Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring

Introduction: Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. Materials & Methods: Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. Results: Twenty one (51.22%) and thirteen (31.70%) patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17%) were able to return to their original occupation with or without minor adjustments. Conclusion: Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring. laboring

Iron deficiency anemia: the utility of upper gastrointestinal endoscopy and histopathohgy

Occult blood loss must be considered as a possible cause in every case of iron deficiency anemia. To evaluate upper gastrointestinal endoscopy in finding a potential cause for iron deficiency anemia among children in Al-Anbar governorate. Twenty five children aged 2-14 years, referred to the gastroenterology unit in Al-Ramadi General Hospital for upper gastrointestinal endoscopy had iron deficiency anemia. Fiberoptic endoscopy was used under general anesthesia and endoscopic tissue biopsies were taken from 22 patients for histopathological examination. The main presenting signs and symptoms were pallor, abdominal pain, and stunting. The upper gastrointestinal endoscopy showed thinning of duodenal folds and serrated mucosa in 8 [32%], duodenal ulcer in 3 [12%], esophageal varices in 1 [4%], nodular gastritis in 1 [4%], and reflux esophagitis in 1 [4%], with a yield rate of 56%. While tissue biopsies revealed histopathological findings suggestive of celiac disease in 12 [48%], Giardia lamblia in 2 [8%], Helicobacter pylori gastritis in 1 [4%], and esophagitis in 1 [4%]. There was a significant association between the endoscopic finding of thinning of duodenal folds and serrated mucosa and the histopathological finding suggestive of celiac disease, P<0.05. Iron deficiency anemia in children 2-14 years of age warrants upper gastrointestinal endoscopy to find potentially treatable causes for the iron deficiency anemia

evaluation of early postoperative hospital discharge after elective caesarean section

Caesarean section is one of the most important operations in obstetrics while the postoperative stay in hospital mostly depends on the hospital policy and the presence of complications. To evaluate the effect of early post elective caesarean section discharge within 24 hours, in relation to the indication of the elective caesarean section, intra operative procedures, post operative antibiotics, analgesia and time of starting feeding and mobilization. This is a retrospective review of all elective caesarean sections done in one hospital from the 1[st] of November 2005 to the 31[st] of January 2006 [total 374]. Files were reviewed for intra operative procedure, post operative antibiotics, analgesia, time of starting feeding and mobilization. Any maternal and fetal complication was recorded. The attendant obstetricians were asked for their opinions, disadvantages, complications, mortality, readmission and also for patient inconvenience from this policy of early discharge. The number of elective caesarean section was 374, the mean time between operation and discharge was 20.57 hours. The mean age of the women was 27.8 years, the mean parity was 2.1. The indications for elective caesarean section were previous scar [39.31%], postdate [20.59%], decrease fetal movement [12.57%], abnormal lie [3.48%], breech presentation [4.00%] and on the personal request of the patient [4.00%]. General anesthesia was used in 362 [96.8%] of the patients, while epidural was used only in 12 [3.2%]. Diclofenac was used as postoperative analgesia in 203 [54.3%] of patients, tramadol in 109 [29.1%] and both in 62 [16.6%]. The mean time for starting feeding was 7.23 hours and mobilization in 6.95 hours. The pelvic and parietal peritoneum was sutured [closed] in 284 [75.9%] of patients. One patient stayed in hospital 36 hours for caesarean hysterectomy and was then readmitted for severe infection. Ten patients had minor infection and were treated as outpatients. There was one fetal loss because of respiratory distress syndrome. This study reveals that early post elective caesarean section discharge [less than 24 hours] is safe, regardless of the indication of elective caesarean section, intra operative procedure, post operative analgesia, antibiotics and time of starting feeding and mobility