Outcome of bipolar hemi arthoroplasty: analysis of using lateral and posteriolateral approach

Objective: To find the outcome of bipolar hemiarthroplasty using posteriolateral and lateral approaches

Study design: Descriptive case series

Place and Duration of study: Departments of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2016

Methodology: Patients of either sex and of age above 40 year, who presented in Emergency Department with femoral neck fractures, were included in the study. Data included basic demorgraphic profile, Harris hip scoring, duration of surgery, hospital stay and blood loss

Results: A total of 200 patients were included in the study. There were 77 [38.5%] males and 133 [61.5%] females. Male to female ratio was 0.58:1 with mean age of 58.2 +/- 6.02 year. Mean follow up was 14.2 +/- 2.5 months. In 134 [67.0%] patients there was history of fall, 41 [20.5%] presented with fracture after low energy vehicle accident, 20 [10.0%] presented after high energy vehicle accident. Duration of surgery and blood loss were less in posteriolateral approach. The complication rate and Harris hip scoring was similar in both the approaches

Conclusions: Outcome of surgery in terms of infection, mobility and pain as well as dislocations were similar in both the approaches. The posterior approach was superior in terms of short duration of surgery and less blood loss

Intraperitoneal infiltration of ropivacaine for post-operative analgesia in open cholecystectomy

Objective: To assess the role of Intraperitoneal infiltration of Ropivacaine for post-op analgesia in open cholecystectomy in a low resource setting

Study Design: Randomized controlled trial

Place and Duration of Study: Study was conducted at department of Anesthesia, Scouts Hospital Chitral, from Jul 2014 to Jun 2016

Material and Methods: After taking approval from hospital ethical committee, total 126 patients were divided randomly in two groups. Group I [study group] was given intraperitoneal ropivacaine and group II [control group] was given routine standard analgesia. After complete recovery, pain was measure on VAS score [1-10] at 1 hour, 6 hour and 24 hour in all patients. Patients having pain score of 4 or more were managed with nalbuphine 5 mg IV bolus. Data was analyzed by SPSS version 16

Results: The comparison of pain score [after 1, 6and 24 hours of surgery], showed that study group had significantly [p-value<0.05] less mean pain score as compared with placebo group. Significant rate of nausea/vomiting was observed [p-value<0.05] higher [62%] in placebo group as compared with [38%] in study group. Statistically there was no significant difference [p-value>0.05] between groups on the basis of mean age [47.89 +/- 8.56 vs. 48.75 +/- 9.36], gender [Females 70% vs. 68%], duration of the surgery [88.54 +/- 12.34 minutes vs. 91.70 +/- 13.50 minutes] and American society of anesthesiologist [ASA] grades in study and placebo group patients respectively

Conclusion: Intraperitoneal ropivacaine infiltration helped in reducing the post op pain significantly in open cholecystectomy

Outcome of shish kabab osteotomies fixed with SIGN NAILI in osteogenesis imperfecta. our experience at Ghurki Trust Teaching Hospital, Lahore, Pakistan

Objective: To evaluate the results of shish kabab osteotomies fixed with SIGN NAIL in long bone deformities of patients suffering from osteogenesis imperfect

Methods: This study was carried out on 12 patients who presented in OPD or Emergency Department with deformities of long bones. Detailed history, examination and investigations including X-ray AP and Lateral view of involved bone were done. All these cases were treated with Shish Kabab Osteotomies and SIGN NAILunder spinal or general anaesthesia. These cases were followed up for up to average of 20 months [range 06 months -6 years ] and results of the nail were observed in terms of union, rehabilitation and complications

Results: It was found that 8 [66.7%] were male and 4 [33.3%] were females with a mean age of 14.83 +/- 5.24. 5 [41.7%] patients having age 10-15 years and 7 [58.3%] were between 16-20 years. Total 21 surgeries performed. 3[25.0%] had surgery on unilateral femur,2 [16.7%] on unilateral tibia, 3[25.0%] on both unilateral tibia and femur,3 [25.0%] had surgery on bilateral tibia and 1[13.3%] with bilateral tibia and femur. The parents of all patients had a first degree consanguineous marriage. The mean hospital stay were 4.17 +/- 1.75 days. All osteotomies sites heal within 06 months, better bone densities, 1 Having recurrence of deformity and no fracture were found. Only two patients using walkers while remaining need no support for walking

Conclusion: Sign Nail along with shish kabab osteotomies in deformities of osteogenesis imperfecta is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and osteotomies site healing response is good as well as decrease risk of fracture

