Evaluation of Clinical & Functional Outcomes Bristow Latarjet Procedure in the Management of Recurrent Anterior Shoulder Dislocation

Background: Glenohumeral joint is highly susceptible to dislocation due to its wide range of movements. Recurrent anterior shoulder dislocations are common in young adults. The Bristow Latarjet procedure is one of the effective techniques for the treatment of recurrent anterior shoulder dislocation. This study aimed to assess the clinical and functional outcome of the Bristow Latarjet procedure in the management of recurrent anterior shoulder dislocation. Material & Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU, from October 2017 to September 2019. Within this period, a total of 40 cases of recurrent anterior shoulder dislocation that meet inclusion criteria were taken as a sample. Patients were evaluated both pre and postoperatively for functional outcomes according to Rowe’s score for instability. A purposive non-randomized sampling technique was used in this study. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Paired Student’s‘t’ test was performed to compare pre and final postoperative follow-up. The level of significance was calculated at a confidence interval of 95% and p-value <0.05. Results: : In this study age of the patient ranged from 18-40 years and the mean age was 28.2±6.3. 29(72.5). Surgery was done within 4-6 months of the first dislocation in 5 patients, within 6-12 months in 21 patients and after 12 months in 14 patients. The mean (±SD) Rowe score for instability was significantly (p<0.001) higher 6 months after the Bristow Latarjet procedure at 91.87(±9.00) in comparison to preoperative periods 52.62(±18.40). Results were excellent in 32(80%), good in 4(10%), fair in 3(7.5%) and poor in 1(2.5%) patients. 36(90%) patients were in the satisfactory group and only 4(10%) in the unsatisfactory group. Only 1(2.5%) patient developed screw migration, 2(5%) patients developed subluxation, and 1(2.5%) patient developed postoperative arthritis. Conclusion: It can be concluded that the Bristow-Latarjet procedure is a very effective and safe procedure with reduced complications, presenting very satisfactory functional results in the treatment of recurrent anterior shoulder dislocation.

Pro-brain natriuretic peptide plasma levels, left ventricular dimensions and ejection fraction in acute dyspnoea

To determine the association of the pro-brain natriuretic peptide [NT-proBNP] plasma levels with two dimensional echocardiographic determination of left ventricular dimensions and ejection fraction [EF] in acute dyspneic patients. An observational cross-sectional study. Tabba Heart Institute, Karachi, from January to June 2010. One hundred patients were selected by consecutive purposive non-probability sampling who had presented with acute dyspnoea. NT-proBNP levels were assessed by commercial tests [Roche Diagnostics]. The clinical diagnosis of congestive heart failure [CHF], echocardiographic assessment of left ventricular dimensions and function were compared with NT-proBNP levels. Receiver operating characteristic [ROC] curve was estimated for NT-proBNP and compared. The chi-square test was applied for categorical and student's t-test for numerical data at 0.05 levels of significance were used to compare patients with and without heart failure. Further comparative analysis between groups on the basis of ejection fraction was done by one way ANOVA test. Seventy-nine patients [79%] had CHF as a cause of their dyspnoea. Patients with CHF were older [61.9 +/- 14 years vs. 58.6 +/- 14 years, p=0.368], had a lower EF [36.9% vs. 61%, p < 0.0001], had a higher LV dimensions, left ventricular end diastolic dimension - LVEDD [49.94 +/- 5.6 vs. 42 +/- 7.9 mm, p < 0.0001], left ventricular end systolic dimension - LVESD [37.31 +/- 6 vs. 29.21 +/- 10.9 mm, p < 0.0001] and a higher NT-proBNP [10918 +/- 1228 vs. 461 +/- 100 pg/mL, p < 0.0001] than patients without CHF. NT-proBNP values increased with the severity of ventricular impairment. Significant differences were found between patients with LVEF < 25% and patients with moderate ventricular impairment [LVEF = 26 - 40%] and mild ventricular impairment [LVEF = 41-60%, p < 0.001]. The group of patients with LV dilation, had significantly higher BNP levels than those with normal LVEDD [12416 +/- 1060 pg/ml vs. 6113 +/- 960, p = 0.009] and LVESD [10416 +/- 1160 vs. 4513 +/- 960 pg/ml, p = 0.008]. Area under ROC curve for the diagnosis of CHF was significantly higher for NT-proBNP [AUC 0.99, p < 0.003]. The sensitivity of NT-proBNP value of > 300 pg/mL for the diagnosis of CHF was 100% and specificity was 42%. A cut-point of 300 pg/mL NT-proBNP had 100% negative predictive value to exclude acute CHF. NT-proBNP is strongly associated with two-dimensional echocardiographic determination of left ventricular dimensions and EF in identifying CHF in patients with acute dyspnoea

