Seasonal Influence on Postoperative Complications after Total Knee Arthroplasty

PURPOSE: This study is aimed at investigating whether inpatient complications and surgical site infections (SSIs) occurred more commonly in patients undergoing total knee arthroplasty (TKA) during the summer season. MATERIALS AND METHODS: A total of 725 patients who underwent unilateral or bilateral TKA were included in this study. A total of 241 patients (33.2%) underwent TKA between May and August. Our outcomes of interest were the incidence of postoperative complications and length of stay. RESULTS: May–August surgeries were associated with a higher risk of postoperative inpatient complications (p=0.003). May–August surgeries (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18 to 3.85), postoperative transfusion (OR, 2.46; 95% CI, 1.43 to 4.26), postoperative special care unit stay (OR, 4.68; 95% CI, 1.99 to 11.0) and chronic kidney disease (OR, 3.27; 95% CI, 1.15 to 9.28) were associated with a higher odds of developing inpatient complications. No association was present between summer surgeries and SSIs (p=0.486). CONCLUSIONS: The results of this study show that overall complication rates following TKA exhibit a seasonal trend, with a peak during the summer months. These results may have some implication in clinical practice and stricter approaches to hospital guidelines during the summer months.

Comparison of Haemodynamic effect of equivalent dose of Oxytocin given as Bolus and in Fusion

Objective:To compare the haemodynamic effects of equivalent dose of oxytocin given as an intravenous bolus and as infusion

Study Design: Randomized controlled trial

Place and Duration of Study: CMH Rawalpindi from Jan 2016 to Jul 2016

Material and Methods: This randomized control trial was conducted after approval of ethical committee of the hospital and a total 90 patients, American society of anesthesiologists physical status I or II, were included in this study. Patients were divided into two groups [n=45], group-A received oxytocin [5 IU] approximately over 10 seconds as an intravenous bolus and group-B received [5 IU] over 5 minutes as an infusion in infusion pump. Mean heart rate and mean blood pressure recorded at Baseline 0, 1, 5, 10 and 15 minutes. The hemodynamic data was compared between the groups

Results: The Oxytocin when administered as an intravenous infusion showed statistically significant effects on heart rate when compared with bolus group from 1 minute to 15 minute [p<0.001]. Similarly, oxytocin once administered as an intravenous infusion showed statistically significant difference in mean arterial pressure [MAP] when compared with bolus group from 1 minute to 15 minute [p<0.001]

Conclusion:It is concluded that oxytocin [5IU] once administered as an infusion during elective caesarean section causes less haemodynamic changes

Guidelines on the use of acitretin in Pakistan

Actretin is a second generation retinoid which is commonly used in psoriasis and many other disorders of keratinization. The present review focuses on its uses, side effects and monitoring in the local perspective.

Comparison of methotrexate and azathioprine in the treatment of psoriasis: a randomized controlled trial

Treatment of psoriasis requires a safe and effective drug which can be used on long term basis. Azathioprine is one such agent which was used in the past but has not been tested recently. A randomized controlled trial was conducted at dermatology department, Combined Military Hospital, Kharian, to compare the efficacy and safety of azathioprine with that of methotrexate in patients with severe psoriasis requiring systemic therapy. Patients included in the study were randomized into two groups. Group A received tablet methotrexate 10 mg weekly for 8 weeks. Group B patients received tablet azathioprine in a dose of 1.5-3 mg/kg/day. In all the adult patients who were weighing more than 50 kg azathioprine was started at a dose of 50 mg tablet thrice daily for 8 weeks. PASI score was assessed at the start and end of treatment. Scores were compared in the two groups before and after and statistically analyzed using paired and independent sample t test. 50 patients entered the study. Results were stratified into excellent, good, and poor response, based on improvement in PASI scores. Excellent response was seen in 73% patients in group A and 27% patients in group B [p<0.5]. Good response was seen in 45% patients in group A and 55% patients in group B [p>0.5]. Poor response was seen in one patient in each group [p>0.5, paired sample t test]. Azathioprine is less effective in systemic treatment of psoriasis. Nevertheless it can be a useful alternative in selected patients

Pit falls in stroke rehabilitation: a Pakistani perspective

To identify short comings in the stroke rehabilitation referral and consultation in Pakistan. Observational study. Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi from March 2005 to September 2005. 171 patients of stroke fulfilling the inclusion criteria were enrolled in the study. Detailed history was obtained and a thorough examination with emphasis on neurological and musculoskeletal system was performed. Medical records and radiological investigations were reviewed. There were 132 [77.2%] males and 39 [22.8%] female patients. Radiological investigations were not available in some patients. In the remaining patients the frequency of Ischemic vs Hemorrhagic was 82% and 18% respectively .Involvement of right and left cerebral hemisphere was almost equal with 53% and 47% respectively. Majority, i.e 153 [89.5%] of the patients were referred as OPD cases while indoor rehabilitation consultation was made only for 18 [10.5%] patients. Only 04 [2.3%] patients were seen within 48 hours of stroke onset. In 39 [22.8%] cases consultation was made between one week to one month and for 116 [67.8%] between one to six months, while it was delayed beyond six months in 12 [7%] patients. Important shortcomings identified were non availability of physicians in rehabilitation medicine, late/ no referrals, inadequate referrals, long term placement of indwelling catheters and lack of patient and family education. Stroke is an important cause of long-term disability. Timely and comprehensive stroke rehabilitation minimizes the impairments and leads to successful reintegration of individual into the society. It is a poorly understood concept in Pakistan. Physicians are either not aware of the concept and significance of stroke rehabilitation or often confuse it with physiotherapy alone. There is a need to improve the stroke rehabilitation services in the country