Non-islanded distally based sural artery flap: a reliable solution for an unreliable flap

Objective: to assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure [partial and major flap necrosis], number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel

Study Design: cohort study

Place and Duration of Study: department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014

Methodology: distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05

Results: the mean age of patients was 38.4 +/- 16.2 years in G1 and 35.1 +/- 18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 +/- 1 and 2 +/- 1 in G2 [p < 0.001]. The mean hospital stay in G1 was 43.1 +/- 3.6 days while 27.9 +/- 2.1days in G2 [p < 0.001]. There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps [G1] and in 9 out of 41 non-islanded flaps [G2] [p=0.0203]. Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps [p=0.024]

Conclusion: distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap

Prevalence of zinc deficiency among rural women during childbearing age in Peshawar, Pakistan

Zinc deficiency is a commonly reported health problem throughout the world. This cross sectional survey was conducted in rural Peshawar with an aim to estimate the prevalence of zinc deficiency in women of child bearing age and find its association with age, marital, pregnancy status and parity. Data was collected from 353 women age 15-45 years. EPI INFO version 6.04 was used for data analysis. Overall 98 [27.8%] women were zinc deficient [

Involvement and barriers to research amongst students of Khyber Medical College

To find the involvement in research amongst students of Khyber Medical College and to identify reasons for not doing research. A cross-sectional study was performed in which medical students [n=160] from different years of study were asked to fill a questionnaire. Stratified random sampling was done as 20 male students and 20 female students from each year answered the 10-question. Total positive score was calculated. One-hundred and sixty students completed the survey. There were equal male and female respondents [80 each]. The students were from 2[nd], 3[rd], 4[th] and final year. Among the respondents, only fifteen [9%] were involved in a research project; one hundred and thirty students [81.2%] believed that research is easy if proper guidance is given. One hundred and one students [63%] thought that research could enhance understanding of the subject. Most students disagreed with the idea that research could only be done by intelligent students [139, 86.8%]. One hundred and forty students [87.5%] replied that they are interested in doing research, provided proper guidance is given. In this study, we found out that very few students of Khyber Medical College are involved in research. Lack of awareness regarding importance of research and lack of guidance for undertaking research were identified as main barriers for doing research. The concerned authorities need to take steps to encourage students and should involve teachers to streamline the process

Comparison of Phytochemical constituents and antimicrobial activities of Mentha spicata from four northern districts of Khyber pakhtunkhwa.

The medicinal value of plants lies in bioactive phytochemical constituents that produce definite physiological actions on the human body. Some of the most important bioactive phytochemical constituents are Tannin, Alkaloids, Saponins, Flavonoids, Steroids, Anthraquinones, Coumarins and Sterols and Terpenes. Infectious diseases are the leading cause of death worldwide, accounting for nearly one half of all deaths in tropical countries which are also becoming a significant problem in developed countries. Therefore the present study was aimed to analyzed the phytochemicals and antimicrobial activities of Mentha spicata. The phytochemical constituents were determined by using known literature method while the antimicrobial activity was analyzed by classical literature methods. In case of phytochemicals, Tannin, Alkaloids, Glycosides, Flavonoids, Steroids, Coumarines, Sterols and Terpenes were found while saponins and anthraquinones were not determined in all the samples. Antibacterial activity was noted high in all the samples of crude extract followed by ethyl acetate and lowest activity was found was found in aqueous extract of Mentha spicata. The Same results were analyzed for antifungal activity.

Modified acid fast staining: a better diagnostic tool in chronic diarrhoea due to cryptosporidiosis

Background: Cryptosporidium parvum is an emerging pathogen responsible for chronic diarrhoea in children and immuno-compromised individuals, especially AIDS patients. Currently, there is no effective therapeutic strategy for treating cryptosporidiosis, therefore control and supportive treatment of cryptosporidiosis depends upon rapid and accurate diagnosis of this infection. Methodology: A descriptive study was conducted in the Pathology Department of Khyber Medical College and Pathology Laboratory of Khyber Teaching Hospital over a period of one year March 2007–April 2008. A total of 200 stool samples were tested for the presence of C. parvum oocysts from children <5 years age suffering from diarrhoea for >5 days. Total and differential leukocyte count was determined to assess immune status of the patients. Modified Ziehl-Neelsen [Z-N] staining, a rapid, sensitive and easy test, was used successfully for the detection of C. parvum oocysts in stool specimen. Results: Cryptosporidium oocysts were found in 18 [9.0%] samples. Out of 18 positive cases, 13 [72.2%] children had lymphopenia hence their immune status was impaired. Infection was common in children between 1–24 months of age. Mean duration of diarrhoea was 11 months. Most of C. parvum infected children were consumers of well water [77.8%]. Conclusion: Cryptosporidiosis, although a self-limiting disease, rarely investigated routinely, can become chronic and life threatening in immuno-compromised individuals. Majority of affected patients are immunecompromised. Modified Z-N is a sensitive and rapid method which can explore the gravity of this infection even further if used routinely and may control morbidity and mortality associated with this infection. Keywords: Chronic diarrhoea, modified Ziehl-Neelsen staining, immuno-comprised

