Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study

STUDY DESIGN: Researchers created a proper type II dens fracture (DF) and quantified a novel current posterior fixation technique with spacers at C1–C2. A clinical case study supplements this biomechanical analysis. PURPOSE: Researchers explored their hypothesis that spacers combined with posterior instrumentation (PI) reduce range of motion significantly, possibly leading to better fusion outcomes. OVERVIEW OF LITERATURE: Literature shows that the atlantoaxial joint is unique in allowing segmental rotary motion, enabling head turning. With no intervertebral discs at these joints, multiple ligaments bind the axis to the skull base and to the atlas; an intact odontoid (dens) enhances stability. The most common traumatic injury at these strong ligaments is a type II odontoid fracture. METHODS: Each of seven specimens (C0–C3) was tested on a custom-built six-degrees-of-freedom spine simulator with constructs of intact state, type II DF, C1–C2 PI, PI with joint capsulotomy (PIJC), PI with spacers (PIS) at C1–C2, and spacers alone (SA). A bending moment of 2.0 Nm (1.5°/sec) was applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). One-way analysis of variance with repeated measures was performed. RESULTS: DF increased motion to 320%, 429%, and 120% versus intact (FE, LB, and AR, respectively). PI significantly reduced motion to 41%, 21%, and 8%. PIJC showed negligible changes from PI. PIS reduced motion to 16%, 14%, and 3%. SA decreased motion to 64%, 24%, and 54%. Reduced motion facilitated solid fusion in an 89-year-old female patient within 1 year. CONCLUSIONS: Type II odontoid fractures can lead to acute or chronic instability. Current fixation techniques use C1–C2 PI or an anterior dens screw. Addition of spacers alongside PI led to increased biomechanical rigidity over intact motion and may offer an alternative to established surgical fixation techniques.

Evaluation of Two Novel Integrated Stand-Alone Spacer Designs Compared with Anterior and Anterior-Posterior Single-Level Lumbar Fusion Techniques: An In Vitro Biomechanical Investigation

STUDY DESIGN: In vitro biomechanical investigation. PURPOSE: To compare the biomechanics of integrated three-screw and four-screw anterior interbody spacer devices and traditional techniques for treatment of degenerative disc disease. OVERVIEW OF LITERATURE: Biomechanical literature describes investigations of operative techniques and integrated devices with four dual-stacked, diverging interbody screws; four alternating, converging screws through a polyether-ether-ketone (PEEK) spacer; and four converging screws threaded within the PEEK spacer. Conflicting reports on the stability of stand-alone devices and the influence of device design on biomechanics warrant investigation. METHODS: Fourteen cadaveric lumbar spines were divided randomly into two equal groups (n=7). Each spine was tested intact, after discectomy (injured), and with PEEK interbody spacer alone (S), anterior lumbar plate and spacer (AP+S), bilateral pedicle screws and spacer (BPS+S), circumferential fixation with spacer and anterior lumbar plate supplemented with BPS, and three-screw (SA3s) or four-screw (SA4s) integrated spacers. Constructs were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Researchers performed one-way analysis of variance and independent t-testing (p≤0.05). RESULTS: Instrumented constructs showed significantly decreased motion compared with intact except the spacer-alone construct in FE and AR (p≤0.05). SA3s showed significantly decreased range of motion (ROM) compared with AP+S in LB (p≤0.05) and comparable ROM in FE and AR. The three-screw design increased stability in FE and LB with no significant differences between integrated spacers or between integrated spacers and BPS+S in all loading modes. CONCLUSIONS: Integrated spacers provided fixation statistically equivalent to traditional techniques. Comparison of three-screw and four-screw integrated anterior lumbar interbody fusion spacers revealed no significant differences, but the longer, larger-diameter interbody spacer with three-screw design increased stabilization in FE and LB; the diverging four-screw design showed marginal improvement during AR.

