Titanium elastic nail or external fixator in pediatric femoral diaphyseal fractures: complication rate

Objective: To compare complications rate of Titanium elastic nail with External fixator in pediatric femoral diaphyseal fractures

Study Design: Prospective randomized study

Place and Duration of Study: This study was carried out at the Orthopedic Department, Lahore General Hospital/PGMI, Lahore from 01.10.2013 to 01.10.2015

Materials and Methods: Complication rate was compared in two groups of children [20 each] of 5-11 years of age with closed or Gustilo type I open femoral diaphyseal fractures treated with Titanium elastic nailing and external fixator

Results: At final review, 3 patients in External fixator group developed superficial pin tract infection which resolved by oral antibiotics. 2 patients had a LLD [limb length discrepancy] of up to 1cm and 4 patients had mal alignment of 5-10 degree

While only one patient in Titanium elastic nail group developed pain and irritation at medial insertion point and another had mal alignment of 10 degree in AP plane. Overall there was decrease complication rate in Titanium elastic nail group

Conclusion: Titanium elastic nail is a better choice in children of 5-11 years of age with femoral diaphyseal fractures than External fixator

Perceived effects of undergraduate medical study on social life: a descriptive study at poonch Medical College in Rawlakot Azad Kashmir

This study explored how second year medical students of Poonch Medical College related studying in medical college with their social activities. Cross-sectional study. This study was conducted with the first batch of students at PMC in Rawlakot AJ and K from January 2013 to July 2014. This study obtained data in a purposive sample from the entire second year class using a structured self-administered questionnaire, with 88% response rate. Of total 88 respondents, 63 girls [72%] and 25 boys [28%] with a mean age of 19 participated. More than 80% respondents had many friends, 81% girls and 36% boys didn't have time to meet them [[p<.000]. Around 89% girls and 68% boys didn't have time to play [[p.029], 49% girls and 44% couldn't see their families [p<.197], 40% hostelite and non-hostelite could play [p<.991], and 76% boys and 65% girls perceived burdensome medical study which deprived them from regularly meeting with their family and friends. Findings of this study have broader implications for furnishing academic environment in medical institutions of Pakistan more conducive, supportive and effective. Medical instititionsshould review their curriculum and teachinglleaming schedules and try to redesign their educational programs keeping a balance between study load and the social life of a medical student. Students should also be encouraged to set their educational and social priorities and try to ensure this balance

Polydioxanone vs prolene closure for midline abdominal incisions: to compare postoperative wound dehiscence

The objective of this study was the comparison of Polydioxanone and Prolene for midline abdominal closure in terms of postoperative wound dehiscence. Randomized control trial. This study was conducted at Department of Surgery, Sheikh Khalifa Bin Zaid AlNahyan Hospital Rawlakot Azad Kashmir from 20-12-2012 to 25-12-2014. We studied 106 patients for midline closure of abdominal surgery. We made two groups [Group A consisted patients in whom abdominal closure was done with Polydioxanone no. 1 and Group Bcontained patients who underwent closure with Prolene no. 1. The outcome variablewas wound dehiscence. The average of age for 106 patients was 36.88 +/- 13.28 years. In group A, the wound dehiscence was seen in 4 [3.8%] patients while in group B it was seen in 12 [11.3%] patients. Wound dehiscence was considerably high in group B as compared to groups A, [p-value < 0.05]. Polydioxanone is a synthetic absorbable suture which retains its strength for longer than other absorbable materials. According to our experience Polydioxanone causes less wound dehiscence as compared to Prolene in midline abdominal wound closure

Frequency of recurrent laryngeal nerve palsy after thyroidectomy at sheikh khalifa bin zaid hospital rawlakot Azad Kashmir

The objective of the study was to determine the frequency of post thyroidectomy RLN palsy and to adopt measures to reduce the frequency of RLN palsy after thyroidectomy. Descriptive study. This study was carried out at General Surgery Department, Sheikh Khalifa Bin ZaidHospital Rawlakot Azad Kashmir from 16.11.2012 to 16.11.2014. Total of 80 patients of goiter undergoing thyroidectomy were admitted through outpatient department. All patients underwent thorough clinical examination and investigations. They were informed of th ebenefits and risks associated with surgery and written informed consent was obtained. All information was recorded on performa. Vocal cord status was assessed pre and postoperatively by indirect laryngoscopy. Size of thyroid gland was measured before operation in all the patients and weight of thyroid tissue removed during operation was also assessed. 03 patients were excluded from the study as they were already having hoarseness of voice. 29 were subjected to subtotal thyroidectomy, 30 to total thyroidectomy, and 21 to hemi-thyroidectomy randomly. All were followed up for RLN palsy for 03 months. According to our objective, no test of significance was applicable. However, descriptive statistics including mean, standard deviation was used by using Microsoft statistical package for social sciences [SPSS Version 10.]. The age range of the patients undergoing thyroidectomy was 20-68 years with an average age of 44. Total mortality rate was 0%. Transient hoarseness of voice was present in 01[1.2%] which improved spontaneously with time and permanent hoarseness in 0% patients. No patient was lost at any point. Frequency of RLN palsy can be reduced by careful identification of recurrent laryngeal nerve by various methods per-operatively

Effects of medical study on sports activities of medical students in Azad Kashmir

Objective: To determine the effects of medical study on sports activities of medical students

Study Duration: cross sectional study

Place and Duration of Study: This study was conducted at PMC in Rawlakot AJ and K from March 2013 5o March 2015

