Thoracic impalement injury: A survivor with large metallic object in-situ / 中华创伤杂志(英文版)

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

Postgraduate medical trainees' understanding of biostatistics: a pre- and post-research methodology workshop experience

Objective: To evaluate understanding of biostatistics among postgraduate medical trainees before and after biostatistics workshop

Study Design: Quasi experimental study

Place and Duration of Study: Regional Centre, Islamabad, College of Physicians and Surgeons Pakistan, from March to September 2017

Methodology: Two hundred and seventy postgraduate trainees were enrolled after taking informed consent. Structured questionnaire containing 21 multiple choice questions regarding understanding and application of biostatistics was given to all participants on the first and the last day of workshop and compared pre- and post-workshop by McNemar test of significance. SPSS version 21 was used for data analysis with p-value <0.05 as significant level

Results: The response rate was 100%. Among these participants, males were 81 [30%] and females were 189 [70%], mean age was 28.5 +/- 2.5 years. One hundred and twenty-five [46%] postgraduate trainees were from Islamabad. Most of the doctors were in the first year [37%] and second year [57%] of their training. With total correct answers of 42.9% [preworkshop] and 57% [post-workshop], p-value was <0.001

Conclusion: Understanding regarding application of biostatistics in research among PGTs improved significantly and immediately after teaching biostatistics in research methodology workshop

Role of non coaxial bone marrow biopsy needle and bone biopsy needle in CT guided core needle biopsies

Objective: to compare bone marrow biopsy needle [BMBN] with bone biopsy needle [BBN] in CT guided core biopsies considering size of core, diagnostic yield and cost of needles

Methodology: retrospective study was done on 50 out of 68 patients referred to Interventional Radiology department for CT guided bone biopsy from 2008 till 2013. Grading of specimen length was done as small, medium and large. Diagnostic yield was determined on basis of clinical, imaging and histopathology data. Local cost of both needle types was determined. Comparison was made and statistical analysis was performed

Results: biopsy was performed by BBN in 16 patients and by BMBN in 34 patients. Overall diagnostic yield of bone biopsies was 82% [41 of 50 biopsies]. Diagnostic yield with BMBN was 85% and with BBN was 75%. Overall longer specimen length was obtained using BMBN. Statistically, there was no significant difference between them in diagnostic yield and specimen length; however, BMBN costs almost one half than BBN

Conclusion: diagnostic yield and sample length using bone marrow biopsy needle proved to be equivalent to bone biopsy needle. Bone marrow biopsy needle has an added benefit of being low in cost. Despite being a non-coaxial technique these needles can achieve diagnostic yield comparable to that of coaxial techniques as reported in past literature

Asthma control among asthmatic patients: a single center study

Background: Asthma, when uncontrolled is a crippling condition and due to increasing allergens, the patients are increasing in number worldwide

Objective: To determine the level of asthma control in southern Punjab and impact of education level, habitat and gender on it

Subjects and Methods: This cross sectional study was conducted in the outpatient consultant's clinic, Bahawal Victoria Hospital, Bahawalpur, from 1[st] February to 30[th] September, 2011. All the patients diagnosed as having asthma by the physicians, were interviewed about the control of asthma. The data was collected on a questionnaire that included questions on the level of control of asthma and other related variables. Data was entered and analyzed by SPSS version 10

Results: A total of 768 patients were included in study, out of which 75% were having poorly controlled asthma. There were 224 [29.2%] females and 544 [70.8%] males. Fifty percent patients were of young age group. Middle age and elderly were 37% and 12% each. In the patients of urban area 61.53% were educated while from rural area 38.46% were educated. Among poorly controlled asthma group 320 [55%] were from rural area and 256 [44%] from urban area. In poorly controlled group 32 [5.55%] were on no treatment. Hundred percent of partially controlled and well controlled were having physician prescriptions. In well controlled group 64 [66.66%] were young. In poorly controlled group 288 [50%] were young. In well controlled group 100% were educated while in poorly controlled group 288 [50%] were uneducated. In poorly controlled group 32 [5.55%] were on no treatment while 544 [94.44%] were on some medications with prescription. In fully controlled group 100% patients had prescription

Conclusion: Asthma control is mostly poor in rural areas of Southern Punjab and almost half of the patients are uneducated, and young

End treatment response with pegylated interferon among chronic Hepatitis C non-responders

To determine the frequency of end treatment virologic response [ETR] with pegylated interferon alpha and ribavirin in treatment of chronic hepatitis C patients who failed to respond to interferon plus ribavirin therapy given for at least 24 weeks. Descriptive study. Medical Unit-II, Benazir Bhutto Hospital, Shafi clinic Rawalpindi and PAEC Hospital Islamabad, Pakistan, from July 2208 to June 2009. Patients with hepatitis C who were non-responders to previous treatment with standard interferon and ribavirin, were given Pegylated Interferon alpha plus ribavirin. Total duration of treatment was 24 weeks for genotypes 2 and 3 and 48 weeks for genotypes 1 and 4. The primary end point was undetectable HCV RNA by polymerase chain reaction assay at the completion of therapy. Out of the 44 enrolled patients, 24 [54.5%] were males and 20 [45.5%] were females. Mean age of patients was 45.25 +/- 7.14 years. HCV genotypes were 3 in 64%, 2 in 30% and 7% each had genotypes 1 and 4. Both the early virological response and end of treatment response was seen in 75% patients. There was a high ETR rate of 75 in previous non-responders to conventional combination therapy. This high ETR as compared to international data is because of existence of favourable genotypes in our country which is encouraging in the treatment of non-responders

Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Survery. National Institute of Science and Technology, Islamabad, from June through August 2008. Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures

Complementary and alternative medicine: Attitude of medical community in Pakistan

To determine the awareness and use of Complementary and Alternative Medicine [CAM] among General Practitioners [GP's] and Medical students in Islamabad/ Rawalpindi area. In this descriptive study, a self-administered proforma with eight questions was distributed to randomly selected GP's in Islamabad and Rawalpindi area and final year medical students of Shifa college of medicine, Islamabad in 2005-2006. Responses of the participants were analyzed by computer software SPSS version 10. Up to 71% GP's and medical students claim to have self knowledge about CAM. Less than 31% had any formal education [workshop or seminar] about CAM. Less than 45% claim to have used it personally or refer patients for CAM therapy. More than 80% take history from patients about CAM use and about 50% had noted significant side effects of CAM. More than 50% GP's and students think that homeopathy, herbal medicine and acupuncture are effective way of treatment and recommend strongly to include those at National level. Knowledge of GP's and final year medical students about CAM is predominantly based on self-learning without any formal education on this subject. Practice of CAM is quite similar in terms of personal use, patient referral, patient history taking and witnessing of side effects in both groups

Intraction studies of omeprazole with mefloquine, pyrimethamine and sulfadoxine

Mefloquine hydrochloride, pyrimethamine and sulfadoxine as readily tolerated antimalarial drugs that are highly active against both usual and multidrug resistant strains of Plasmodium falciparum. Omeprazole reduce gastric acid secretion, irreversibly by inhibition of H +/- K+ ATPase of the apical membrane of the parietal cell. In order to study the drug interactions of the later with antimalarials, in vitro availability of omeprazole has been studied in presence of mefloquine hydrochloride, pyrimethamine and sulfadoxine. The availability of antimalarial drugs was found to be influenced considerably in presence of omeprazole. The effect of dissolution mediums, simulating various body environments with respect to pH and the influence of temperature on these interactions has been examined in order to elucidate the mechanism of these interactions