Current trends in treatment of hypertension in Karachi and cost minimization possibilities

This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science [SPSS]. Financial impact was also analyzed. On the basis of patients' doctors1 feedback, Beta Blockers,and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective.This trend increases cost by two to ten times. Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines

Tetanus; still cannot be prevented, a three year retrospective study in DHQ hospital, Faisalabad

Tetanus still remains a major public health problem in Pakistan like in most other developing countries, with a high morbidity and mortality. To study the demographic profile the clinical profile, the outcome of the tetanus patients and effectiveness of tetanus immunization coverage in district Faisalabad. Retrospective record based study. Surgical unit-5 DHQ Hospital, Faisalabad from January 2010 to December 2012. All data of 198 patients of tetanus of any age and sex, diagnosed clinically was collected, compiled and analyzed from the Medical Records Department of the Hospital. Out of 198 patients of tetanus,138[69.7%] were males and 60[30.3%] were females. Their ages ranged from 1 to 85 years with a mean and a standard deviation respectively of 29.36 and 17.48 years.162 [81.8%] were from rural and36[18.2%] were from urban areas. 47[23.7%] patients were having prior immunization and151[76.3%] were not immunized. The most common presenting symptoms were trismus [47.5%], body stiffness [24.2%],fits[19.2%] and respiratory distress[9.1%]. 23[11.6%] patients were having mild disease,71[35.9%] patients were having moderate disease,71[35.9%] patients were having severe disease and 33[16.7%] were having very severe disease. Overall mortality rate was 41.4%. Respiratory failure was the most common cause of death and there was statistically significant association between mortality and increasing grades of disease. By making expanded programme of immunization [EPI] more effective and removing flaws from out-dated vaccination through incomplete vaccination. By improving awareness in public and complete vaccination through EPI program, we can reduce the incidence of tetanus

Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit

To reduce ventilator associated pneumonia [VAP] incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate. This study was a prospective longitudinal study conducted on adult intensive care unit [ICU] patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied: head-of-bed elevation; daily "sedation-vacation" along with a readiness-to-wean assessment; peptic ulcer disease [PUD] prophylaxis; and deep venous thrombosis [DVT] prophylaxis. Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance [p=0.001]. Most frequent pathogens found were Pseudomonas aeruginosa [30.8% of all isolates] followed by Acinetobacter baumannii [27.7%], and methicillin-resistant Staphylococcus aureus [15.4%]. Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care

Hand hygiene compliance rate among healthcare professionals

To motivate healthcare professionals, with a focus on improving hand hygiene compliance. An observational, prospective, longitudinal study was conducted on the evaluation of hand hygiene compliance at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from May 2009 to May 2010. Four components to improve hand hygiene compliance were implied; daily audit, monthly staff education; quarterly workshops of hand hygiene, and education material distribution. The compliance rate was calculated by its adherence with number of opportunities. Of total 163 healthcare professionals were surveyed for hand hygiene compliance; 57 [35%] were doctors, 92 [56.4%] nurses, and 14 [8.6%] patient care technicians. The overall compliance rate was 50.3%, and its distribution among staff was as follows; doctors 49.1%, nurses 52.2%, and technicians 42.8%. The highest compliance rate among doctors and nurses was found in surgical units. A low compliance in high intensity patient care area was observed such as in the Emergency Room and out patient department. The patient care technicians showed highly variable results, as their compliance rate was 100% in medical units while 0% in various other clinical areas. The overall hand hygiene compliance rate of healthcare professionals reached 50% after a long education campaign, and was highest among the nurses. Further study is needed to explore the reasons for non-compliance

Lung deposition predictions of airborne particles and the emergence of contemporary diseases Part-I

Inhaled particles can cause a variety of pulmonary illnesses such as asthma, bronchitis, chronic obstructive pulmonary diseases [COPD] and even secondary organismic diseases. Thus, predictions of inhaled aerosol deposition in the respiratory tract are essential not only to assess their possible consequences but also to optimize drug delivery using pharmaceutical aerosols. Deposition of inhaled aerosols is a complex phenomenon that depends on the physico-chemical properties of the particles, lung anatomy, and respiratory patterns of the subject. Hence, the prediction of particle deposition for an individual person poses real challenges. Different conceptual particle deposition models are employed for the estimation of deposition fraction in different region of the lung. However, these deposition fractions vary with the above mentioned parameters in addition to the modeling and computational technique. Part-I of this review article briefly describes the deposition behaviour of inhaled particulate matter and the currently available approaches for the prediction of aerosol deposition in the respiratory tract. Part-II continues this thread and provides a broad view of the health-related issues of particle exposure

Lung deposition predictions of airborne particles and the emergence of contemporary diseases - Part II

