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Background: Dengue fever, an emerging public health issue in Pakistan bears considerable morbidity and mortality. This descriptive cross sectional study was conducted to analyze clinical, hematological and serological characteristics of dengue fever variants and to identify biomarkers that predict its severity
Methods: 105 dengue cases [>12 years] were selected after ethical approval from Rawal Institute of Health Sciences and Benazir Bhutto Hospital Rawalpindi over 6 months [July to Dec 2015]. Patients having pre-existing hematological disorder, liver disease, malaria and typhoid co-infection were excluded. Demographic data, clinical findings, hematological and serological profile documented. Patients were classified as classic dengue fever [DF], dengue hemorrhagic [DHF] and dengue shock syndrome [DSS]. Data analyzed via SPSS version 17
Results: Among 105 cases, there were 79[75%] males and 26[25%] females. Mean age was 30 +/-12.8 years and mean duration of symptoms 5 +/-2 days. Dengue fever was found in 75[75%], dengue hemorrhagic fever 24[23%] and dengue shock syndrome 2[2%]. Gender, mean age and duration of symptoms were comparable between DF, DHF and DSS. Common clinical features were fever [100%], headache [56%], muscle pain [43%], vomiting [43%], retro-orbital pain [23%], bleeding [12%] and hypotension [10%]. Thrombocytopenia, leukopenia and pancytopenia were frequent in DHF vs. DF. Dengue NS-1 antigen positive in 71[90%] of DF cases vs 16[57%] DHF and 1[50%] DSS. Dengue-IgM positive in 32[47%] DF vs. 19[79%] DHF and 2[100%] DSS. Dengue -IgG detected in 33[42%] DF vs. 17[71%] DHF and 1[50%] DSS. 101[96%] dengue cases were treated successfully and one case expired
Conclusion: Dengue-IgG and IgM are better predictive variables for dengue hemorrhagic fever as compared to NS-1 antigen that predicts classic dengue fever. Utilizing these predictive variables, imminent severe dengue may be identified and with vigilant monitoring, fluid resuscitation and pre-hand arrangement of blood products we may reduce complications and mortality in high risk cases
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To study the adaptive strategies from harmful effect of heat wave on an urban, educated, well to do subjects for a period of May to July 2014. 250 selected young students of RIHS. Descriptive Study. Rawal Institute of Health Sciences, Islamabad. March - July 2014. A questionnaire was circulated among the students of Rawal Institute of Health Sciences Islamabad regarding effects of heat and measures taken to combat its effects. A total of 250 urban students with mean age of 19.77 +/- 1.10 years were inducted in the study, having resources to face the extreme heat. A significant number of female non boarder students [p=0.000], wearing cotton clothes [p=0.000] having fair skin [p=0.000] and using air condition at homes [p=0.000] were not acclimatized to heat waves still have headache and anxiety. A great percent of students did not complaint of headache, heat exhaustion, heat cramp or syncope, except mild sweating, effect on studies. A great percentage [>65%] of students complained of malaise, nausea vomiting. Male students showed increase thirst than female, while anxiety state was noticed more in female than male students. The use of cotton clothing, daily bathing, increased water intake and use of air conditioner minimized the severe adverse effects like heat exhaustion, heat syncope, and heat stroke, although the minor effects like skin tanning, disturbed sleep, anxiety and adverse effects on studies cannot be avoided in heat wave season
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To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Randomized controlled trial. Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Patients [n = 120] of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age < 15 years or > 60 years were excluded. Subjects were randomly assigned to pre-rib harvest [group-1] and post-rib harvest [group-2]. Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Mean age was 31.43 A +/- 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 A +/- 0.609 and 2.4667 A +/- 0.812 in pre-rib harvest and post-rib harvest groups respectively [p < 0.0001]. The mean pain scores at 12 hours postoperatively were 1.45 A +/- 0.565 and 3.65 A +/- 0.633 in pre-rib harvest and post-rib harvest groups respectively [p < 0.0001]. The mean tramadol used postoperatively in first 24 hours was 169 A +/- 29.24 mg and 255 A +/- 17.70 mg in prerib harvest and post-rib harvest groups respectively [p < 0.0001]. Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use
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Objective: To determine the outcome of microvascular free tissue transfer with or without use of postoperative heparin in terms of flap viability and postoperative complications. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Plastic Surgery, King Edward Medical University, Lahore, from July 2010 to July 2012