Giant iliac vein aneurysm secondary to long standing traumatic popliteal arteriovenous fistula

A 48-year-old man presented with a traumatic arteriovenous fistula [AVF] in the left popliteal space, due to a bullet injury 20 years back. A computed tomographic [CT] angiography revealed an AVF in the left popliteal space with an associated large iliac vein aneurysm [9.2 x 9.0 cms]. Primary repair of the AVF was done. A Doppler scan showed marked reduction in the size of the aneurysm, 4 months after surgery. Cases associated with a venous aneurysm distant from the site of AVF are rare and there are only 7 cases reported in the international literature

prevalence of different forms of psoriasis, the possible aggravating and predisposing factors in Kashmir valley. A detailed epidemiological study - Part I

350 patients of psoriasis or Daus sadaf as referred in Unani System of Medicine, with different age and sex were registered in the OPD of Regional Research Institute of Unani Medicine, Srinagar from 01-4-1997 to 31-3-2003 for detailed clinical study and treatment. Overall 0.4% patients were found to suffer from psoriasis among 86805 new patients who attended the OPD of the Institute for treatment of their different diseases during this reporting period. The duration of the study was 6 years. The patients were subjected to clinical and some laboratory examinations. During the study, some important Findings were observed like the types of psoriasis, age of onset of disease, dominance of sex family history of the disease, food habits and aggravation of diseases, seasonal effects, gastrointestinal disorders and disease activities, worm [Helminths] infestations and disease activities, effects of' stress and strain on disease activities, possible predisposing factors etc. The aim of the study was to find out the incidence of different forms of disease prevalence, and its possible predisposing and aggravating factors in the Kashmir valley

Antibacterial activity of 1,2-benzenedicarboxylic acid, diisooctyl ester isolated from the root of plumbago zeylanica linn

1,2-Benzenedicarboxylic acid, diisooctyl ester [diisooctyl phthalate] isolated from the roots of Plumbago zeylanica was screened for its antibacterial activity against eleven human pathogenic bacteria viz., Bacillus subtilis, B. cereus, B. megaterium. Escherichia coli, INABA ET [Vibrio], Shigella dysenteriae, S. sonnei, Salmonella typhi, S. paratyphi, Staphylococcus aureus and Pseudomonas mutabilis. The antibacterial activity of the compound was evaluated using the disc diffusion and macrodilution method. The compound showed moderate to good antibacterial activity against almost all the test bacterial pathogens. The largest zone of inhibition 22 mm, 14 mm, 11 mm, and 6 mm in diameter were recorded against Pseudomonas mutabilis at the concentration of 50 micro g, 20 micro g, 10 micro g and 5 micro g/disc respectively. The compound exhibited the lowest MIC [40 micro g/ml] against Bacillus subtilis, B. cereus, B. megaterium, Escherichia coli, Shigella sonnei, Salmonella paratyphi and Pseudomonas mutabilis and MBC [160 micro g/ml] against Bacillus cereus, B. megaterium, Escherichia coli and Pseudomonas mutabilis

Comparison of lidocaine vs lidocaine + ketorolac in intravenous regional anaesthesia [bier's block]

To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. An international quasi experimental study. This study was carried out in Nishtar Hospital Multan from 01/01/2006 to 30/06/2006 [6 Months]. Results: Patients were divided into two groups A and B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. We conclude that 30mg Ketorolac added to Lidocaine in IVRA increases degree of anaesthesia and also provide prolonged postop analgesia

Difficult ventilation in a patient after Endotracheal intubation: an unusual manufacturing defect in E.T.T. connecter

