rare late presentation of os-odontoideum with severe progressive myelopathy

Os odontoideum is a rare condition, first described in the 19th century. It is an independent ossicle of variable size separated from the hypoplastic dens. It is classified into two anatomic types, dystopic and orthotopic. The condition is commonly seen in males in their second and third decades, and may be found incidentally or manifests as cervical myelopathy. Descriptions of the causes, natural history, optimal management, and surgical interventions are limited and a subject of debate. We report a fifty-seven-year-old female who presented with features of severe progressive cervical myelopathy and severe neck pain, dizziness, and gait imbalance. Imaging revealed os odontoideum with myelomalacia. She underwent C1-C2 closed reduction and posterior fusion using Goel and Harms technique. Symptomatic improvement in terms of pain and balance was observed postoperatively and during follow-up

Use of postoperative antibiotics in elective soft tissue hand surgeries

Objective: To evaluate prophylactic postoperative antibiotic use in elective soft tissue hand surgeries

Design: A Retrospective Cohort Study

Setting: King Haniad University Hospital, Bahrain

Method: Retrospective review of 309 patients undergoing elective soft tissue hand surgery from 2012 to 2015. One hundred fifty-nine [51.5%] of these patients received postoperative prophylactic antibiotics while 150 [48.5%] did not. The records were reviewed for the type of procedure performed, comorbidities, use of postoperative antibiotics, outpatient visits and associated complications

Result: One hundred fifty-nine [51.5%] patients [group I] received postoperative prophylactic antibiotics and 150 [48.5%] did not [group II]. Four [1.3%] patients had infection [3 from group I and 1 from group II]. One [0.3%] patient had deep surgical site infections and 2 [0.6%] patients had superficial surgical site infections, all received postoperative antibiotics. The P-Value obtained was 0.63

Conclusion: Our study failed to demonstrate a benefit of prescribing prophylactic postoperative antibiotics to patients undergoing elective soft tissue hand surgery. Unwarranted antibiotic administration may pose harm to the patient as gastrointestinal side effects, allergic reactions and/or antimicrobial resistance

Chloroquine resistant malaria in neonates

To analyze the clinical presentation, treatment given, and outcome of patients suffering from congenital and acquired malaria in neonatal period. Analytical study. Paediatrics Ward-2, QAMC/BVH, Bahawalpur for 02 years from October 2001 to October 2003. The study included 45 cases of neonatal malaria. Thirty cases of malaria, admitted during first ten days of life, diagnosed as congenital malaria, were kept in group A, while 15 cases admitted in the ward from the age of 11 to 28 days, labeled as acquired malaria, were named group B. The clinical features at the time of presentation were noted in each group from the charts having positive malarial parasite [M.P.] on thick and thin slides. The diagnosed cases were treated with the standard dose of chloroquine sulphate. Those patients who improved clinically as well as revealed no parasite on follow-up were labeled as chloroquine sensitive. On the other hand, patients showing poor clinical response with persistence of the parasites in the blood or initially disappearing but later again having a clinical disease with positive M.P. on follow-up, were labeled as chloroquine resistant. They were treated with quinine sulphate. Outcome was compared in both the groups regarding the pattern of chloroquine resistance and death/ survival. Data was collected on which Fischer's exact test of significance was performed to know the level of significance. P-value of < 0.05 was taken as statistically significant. Low birth weight, severe hemolytic anemia with history of fever in the mother were main features in group A while in group B fever, anaemia and history of blood transfusion were marked features. In group A 76.66% were caused by Plasmodium [P.] falciparum. While in group B 60% were caused by Plasmodium vivax. In group A 26.66% were chloroquine resistant while 33.65% were chloroquine resistant in group B. The mortality was 16.66% in group A and 13.33% in group B. Intrauterine growth retardation, hemolytic jaundice and history of fever in the mother in the last trimester of pregnancy in the congenital while fever, history of blood transfusion in the neonates in acquired malaria but pallor in both the groups, were important clinical features. Pattern of chloroquine resistance and mortality in both the groups was not statistically different