Monopolar cautery versus cold steel dissection for tonsillectomy in children. a randomized clinical trial

Objective: To compare monopolar cautery with cold steel dissection for tonsillectomy in pediatric age group

Study Design: A randomized clinical trial

Place and Duration of Study: Ear, nose and throat [ENT] department Combined Military Hospital Gujranwala, from Jan 2013 to Jan 2015

Material and Methods: A total of 220 consecutive pediatric patients undergoing tonsillectomy for recurrent or chronic tonsillitis between Jan 2013 to Jan 2015. Both groups were compared with regards to surgery time, intraoperative bleeding, post operative pain and complications

Results: A total of 20 patients were excluded from the study for various reasons while the data of the rest of the patients has been presented. Mean age of the study group was 8.82 years. A total of 58% of the patients were male. Average time of surgery for monopolar cautery was 29.33 [SD 2.77] min as compared to 18.53 min [SD 2.94] for dissection method which was significant [p<0.005]. Average blood loss for monopolar surgery was 11.66 ml and 29.04ml for dissection method [p<0.005]. Average pain scores were less for dissection method at 2nd post op day 3.59 vs. 5.51. Rates of primary and secondary hemorrhage were less for monopolar method although they were not statistically significant

Conclusion: Monopolar cautery though causes decreased intraoperative blood loss however requires longer anesthesia and causes significant post operative pain to the patient

Association of specialty and working hours with compassion fatigue

Objective: To find out association of speciality and working hours with compassion fatigue

Study Design: Cross sectional comparative study

Place and Duration of Study: Military Hospital and Combined Military Hospital Rawalpindi, Combined Military Hospital Sialkot, from December 2013 to July 2014

Material and Methods: Fifty four doctors from departments of Medicine, Surgery, Anesthesia and Gynaecology participated in the study. Other health care related personnel, not directly related to patient care, were excluded from the study. The data collection tool was a questionnaire "Professional Quality of Life Measure version 5". Data was analysed by SPSS version 22. Chi Square test for goodness of fit was used to determine difference in the frequency distribution of various categories of a single variable whereas Chi square test for independence was used to find association between two categorical variables. The p-value was kept at < 0.05 for significance

Results: Results showed 11 females and 43 males with mean age of 37.69 +/- 9.72 years. Cronbach's alpha was 0.81. Eleven participants [20.4%] showed low compassion fatigue, 37 [68.5%] showed average whereas only 6 participants [11.1%] showed high compassion fatigue scores and the difference was significant [p-value < 0.001]. Working hours were associated with compassion fatigue [p-value = 0.03] but speciality was not [p-value = 0.41]

Conclusion: Chances of suffering from compassion fatigue are significantly higher if working hours are 12 or more, however the disorder is not associated with speciality

Pattern of facial gunshot and blast injuries amongst law enforcing forces

Objective: To assesses the pattern of maxillofacial gunshot and blast injuries amongst law enforcing forces personnel

Study Design: Descriptive Study

Place and Duration of Study: Combined Military Hospital Lahore from Jan 2010 to Dec 2010

Materials and Methods: This prospective study evaluated 52 patients from Jan 2010 to Dec 2010 at Combined Military Hospital [CMH], Kohat Pakistan. All patients in this study were males as fighting corps of law enforcing forces comprises only male soldiers and officers. Patients aged from 18 to 50 years with mean age 29.12 years +/- 8.56 years

They were assessed for presence of gunshot and ballistic injuries by clinical examination and evaluation of necessary radiographic investigations

Results: Nineteen patients out of total 52 patients had no other injury which accounts for about 36.9%. In maxillofacial area upper third of face was most frequent site to receive gunshot and ballistic injuries as 10 patients received injuries to upper face which measures about 19.2%. Along with maxillofacial area upper limbs were most common site affected as 14 patients received injuries to upper limbs which is 26.9% of all patients

Conclusion: Gunshot wounds present a great challenge to oral and maxillofacial surgeons and a multidimensional team approach is required to rehabilitate the victims of gunshot injuries

Autologous percutaneous bone marrow injection in long bone fractures with delayed and nonunion

Objective: to determine the outcome of bone marrow injection in fractures with signs of delayed union and nonunion in terms of clinical and radiological evidence of union

Study design: descriptive case series

Place and Duration of study: department of Orthopedics and Spinal Surgery, Ghurki Trust Teaching Hospital Lahore, from October 2014 to May 2015

