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

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

Primary osteosarcoma distal femur; incidence of pulmonary metastasis detected at the time of diagnosis

This study was designed to estimate the incidence rate of pulmonary metastasis at the time of diagnosis of primary osteosarcoma distal femur in a tertiary care hospital. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from March 2011 to September 2012. Nine patients of primary osteosarcoma distal femur were assessed with CT chest for pulmonary metastasis. The frequency and patterns of pulmonary metastasis on CT chest were documented. After the biopsy reports all patients were referred for neo adjuvant chemotherapy before any definite surgical procedure. The histological types of osteosarcoma were noted. Nine patients including 7 male [77.7%] and 2 females [22.2%] with mean age 12.4 years were included in our study. 66.6% [n=6, 5 males, 1 female] had pulmonary metastasis on CT chest at initial presentation while 33% [n=3,2 males,1 female] had no pulmonary metastases on CT chest. Three [50%] patients had pulmonary metastasis in the right lung, 1[16.6%] had on left side while 2[33.3%] had bilateral pulmonary involvement. Of the cases with metastases at diagnosis, 55.5% had osteoblastic histology of osteosarcoma compared with 33.3% of those with non metastatic disease. Majority of osteosarcoma distal femur presented with pulmonary metastasis at initial presentation. A high index of suspicion accompanied by careful examination of the limb and appropriate radiographs at initial assessment may reduce the incidence of such delays in diagnosis and the associated risks

Determine the prevalence and pattern of killings in Quetta, Balochistan

Homicide is defined as Human life slaughter of a human being by the conduct of another human being. This study was conducted to determine the pattern of killing in Quetta. Observational study. All medico-legal autopsy reports conducted in Civil Hospital Quetta, by Department of Forensic Medicine, Bolan Medical College, Quetta, from 1[st] January, 2009 to 31[st] December, 2010 and police in quest reports of the respective cases were studied. All police inquest reports of the respective medico-legal autopsies were also made part of this study. Preformed were used to record Medico-legal case number, date, day and time of arrival of dead body and autopsy, brought by police or relatives cause of death, type of weapon used, type and site of injuries, place of occurrence, mode, manner and cause of death. A total of 200 cases of medico-legal autopsies were studied, out of which 113 were declared as homicidal deaths. The most common weapons used for homicide were Automatic firearm weapons. The most affected age group was 31 to 40 years followed by 21 to 30 years and 11 to 20 years. The cases of homicide in district Quetta are mostly by firearm weapons. Male are affected more than females. The most common age group affected is 31 to 40 years

Chronic osteomyelitis; microbiology of long bones in a tertiary care hospital

To determine the causative organism of long bone chronic osteomylitis through culture of the sequestrum. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from September 2011 to April 2012. Twenty five patients with radiologically proven chronic osteomyelitis of long bones who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot, decubitus ulcers, and infected implant. At least one specimen of sequestrum was taken from each individual and subjected to complete microbiologic analysis. Staphylococcus aureus was the most frequently found organism [n=11, 44%], followed by Enterobacteriaceae [n=5, 20%], coagulase-negative staphylococci [n=3,12%] Escherichia coli [n=2, 8%] P aeruginosa [n=1, 4%], Streptococcus species [n=1, 4%] and no growth [n=2, 8%].More than one microorganism was isolated in two [8%] patients. Staphylococcus aureus was the most common organism isolated. Sequestrum culture provides accurate identification of causative bacteria

Incidence of deaths due to gunshot injuries at district Barkhan, Balochistan

Objective: to determine the incidence of deaths due to gunshot injuries in the District Barkhan, Balochistan

Study design: a retrospective study

Place and duration: district Head Quarter Hospital Barkhan, Balouchistan from January 2007 to December 2010

Method: case records of deaths were selected on the basis of history of fire arm injury, cloth examination and general physical examination of the dead body. The injuries were numbered, chartered and their size, shape and exact site of gunshot injury and its diagnostic characteristic were noted

Results: the total number of patients was 268; 264 [98.51%] males and 4 [1.49%] females. The most common age group of victims was 31 to 40 years [166, 61.94%]. Most common time for gunshot crimes were at morning [114, 42.54%]. Among all the cases 97.1% were due to old hostility, homicidal 2.24% were accidental and only 0.75% was suicidal. The most common site of bullets' entry was chest and abdomen 56%. Automatic guns [AK47] were most frequently used i.e. in 254 [95%] cases

Conclusion: males of young age are very frequently assaulted by automatic weapons, most of the time due to long-term hostility. Chest and abdomen most frequently sustained bullets as compared to other parts of the body

Awareness and practice of thromboprophylaxis among surgeons in tertiary care hospitals of Khyber Pukhtunkhwa

To find out the awareness and practice of thromboprophylaxis among surgeons working in teaching hospitals of Khyber Pakhtunkhwa. This was a descriptive study carried out in Hayatabad Medical Complex, Khyber Teaching Hospital, Lady Reading Hospital Peshawar and Ayub Teaching Hospital Abbottabad. Consultants from General and Orthopaedic surgery in four teaching hospitals working as senior registrar or above grades were included in the study and were interviewed using proforma about use of thromboprophylaxis. The results were analysed using SPSS version 10.0. A total of 48 consultants participated in this study. 20 of these were orthopaedic surgeons and 28 were general surgeons. Thirty two [66.6%] of the consultants were using thromboprophylaxis but out of these, only 7 [22%] were following the national guide lines. Out of the 16 [33.4%] who were not using thromboprophylaxis, 10 [62.5%] consultants had the impression that it is not necessary while 4 [25%] thought that it increased the risk of bleeding and 2 [12.5%] consultants had the impression that it is expensive. Eight [16.7%] consultants said that they have departmental policy for thromboprophylaxis. Although majority of surgeons were using throboprophylaxis, however few were well versed about the guidelines and very few were following these

Clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]

To evaluate the clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]. Hospital base perspective and retrospective study. This study was conducted in Department of Nephrology Sandeman, Provincial Hospital Quetta, from Nov. 2008 to Dec. 2010. In this study, 50 patients were taken with autosomal dominant polycystic kidney disease diagnosed by abdominal ultrasonography which were evaluated for their clinical spectrum by symptoms, clinical examination, ultrasonography, urine detailed report, urea, creatinine, 24 hours urinary creatinine and also evaluate for the extra-renal manifestation by abdominal utrasonography, gastrointestinal endoscopy and computed tomography [C.T Scan] of brain