Mankind has been exposed to airborne nanosized particles [<100 nm] for eons, yet mechanization and industrialization of societies has increased the overall load to which humans are exposed to. Ultrafine-particles [below 1 µm in diameter] can thus be incorporated via any organic surface structure and in particular when the area available is large enough – as is the case with the skin [approx. 1.5-2 m2], the digestive tract [intestinal villi, approx. 200 m2] or the lungs [approx. 140 m2]. Since aerosolised particles are readily inhaled rather than ingested, th lungs represent an ideal gateway with high penetration efficiency rates. If seen from a toxicological rather than from a therapeutic point of view, deposited xenobiotic particles that interact with biological tissues do so first on a cellular level where they are readily translocated into the cell to interfere with metabolic pathways and eventually induce inflammatory cellular responses. At an organismic level and in response to long-term exposure, these particles become redistributed via the lymphatic or the blood circulatory system to reach sensitive organs or tissues such as the central nervous system, bone marrow, lymph nodes, spleen, and heart. At this organismic level, the persistent particle exposure may trigger or even modulate the severity of chronic diseases

morphological study of common carotid arteries in atherosclerosis

Objective: to review the pattern of atherosclerosis in common carotid arteries

Material and Methods: the pattern of atherosclerotic lesions was studied in common carotid arteries in 30 human autopsy cases, This study was conducted in the mortuary of King Edward Medical College, Lahore. Both the right and left carotids of all 30 cadavers were opened and reviewed both grossly and microscopically

Results: the fatty streaks were present in 10 cases in the right common carotid artery and 10 cases in the left common carotid artery. The fibro lipid plaques were seen in 9 cases in the right common carotid artery and 9 cases in the left common carotid artery. The complicated lesions were present in 5 cases in the right common carotid artery and 6 cases in the left common carotid artery. In the right common carotid artery 4 cases showed ulceration and one case showed intimal vascularization and haemorrhage along with thrombus formation. In the left common carotid artery 4 cases showed ulceration and 2 showed intimal vascularization and haemorrhage along with thrombus formation. The calcified lesions were seen in 4 cases in the right common carotid artery and 5 cases in the left common carotid artery. The morphological changes in media and elastic were present in 6 cases in the right common carotid artery and 7 cases in left common carotid artery

Conclusion: this study shows that raised atherosclerotic lesions are reasonably common in our population and stresses the need to conduct larger studies to comment on the relationship with age and sex

Retinopathy: variable clinical spectrum and postendarterectomy changes

The Carotid Artery Insufficiency Retinopathy [CAIR] is an uncommon sign of carotid artery obstruction. It is mainly found in patients with complete occlusion or severe obstruction of Internal Carotid Artery [ICA]. Retinopathy is caused by progressive and chronic hypoxia to ocular tissues. The purpose of the study is to describe the variable presentation of CAIR in patients with internal carotid artery stenosis and to asses the resolution of retinopathy in patients who had carotid endarterectomy. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Patients' demographic data and way of presentation to ophthalmologist was recorded. Associated systemic vascular diseases were also recorded on the proforma. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Thirteen eyes of 10 patients were included in study with male to female ratio of 9:1. Patients' clinical presentation ranged from scattered blot haemorrhages to ocular ischemic syndrome. Patients presented with retinopathy at different stages. The presentation of retinopathy varied from scattered blot haemorrhages to ocular ischemic syndrome. Endarterectomy resolved CAIR in 2 out of 3 patients, with one patient having bilateral resolution. CAIR should be suspected if retinopathy is unilateral. On the other hand patients with asymptomatic Carotid artery stenosis should be examined for signs of ocular ischemia. All patients with CAIR should be investigated for cardiovascular diseases. Endarterectomy in selected patients can resolve CAIR

Outcome of anastomotic urethroplasty for stricture urethra

To evaluate the outcome of end-to-end urethroplasty for stricture urethra and need for ancillary procedures. Prospective, study was carried out in Department of Urology Allied Hospital Faisalabad from Oct, 2007 to April, 2010 to see the outcome for anastomotic urethroplasty in 40 patients. Simple perineal urethroplasty was done in 30 patients. Perineal urethroplasty with separation of corporal bodies was done in 06 patients and inferior pubectomy was required in 02 patients according to indication. Age, length of stricture and ancillary techniques required during reconstruction were combined. Success was considered when there was no need for redo anastmosis, IOU or patient was cured by dilatation. Out of 40 patients that underwent end-to-end urethroplasty, 35 [87.5%] were successful. Simple perineal urethroplasty showed a success rate of 93.75%. Perineal urethroplasty with separation of corporal bodies had a success rate of 66.66%. Patients in which inferior pubectomy was required had success rate of 50%. End-to-end urethroplasty is an excellent option for treatment of stricture urethra and majority of failures occurs in children and those having very proximal membranoprostatic urethral strictures

