied to determine the antioxidant potential. The fruit of Rubus ulmifolius L. [blackberry] possessed the highest values of energy [403.29 Kcal], total protein [6.56g/100 g], Nitrogen [N] content [1500mg/100g], K [860.17mg/100g], Ca [620.56mg/100g], Zn [17.509mg/100g] and the strongest antioxidant activity [98.89% inhibition]. While the raspberries [Rubus ellipticus Smith, Rubus niveus Thunb.] exhibited more significant contents of dietary fiber [5.90g/100g], carbohydrates [86.4 g/100 g] and Fe [4.249mg/100g]. Significant variation was observed among the tested samples in all the investigated features. The combination of bio elements and active antioxidants clearly showed the applicability of these berries as a nutraceutical supplement

Outcome of surgical treatment of de-quervains disease

Background: De Quervains disease causes significant pain among patients

Objective: The purpose of this study was to evaluate the outcome of surgical treatment of de-Quervains disease

Material and Method: This cross-sectional study was conducted in Sheikh Zayed Medical College/Hospital Rahim Yar Khan from 1[st] January, 2009 to 31[st] December 2011. Patients with de Quervains disease who did not respond to conservative treatment with analgesics, splintage and local steroid injections for four to six months, were operated under local anesthesia. The tendons of abductor pollicis longus and extensor pollicis brevis were released in separate compartments. Patients were followed for a minimum of 4 months to assess the outcome of procedure. The data was analyzed by using SPSS version 15

Results: A total of 20 patients were included in study.Female to male ratio was 8:1. All females were house wives, exposed to manual work, four of them had rheumatoid arthritis. The age range was 35-50 years with mean age of 39 years. Results of surgical treatment were excellent with 94% patients being completely relieved of symptoms

Conclusion: Surgical release of first dorsal compartment [abductor pollicis longus and extensor pollicis brevis] of wrist has excellent results in patients with resistant De-Quervains disease