Methodology: patients admitted with nonunion or delayed union were included in the study. After evaluation and taking informed consent bone marrow was taken from the iliac crest with the help of bone marrow biopsy needle and injected at the site of fracture with the aid of lumbar puncture [LP] needle under image guidance. Repeat injection was given at three month interval, if needed. Clinical and radiological evidence of bone healing was assessed at six weekly follow ups till six months

Results: a total of 80 patients were included. There were 48 males and 32 females. There were 42 tibial, 18 femoral, 11 radius/ulna and 9 humeral fractures. Sixty-two procedures under local anesthesia and eighteen under short sedation were performed. In 67 patients union occurred following injection. The mean healing time was 16 weeks

Conclusion: percutaneous bone marrow injection is an alternative treatment of choice for delayed union and nonunion for long bone fractures

Autologous blood injection for lateral epidcondylitis of elbow

Objective: to determine the outcome after autologous venous blood injection in patients with lateral epicondylitis of elbow

Study design: descriptive case series

Place and Duration of study: Ayub Teaching Hospital Abbottabad and Saidu Teaching Hospital Swat, from August 2014 to March 2015

Methodology: patients having lateral epicondylitis of elbow were selected from the outdoor department.Two ml of autologous venous blood was drawn from the contralateral antecubital fossa of the patient and slowly injected into the site of maximum tenderness. Patients were advised to continue their normal daily activities and followed up at 2nd, 4th, 8th and 12th weeks post-procedure for assessment of intensity of pain using VAS pain score and Nirschl staging

Results: there were 38 males and 61 females with ratio of 1:1.6. The mean age was 40.91+/-8.21 year. The mean pre-injection Visual Analogue Score [VAS] and Nirschl score were 6.9+/-1.2 and 6.0+/-0.9. At follow up it decreased to 0.9+/-1.0 and 1.5+/-1.1 respectively

Conclusion: autologous blood injection is an effective way to treat patients of epicondylitis of elbow especially in refractory cases

Geriatric fractures: an experience at a tertiary care hospital

Objective: To find out demographics, mechanism of injury and bones involved so as to suggest preventive measures in geriatric population

Study design Retrospective case series

Place and Duration of study: Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2015

Methodology: This study included all patients of age greater than 50 year of either sex admitted through emergency or OPD having any type fracture. The data were taken from hospital database and included clinical, epidemiological and radiological records. The results were analyzed using SPSS version 17.0

Results: A total of 1215 patients were included in the study. Of these 880 [72.4%] were males and 335 [27.6%] females. Male to females ratio were 1.38:1 with mean age of 56.21 +/- 12.603 year. Most of them were between 51-60 year [n=629 - 51.77%]. Femoral fractures were the most common and the main mechanism of injury were fall followed by road traffic accidents

Conclusions: Femoral neck fractures were the most common fractures and mostly females were involved. Fall was the main mechanism of injury

Management of lower limb wounds by negative pressure dressings

Objective: To determine the outcome of home-made negative pressure dressings in acute complex wounds of the lower extremity in terms of healing

Study design: Descriptive case study

Place and Duration of study: Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, from September 2012 to February 2013

Methodology: Patients with soft tissue defects of lower extremity were included. Preoperative size of the wound with Gustilo type IIIA and IIIB was measured and negative pressure dressings were applied. Each dressing was applied for 72 hours. Outcome of the wound was assessed on 9th day after 3 dressings. The quality of granulation tissue and wound healing were noted

Results: A total of 100 patients were enrolled. There were 75 males and 25 females with a ratio of 3:1. Mean age was 32.88 +/- 6.10 year. Seventy percent patients had decrease in size of the wound. Ninety patients developed granulation tissues in the lower limb wounds

Conclusion: Home-made negative pressure dressing was a valuable therapy in the management of acute injuries of lower limb as it resulted in granulation and healing of the wound under challenging conditions

Compassion fatigue amongst health care providers

To find out the frequency of compassion fatigue in health care providers in military hospitals. Cross sectional comparative study. Armed Forces Post Graduate Medical Institute [AFPGMI] CMH Rawalpindi, MH Rawalpindi and CMH Sialkot from December 2013 to July 2014. Two hundred and fifty four health care professional participated in the study. The participants included doctors, nurses and male nursing assistants. The instrument for collecting data consisted of [Professional Quality of Life Measure version 5] [Pro QOL-5] questionnaire. Data was analyzed by using IBM SPSS version 22. The alpha value was set at <0.05 for significance. There were 128 male and 126 female participants with mean age of 31.72 +/- 8.28 years. Reliability of the questionnaire was determined by Cronbach's alpha which was calculated to be 0.81. Seventy nine participants [31.1%] showed low compassion fatigue, 168 [66.1%] showed average compassion fatigue whereas only 7 participants [2.8%] showed high compassion fatigue scores. The difference in frequency of three compassion fatigue levels was significant [p-value < 0.001]. Compassion fatigue was significantly different amongst doctors, nurses and nursing assistants [p-value < 0.01]. Compassion fatigue is higher in doctors as compared to para medical staff irrespective of gender