Methodology: Thirty eight patients requiring elective or emergency microvascular free tissue transfer were selected. Those with poly-trauma, previous failed free flap and re-anastomosis of vessels were excluded from the study. All anastomoses were performed by trained microvascular surgeons. Per operatively, Aucland test was performed to ensure anastomotic patency. Thereafter, patients were divided into two groups: in group A, heparin was not given postoperatively and in group B, heparin was given postoperatively. The flaps were monitored for signs of vascular compromise, viability or non-viability and complications of the procedure. Chi-square test was used to compare the distribution of qualitative variable in two groups. P-value less than 0.05 was considered significant
Results: In group A, the number of viable flaps was 13 [81%] and non-viable flaps were 3 [19%]. In group B the number of viable flaps was 11 [73%] and non-viable flaps were 04 [23%] [p = 0.68]. There was no significant difference regarding postoperative complications between the two groups [p > 0.05]
Conclusion: Postoperative heparin does not appear to have an influence on the viability or complications of free flaps
RESUMEN
Background: Fracture shaft of humerus is a common orthopedic problem and represents roughly 3% of all fractures, usually managed non-operatively. The usual operative modalities used for fixation of humerus fractures are the kuntscher nails, dynamic compression plate [DCP], external fixator and intramedullary nail [IMN]. Plating of fracture shaft of humerus is the more common surgical treatment option. There is a higher rate of excellent and good results and tendency for earlier union with the plating of fracture shaft of humerus
Methods: This study was conducted at Orthopedic Department of Allied and DHQ Hospital Faisalabad from November 2011 to November 2012. All patients with fracture shaft of humerus were included and treated with dynamic compression plating
Results: 91 patients with mean age of 37.24 including 70 [76.9%] males and 21 [23.1%] females falling in inclusion criteria were operated by same orthopaedic surgeons team with same implant i.e. DCP. At 1ST postoperative day, 87 patients [95.60%] had no neurological deficit while 4 patients [4.40%] had neurological deficit. At 12th postoperative day only 9 patients [9.9%] had superficial wound infection while 82 patients [90.1%] have no wound infection
Conclusion: Humeral shaft fracture is one of the commonest fractures among the working community and elderly. Fixation of fracture with Dynamic Compression Plate is the treatment of choice. Postoperative radial nerve injury is an important complication and few patients in this study developed neurological deficit
RESUMEN
Background: With increasing number of motor vehicles and population, trauma patients are increasing day by day. Motorcycle accidents are one of the major causes of disabilities and deaths in young males
Objectives: To determine the pattern of orthopaedic injuries and outcome of its treatment in patients presented to Allied Hospital Faisalabad after motorcycle accidents and to provide the baseline data to policy makers and other stakeholders who want to undertake necessary measures to improve road safety in the country
Study design: Descriptive cross sectional
Setting: Accident and Emergency [A and E] and orthopaedic department of Allied Hospital Faisalabad
Duration of study: January 2012 to December 2012
Method: All patients were admitted through Accident and Emergency department. The data was collected in retrospective way and was analyzed using SPSS version 17
Results: Total 1003 patients were included in this study. 859 were male [85.6%] and 144 were female [14.4%]. The patient ages ranged from 3 to 90 years with peak frequency of 21-30 years 318 [31.7%]. Businessmen290 [28.9%], employee/public workers 224 [22.3%] and students 216 [21.5%] were the majority of victims. Collision of motorcycle with vehicles was the most common mechanism of injury 31.4% and Motorcycle riders 613 [61.1%] were the usual victims. Frequency of non-helmet use was 93.4% and of head injuries along with orthopaedic injuries were 33.1%. Most common orthopaedic injury pattern in motorcycle accidents was fracture of tibia and fibula 43.4%. Mean duration of hospitalization was 9.1days
Conclusion: Road traffic accidents constitute one of most important public health problem in our society. Disabilities and deaths in motorcycle crash are increasing day by day. Preventive programs must be launched by policy makers of concerned departments and stakeholder at national level as solely a medical approach is insufficient to save precious lives of many people