Materials and Methods: This study obtained data [88 persons] in a purposive sample from the entire second year class using a structured self-administered questionnaire, with 88% responserate

Results: Out of total 88 respondents, 63 girls [72%] and 25 boys [28%] with a mean age of 19 participated. More than 80% respondents had many friends, 81% girls and 36% boys didn't have time to meet them [p<.000]. Around 89% girls and 68% boys didn't have time to play [[p.029], 40% hostelite and non-hostelite could play [p<.991], and 76% boys and 65% girls perceived burdensome medical study which deprived them from regularly meeting their friendsand participating in theseactivities

Conclusion: Findings of this study have broader implications for furnishing academic environment in medical institutions of Pakistan more conducive, supportive and effective. Medical institutions should review their curriculum and teaching/learning schedules and try to redesign their educational programs keeping a balance between study load and sports activities of a medical student. Students should also be encouraged to set their priorities and try to ensure this balance

Postoperative wound infection after midline abdominal incisions

Objectives: The objective of this study was to compare postoperative wound infection rate after abdominal closure with Polydioxanone and prolene for midline incisions

Study Design: Randomized control trial

Place and Duration of Study: This study was conducted at the department of Surgery Sheikh Khalifa Bin Zaid Hospital Rawlakot Azad Kashmir from 09-05-2013 to 28-05-2015

Materials and Methods: Total of 106 patients undergoing elective and emergency laparotomies. In this randomized control trial conducted at Sheikh Khalifa Bin Zaid Al Nahyan Hospital Rawlakot Azad Kashmir Department Of Surgery, we studied 106 patients for midline closure of abdominal surgery. We made two groups [Group A consisted patients who underwent abdominal closure with Polydioxanone no. 1 and Group B contained patients who underwent closure with Prolene no.1]. The outcome variable waswound infection

Results: The average age of 106 patients was 36.88 +/- 13.28 years with range of 49 years. Statistically the post operative wound infection was present in 25 [23.6%] patients, in which 7 [6.6%] were from group A and 18 [18%] were from group B. The percentage of wound infection was statically higher in group B as compared to group A [p-value < 0.05]

Conclusion: Polydioxanone is inert in tissues if we compare it with other absorbable materials. According to our experience, Polydioxanone causes less wound infection as compared to Prolene in midline abdominal woundclosure

Impact of pneumoperitoneum on hepatic functions after laparoscopic cholecystectomy [LC]

To find out the alterations in hepatic functions after laparoscopic cholecystectomy and the possible mechanisms behind such effect. A prospective analytic study. The study was conducted in surgical unit-1; Allied Hospital Faisalabad, from January 1st, 2009 to June 30th, 2009. With approval from the institutional ethical committee and informed consent, as per inclusion and exclusion criteria, 100 patients for laparoscopic cholecystectomy were included in the study. The blood samples of the patients were collected to test liver enzymes; bilirubin, alanine aminotransferase [ALT] aspartate aminotransferase [AST] and alkaline phosphatase [ALP] once preoperatively and then on 2nd and 10th post operative days. The preoperative values were compared with that of postoperative values. During LC intraabdominal pressure for pneumoperitoneum was maintained at 14 mmHg of CO2 and the duration of CO2 insufflation was measured. Forty eight hours after LC, levels of ALT, AST and bilirubin were found to be increased [ALT: 51.11 U/L, P<0.001; AST: 53.79 U/L, p < 0.001 and Bilirubin: 1.38mg/dl P < 0.001 which were statistically significant. Moreover, these hepatic enzymes were significantly increased in patients who had longer durations of CO2 insufflations. The changes in alkaline phosphatase measurements were found to be non significant. The levels of hepatic functions returned to normal or near normal values in samples of 10th post operative day. Transient alterations in hepatic functions are frequently observed after uneventful laparoscopic cholecystectomy, which clinically appear to be insignificant. CO2 Pneumoperitoneum seems to be the main reason for theses changes but other factors may also contribute

Incisional hernia repair by preperitoneal [sublay] mesh implantation

Incisional Hernia is a common surgical condition with a reported incidence of 2-11% following all laparatomies. Results of tissue repair have been disappointing. The optimal approach for abdominal incisional hernias is still under discussion. To evaluate the technique of preperitoneal [sublay] mesh repair of incisional hernias. This retrospective study of consecutive 50 cases was done from January .2004 to January 2006 using a computerized database. Preperitoneal [sublay] mesh implantation was done in all the 50 cases. Follow up of 12-24 months was carried in the OPD and on telephone with regards to postoperative complications, hospital stay and recurrences if any. In our study of fifty patients, eighty percent of females [n= 40] outnumbered twenty percent males [n=10]. The female to male ratio was 4: 1 and the highest incidence was in the 5th decade of life. The main presenting feature was swelling of the abdomen in all the fifty patients [100%] in the vicinity of the previous operative scar. In sixty percent of patients [n=30], the most common incision leading to incisional hernia was the midline incision of abdomen followed by Pfannensteil's incision in fourteen percent [n=7] and paramedian incision in twelve [n=6]. Major wound infection occurred in two patients [4%] only but without the removal of mesh. Forty patients [80%] attended for follow up ranging from 12 months to 24 months. Twenty seven patients [67.5%] attended OPD for follow up and thirteen patients [32.5%] replied the questions on phone. No recurrence was noted in follow up group. Based on this study, we conclude that preperitoneal [sublay] mesh repair is the ideal technique for incisional hernia. Though still there are few publications regarding this technique of repair