Airway resistance depends upon the diameter of endotracheal tube [E.T.T] and other respiratory organs. Actually resistance to flow through a tube increases up to sixteen times if diameter is reduced to half of the original size. Disposable E.T.T which are currently used in anaesthesia practice are made up of P.V.0 with a connecter which is fitted on proximal end of endotracheal tube and proximal end of connector is attached with breathing circuit. Usually the internal diameter of connector should be equal to internal diameter of endotracheal tube. In the market, tubes of different manufacturers and of different sizes are available for all age groups. In developing countries like Pakistan, hospital administration usually purchases the endotracheal tubes and other equipments which are relatively cheaper because of lack of funds. Here we present a case where there was a manufacturing defect in E.T.T connector with a very narrow internal diameter that was causing severe respiratory obstruction in a child undergoing laparotomy. We conclude that the anaesthetists must keep in their mind the possibility of E.T.T connector manufacturing defect if they face problem of increased airway resistance in an intubated patient after excluding other possibilities of high airway resistance

Frequency of oesophageal varices among patients undergoing GI endoscopy

At least two thirds of cirrhotic patients develop Oesophageal Varices [OV] during their lifetime. Severe Upper Gastro Intestinal [UGI] bleeding as a complication of portal hypertension develops in about 30%-40% of cirrhotics. Despite significant improvements in the early diagnosis and treatment of oesophagogastric variceal haemorrhage, the mortality rate of first variceal haemorrhage remains high [20%-35%].Aim: To find out frequency of OV in two different areas of Karachi.Method: We prepared a register of 255 patients who underwent upper GI endoscopy at Murshid Hospital and Health Care Centre between 1999 and 2003 and compared it with 254 patients scoped at Hamdard University Hospital Karachi during the same period. At Murshid Hospital oesophageal varices were present in 58 cases 22.75%, age specific occurrence was 10.3% [20-30 years], 25.8% [>30-40 years], 63.7% [>40 years] while at Hamdard University Hospital the frequency of oesophageal varices was 18 cases 7.1%, age specific occurrence at this centre showed that all cases of oesophageal varices were above the age of 45 years. A record linkage population based study of oesophageal varices allows outcomes to be identified and workout the cost. Those at risk in the population should be informed about the future implication to their health and costs. The health service should investigate the increasing incidence and prevalence of oesophageal varices at local as well as national level

Some indigenous medicinal knowledge for treating jaundice in Chittagong hill tracts, Bangladesh

Indigenous medicinal knowledge on 16 species used for Jaundice in the Chittagong Hill Tracts has been documented. These plants have been used by Chakma and Marma tribes for treating Jaundice from time immemorial. The documentation has been carried out with the consultation of tribal practitioners in arranging group participation. Short diagnostic descriptions of the plants, systematic position, tribal name and plant preparation, dose details are described

Ethno-medical uses of some medicinally active plants for treating diabetes in Chittagong Hill Tracts, Bangladesh

Traditional medicinal knowledge on 14 plant species in the Chittagong Hill Tracts known to have properties in the treatment of diabetes is documented. These plants are being used in the Chitthgong Hill Tracts by the 13 tribal communities in traditional medicine for hundreds of years with reputation as efficacious remedies although there may not be sufficient data for sustaining their efficacy. Short diagnostic descriptions, systematic position and tribal names of the plants are described. Plant preparation, dose and period of use are directly translated from Chakma and Marma pharmacopoeia in collaboration with tribal professional practitioners and bilingual tribal guides of Khagrachari Hill district. Chittagong Hill Tracts

Pattern of cardiovascular problems among Haj Pilgrims

To identify the cardiovascular problems of Haj pilgrims to help plan their health care needs. Prospective stud among Haj pilgrims admitted with medical problems. Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia. Seven hundred fifty four foreign Haj pilgrims visiting Saudi Arabia for this purpose from abroad during the 1993 Haj season. Main outcome measures: Morbidity and mortality due to cardiovascular diseases among Haj pilgrims with diagnosis based on history, physical examination and investigations. Cardiovascular diseases were present in 462 [61%] of the 754 admitted Haj pilgrims and were the second only to respiratory diseases as the cause of morbidity. Ischaemic heart diseases [25%], hypertension [24%] and myocardial infarction [16%] were the common cardiovascular diseases. Myocardial infarction was the most common cause of mortality among Haj pilgrims. Most of these cases suffered from more than one cardiovascular or other medical problems. Cardiovascular diseases are the second most common cause of morbidity and the main cause of mortality among admitted Haj pilgrims in Modinah Al-Munawarah, Saudi Arabia