Correlation of plasma endothelin-1 levels with pulmonary hypertension after inhaled nitric oxide therapy

Variable response to inhaled nitric oxide [iNO] therapy in patients with mitral stenosis [MS] having pulmonary hypertension [PH] has been documented in early studies. The objectives of this study were to measure plasma Endothelin-1 [ET-1] levels in those patients and to correlate them with pulmonary vascular indices after iNO therapy. It was Quesi-experimental study. Thirty patients with mitral or mixed mitral and aortic valve disease with severe pulmonary hypertension and vascular indices and cardiac output were recorded. After the surgery, 10-20 ppm iNO was administered for 1 hour and all the parameters were again recorded. Patients were grouped into responders and non responders on the basis of% reduction in Pulmonary Vascular Resistance [PVR] after iNO therapy. Plasma ET-1 levels were measured in both groups by ELISA before and after the iNO therapy. Paired sample t-test was used to compare mean values for significance. The correlations between variables were then calculated by using Pearson's coefficient. The plasma ET-1 levels were very high in all patients. They reduce in responders after iNO therapy; non-responders paradoxically showed significant increase in the levels of ET-1 after iNO therapy. Moreover, a positive correlation was observed in plasma ET-1 levels and post operative levels of PVR. The correlation of changes in PVR and plasma ET-1 is a key mediator of poor response in PH secondary to MS, after iNO therapy

Genitofemoral nerve block and intraoperative analgesia in children during inguinal hernia repair

Ilioinguinal and iliohypogastric nerve blocks has been widely used in children undergoing inguinal herniorraphy. This technique may provide insufficient intraoperative analgesia as the inguinal region may receive innervation from genitofemoral nerve. We proposed that the addition of genitofemoral nerve block might improve the quality of analgesia. The objective was to find the efficacy of genitofemoral nerve block in addition to ilioinguinal and iliohypogastric nerve block for better intraoperative pain management in children under going inguinal hernia repair under general anaesthesia. After informed consent, 100 children of 1-10 yrs of age and ASA I or II status undergoing inguinal hernia repair were selected and divided in group I and II of 50 patients each. After induction of general anaesthesia, Group I patients received ilioinguinal and iliohypogastric block using bupivacaine 0.375% at a dose of 0.75 mg/kg, where as patients in group II were given genitofemoral in addition to ilioinguinal and iliohypogastric nerve blocks using bupivacaine 0.375% at a dose of 0.375 mg/kg at each site. Changes in heart rate, systolic, diastolic and mean arterial pressures were recorded before the start of surgery, at skin incision, at sac traction and at the end of surgery as a measure of efficacy of the block. Haemodynamic data was analysed using repeated measures ANOVA. The two groups showed increase in [Heart Rate] but the increase was lesser in group II at sac traction [p<0.05]. In group I all patients had an increase in systolic, diastolic and mean arterial pressure at sac traction while the patients in group II showed no change during the study period [p<0.05]. We conclude that the addition of a genitofemoral nerve block to ilioinguinal and iliohypogastric nerve blocks may contribute to haemodynamic stability during sac traction indicating better pain relief

Complications of laparoscopic cholecystectomy at Isra university hospital, Hyderabad

The main objective was to determine the complications of laparoscopic cholecystectomy [LC] and its causes at sra University Hospital, Hyderabad. This was a retrospective study carried out from July 2005 to June 2007. Data of all patients undergoing laparoscopic chotecystectomy during the study period and fulfilling the selection criteria was collected and analyzed retrospectively. A total of 216 patients underwent laparoscopic cholecystectomy with an overwhelming majority of females. The overall complication rate was 5%. The complications included bleeding [4/216, 1.8%] from cystic artery and gall bladder bed, port site infection [4/216, 1.8%], bile duct injury [2/216, 0.9%] and colonic injury [1/216, 0.4%]. The common causes of these complications were accidental injury to cystic artery, gross spillage of infected bile and erroneous clipping of common bile duct. Bleeding and Port site infections were the commonest complications followed by common bile duct and colonic injuries. The commonest cause of bleeding was cystic artery injury whereas the commonest cause of port site infection was gross spillage of infected bile

effect of chlorpromazine, diclofenac and their combination on four models of induced pain in mice