Effectiveness of incentive spirometry in preventing postoperative pulmonary complications after laparotomy

Objective: To compare the effectiveness of incentive spirometry with deep breathing exercises in preventing post operative pulmonary complications after laparotomy

Study Design: Observational Analytic study

Place and Duration of Study: This study was conducted in the Department of General Surgery, CMH Abbotabad from Jan 2014 to Mar 2015

Materials and Methods: Total of 100 patients fulfilled the inclusion criteria. Patients of both sex and different age groups were included in the study.50 patients underwent deep breathing exercises and 50 patients underwent incentive spirometry postoperatively in addition to deep breathing exercises for five days. ABGs and the temperature was monitored for five days postoperatively. The findings were recorded and analyzed on SPSS 20

Results: The mean age for deep breathing exercises was 40 + 13.34 and for IS was 43 +12.76..the male :female ratio was 1.34:1 for deep breathing exercises and 1.8:1 for incentive spirometry. In group A 52% had no post pulmonary complications while incidence of PPC varied with grade 01 [30%] ,grade 2 [10%] and grade 3[6%] .In group B 74% had no post operative pulmonary complication while incidence of PPC varied with grade 01[18%] ,grade 02[6%] and grade 3[2%]

Conclusion: Our study showed that the use of incentive spirometry along with deep breathing exercises decreases the incidence of postoperative pulmonary complications as compared to deep breathing exercises alone

use of chicken ileum as an alternative isolated preparation for experimental pharmacology

Objective: to evaluate the use of chicken ileum preparation for graded dose response relationship of acetylcholine

Material and Methods: the isolated chicken ileum was obtained from market and processed for pharmacological testing in Tyrode's solution. Graded dose response of acetylcholine on this preparation was studied and recorded

Results: the responses obtained by this tissue preparation were similar to those with rabbit ileum preparation which is usually used in pharmacology experimentations in our set-up

Conclusion: the chicken ileum can be used successfully in routine pharmacology experiments in place of rabbit ileum preparation as it is cheaper and easily available

Prevention of shivering during lower segment cesarean section; comparison of prophylactic use of ketamine, and ketamine plus midazolam during spinal anaesthesia

Objectives: To compare the efficacy of low-dose prophylactic use of ketamine with ketamine plus midazolam for the prevention of shivering caused by spinal anesthesia, during lower segment cesarean section

Main Outcome Measures: Heamodynamic monitoring, avoidance of lactic acidosis/ increased carbon dioxide production and patient satisfaction

Design: Prospective Randomized Controlled trial

Place: Department of Anesthesia and ICU PNS Shifa Karachi

Duration of study: March 2010 to June 2010

Patients and Methods: 100 ASA-I and II consecutive patients who reported for LSCS in PNS Shifa Hospital were studied. In this double-blind study, patients were randomly allocated to receive ketamine alone [Group I, n= 50], and ketamine plus midazolam [Group II, n = 50]. After standardized Spinal anesthesia, a shivering was recorded at 5 min intervals for 15 minutes

Results: Shivering was observed in 9/50 [18%] patients of group I [Ketamine only] as compared to only 2/50 [4%] patients in Group II [ketamine + midazolam] [p=0.025] which is statically significant. The two groups were comparable regarding distribution of age [p=0.37], BMI [p=0.27] and duration of surgery. Results were analyzed by using chi square test

Conclusions: The efficacy of i.v. ketamine plus midazolam is better as compared to lowdose i.v. ketamine alone in preventing shivering in lower segment Cesarean Section patients, during spinal anesthesia

Prevalence of fluorosis among children aged 12 years, living in urban and peri-urban areas of Quetta district, Balochistan

Fluorosis is a condition of structural disorder of the tooth surface during tooth development, which is denoted as enamel hypoplasia. The most common cause of dental fluorosis is the chronic exposure to excessive fluoride particularly in drinking water at the younger age. The aims of this study were to determine prevalence of fluorosis among primary school children in urban and peri-urban areas of Quetta district. Cross sectional study. This study was conducted at Bolan Medical College, Quetta for a period of one month from March to April 2009. Clinical dental examination of school children aged 12 years was conducted for evidence of dental fluorosis using Dean's fluorosis index and the criteria mentioned in WHO oral health surveys methods 4[th] edition 1997. A total of 153 school children aged 12 years,78 [51%] boys and 75 [49%] girls, who have lived in urban and rural areas of Quetta sub district, were randomly selected from the four schools including boys and girls both. Fluorosis was found to be more prevalent in urban school children [60%] as compared with children living in peri-urban areas [47%] with OR .614 [.323, 1.166] and p-value .135. The boys had a slightly higher prevalence of fluorosis as compared with girls 56% and 52% respectively. OR .837 [.443, 1.582] and p-value .584 recorded which were not statically significant. This study highlighted the high prevalence of fluorosis, more than half of the school children, in urban and rural areas of Quetta district Pakistan. Comparatively, fluorosis is more prevalent in urban areas than in rural

Dental caries status among children aged 12-14 years in urban and rural areas of Lasbella district, Balochistan

To assess the dental caries status among 12 to 14 years old children in urban and rural schools. A cross sectional was done. The study was carried out at Lasbella District of Balochistan in October 2010. The duration of study was one month. The study was conducted in one urban and one rural school. The study population was consist of 108 students aged 12-14 year. The DMFT score was recorded on WHO recommended forms for dental caries status. The study period was one month and was conducted in one urban and two rural schools of Lasbella district. The study population consisted of 108 students and out of them 55.6% belonged to rural school and 44.4% belong to urban school. The mean DMFT of rural was higher 2.63 +/- 2.44 as compared to the urban population 2.08 +/- 2. DMFT was highest at the age of 13 years 2.55 +/- 2.17. Males had a higher mean of DMFT 2.46 +/- 2.17 as compared to females 2.32 +/- 2.44. Although there were no significant differences of means of DMFT by age, sex and location of school. Out of the total urban students 39.6% of school children were caries free as compared to 20% of students in the rural population. Our study highlighted the extent of dental disease in urban and rural areas of district Lasbella. There is need and high demand for dental services and awareness raising programs in these areas

HIV/AIDS control practices by dentists of Balochistan - Pakistan

A cross-sectional survey was carried out in Balochistan province of Pakistan to assess the knowledge, perception and infection control practices towards HIV/AIDS among the dentists. The study period was two months and was conducted in Quetta district. Data were collected by mailing questionnaire to 115 dentists, out of which 86 responded [response rate 74.8%].Majority of dentists [63.3%] had overall poor infection control practices. The predictors of infection control practices were found to be sex, marital status and educational attainment. There was a significant association between knowledge, perception and age of the respondents with Spearman's correlation coefficient [P <0.0001], however age was not associated with practice. Infection control practices were found to be strongly associated with overall knowledge and perception of the dentists on HIV/AIDS. The female dentists were found to have increased knowledge on HIV/AIDS as compared to their male counterparts. Regarding the intentions to provide dental treatment to the PLWHAs, less than 25% of the dentists expressed their willingness to provide treatment to HIV infected patients. There is an urgent need to conduct trainings and workshops for the dentists, and the government should provide adequate infection control equipment to government hospitals in Balochistan

patterns and causes of neonatal mortality at a tertiary hospital in Oman

To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. This is a retrospective cohort study where four years data [January 2006 - December 2009] of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths [neonatal and post neonatal] at the neonatal intensive care unit was 73 [63 inborn and 10 out born]. Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths [n=58], 34 [59%] were males and 24 [41%] were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% [n=30]. Lethal congenital malformations lead to 17 [29%] newborn deaths, specific diagnosis in 7 newborns [12%], and birth asphyxia in four [7%] of cases. There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Management of obstructive sleep apnea and facial asymmetry by distraction osteogenesis of mandible

Micrognathia and obstructive sleep apnea syndrome [OSAS] are problems subsequent to temporomandibular joint ankylosis [TMJa] in growing patients. For patients with micrognathia and OSAS secondary to TMJa, it is important to restore proper mandibular form and posterior facial height, achieve occlusal stability and satisfactory mouth opening. We report a 2-year follow-up of a patient with Micronesia and OSAS secondary to unilateral TMJ ankylosis of the right side. The patient had an operation of TMJa before she reported to us but mouth opening was limited. The treatment involved vertical ramus osteotomy, coronoidectomy and external distraction osteogenesis of her mandible. After the treatment of micrognathia oropharyngeal airway space was increased, patient was followed up for 2 years and the results remain uneventful

Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.