Adjuvant or co-analgesic drugs, such as antipsychotics are commonly administered in combination with one of the primary analgesics. The present study is carried out to investigate the effects of the antipsychotic drug; chlorpromazine in four animal models of induced pain and to compare its effects with diclofenac sodium and with their combination. All experiments were performed on albino mice [Balb/C] strain. Mice were evaluated for their responsiveness to noxious stimuli using four tests: tail-flick test, hot-plate test, formalin test and acetic acid-induced writhing test. These effects were measured before and one hour after intraperitoneal drug administration. In some experiments, they were followed for 6 and 24 hours. In general,chlorpromazine,on its own, showed a significant analgesic activity in heat-induced pain models [tail-flick and hot-plate tests] increasing latency by around 34% and 80% in the two tests respectively. This is compared to 83% and 88% increase by diclofenac sodium. In the early phase of chemically-induced somatic type of pain [formalin test] and visceral-type of pain [writhing test], chlorpromazine had similar effect to diclofenac sodium. When chlorpromazine was given in combination with diclofenac sodium in writhing test, it did not enhance diclofenac effect. In the other three models, chlorpromazine resulted in a significant enhancement of diclofenac effect in at least two of the remaining three pain models to an extent, ranging from 46% to 55% more than that of the diclofenac effect. Chlorpromazine showed different analgesic activity according to the type of pain model utilized. The analgesic activities were either similar to diclofenac [in writhing and formalin tests], or less than diclofenac effect in tail-flick and hot-plate tests. Chlorpromazine increased the analgesic effect of diclofenac when used in combination in tail-flick, hot-plate and formalin tests

Extremes of hyper and hypotensions in pheochromocytoma-a perioperative management

We report a case of 30 years old female who presented with history of frequent headaches, palpitation, sweating along with mass abdomen. Hypertension was accelerated as ECG reflected sinus rhythm with left ventricular hypertrophy and no papilloedema. Ultrasound abdomen revealed right sided, well defined solid mass posterolateral to the inferior vena cava. Urine analysis revealed raised metabolite vanillylmandalic acid. Patient was diagnosed as a case of pheochrojnocytoma of the right suprarenal gland. After control of blood pressure, laparotomy under general anaesthesia was performed. A big tumour was excised. Histopathology confirmed the diagnosis of pheochromocytoma

Prevalence of metabolic syndrome in patients with ischemic heart disease

Metabolic syndrome is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes. Whereas the syndrome is under scrutiny and extensive investigations worldwide, it has been very little investigated in Iraq with a considerable lack of local pertinent data. Estimation of the prevalence of metabolic syndrome in patients with ischemic heart disease and assessing the severity of coronary artery disease in patients who meet the criteria of metabolic syndrome. The study was carried out at Ibn Albitar hospital, a tertiary center for cardiovascular surgery/Baghdad/Iraq from 1st Oct. 2005 to 30th Dec. 2006. A cross sectional design and consecutive sampling procedure were adopted to enroll 300 patients comprising 226 males and 74 females who met the eligibility criteria and were assigned to undergo coronary angiography. Documentation of data regarding medical history, the required measurements, and investigations was accomplished in accordance with a specially designed data sheet that included all relevant information. The overall prevalence of metabolic syndrome in the study sample was 69.33%. Differentially, the prevalence was very much higher among patients with ischemic heart disease 84% than those without ischemic heart disease 10%. The estimated difference was statistically highly significant [p=0.01]. Only 240 patients showed angiocardiographic evidence of ischemic heart disease; [single vessel disease 24.2%, two vessels disease 35.8%, triple vessels disease 23.3%, and left main stem disease 16.7%]. There was no significant difference in the prevalence of metabolic syndrome among different subgroups of patients with ischemic heart disease classified by the results of coronary angiography. There is a need for having a unified definition of the metabolic syndrome to allow for proper assessment and valid comparison between prevalence data in different populations. Highlighted the need for wider analytical studies enrolling bigger samples with the aim of obtaining a more valid inference, in addition to community based surveys to help early recognition of metabolic syndrome, identify patients at risk of ischemic heart disease, and reduce the impact of ischemic heart disease on the community

Multi-drug resistant Ewingella americana

We report a case of pneumonia due to multi-drug resistant Ewingella americana in a young patient admitted in the Intensive Care Unit of Hera General Hospital, Makkah, Saudi Arabia with severe head injury in a road traffic accident. He was an Indonesian pilgrim who had traveled to the Kingdom of Saudi Arabia to perform Hajj in December 2007. Ewingella americana was identified to be the pathogen of pneumonia with clinical signs and symptoms along with positive radiological findings