Awareness of viral hepatitis in ten villages of district nowshera

Viral hepatitis is a cause of great concerns the world over and more so in the developing countries like Pakistan. Its incidence has increased to alarming proportions and is likely to increase further in near future. This study was conducted to assess awareness of a rural community to Hepatitis B and C. A cross-sectional study was conducted from November 2007 to October 2008, in ten villages of District Nowshera. Questionnaire was designed to assess their knowledge about viral Hepatitis. Data was computed using SPSS version 10. A total of 3654 respondents were interviewed, 642 [17.6%] were aware that Hepatitis B and C were diseases of liver and transmitted by a virus. Respondents reported that there were multiple routes of transmission of this disease. Used syringes were the most common factor reported to be responsible for spread of this disease, followed by dental apparatus, injuries caused by nail cutters and sexual contact. One fifth [20%] of the respondents were unable to identify any physical sign or symptom of the disease. Television, Doctors and Radio appeared to be the most popular sources of information used for obtaining health information on these diseases this was reported by 43%.42% and 40% of the population respectively. Knowledge and awareness regarding the causative agent, mode of transmission and the consequences of Hepatitis B and C are poor in rural communities

Prevalence of obesity in men and its relationship with diet and physical activity

Obesity is one of the major nutritional problems in the world as well as in Pakistan. The objective of this study was to find out the prevalence of obesity in males in six socio-economically diverse areas of Peshawar, and its relationship to energy intake and physical activity. Three urban and three rural areas were selected from District Peshawar to cover the diverse socio-economic variation. One hundred households were randomly selected from all the 4 areas. Male participants who gave consent and were above 30 years of age were selected. A total of 600 participants fulfilled the selection criteria and were included in the study. Data was collected using structured questionnaire and anthropometric indices were calculated using standard tools for measuring height, weight and body mass index. The prevalence of obesity in our male participants was 7% and overweight 34%. The average energy intake in urban areas was 2593 +/- 465 Kcal/day and in rural areas 2433 +/- 425 Kcal/day. The calories consumed consisted of 50-56% of fats, 32-33% of carbohydrates and 11-12% of proteins. Participants who did less physical activity were three time more likely to have a high Body Mass Index, and those who consumed more calories were twice as likely to have higher BMI than those who did not. Multivariate logistic regression showed that high energy intake, living in urban areas and sedentary lifestyle is positively associated with obesity. The prevalence of obesity in males in our set up is 7% and overweight 34%. High energy intake, living in urban areas and sedentary lifestyles are positively associated with obesity

Relationship between silica dust exposure and chronic obstructive pulmonary disease in workers of dust generating industries of district Peshawar

Chronic Obstructive Pulmonary Disease is a common cause of morbidity worldwide. This study was conducted to assess the relationship between silica dust inhalation and COPD among workers of dust generating industries. This cross sectional study was conducted in three main industrial regions of Peshawar i.e. Industrial Estate Hayatabad, Industrial area Ring Road and Industries of Warsak Road Peshawar. A preformed questionnaire was used to interview 160 workers, 40 each from stone-grinding, ceramics, pottery and brick industries respectively. Only workers having worked for more than five years were selected through convenient sampling. A total of 160 workers were interviewed out of which 56[35%] were symptomatic while 104[65%] were asymptomatic. Among symptomatic ones, 20[19.8%] were in 20-40years age group and 36[61%] in 41-60 years age group. In regard to exposure status, 7[26%] were symptomatic in those exposed for 5-10 years, 29[31.5%] amongst those exposed for 11-15 years and 20[49%] in those exposed for 15-20 years. With respect to working hours, none was symptomatic in those who had worked for 6 hours or less while 56[40%] were symptomatic in those who had worked for 8 or more hours. Among 128 smokers, 48[37.5%] were symptomatic and amongst 32 non-smokers 8[25%] were symptomatic. Amongst the symptomatic cases symptoms appeared within 5-10 years in 7[12.5%] of the cases, within 10-15 years in 29[51.8%] of the cases and within 15-20 years in 20[35.7%] of the cases. The major symptoms reported were cough in 56[100%] of the cases, dyspnea in 48[85.7%] and wheezing in 49[87.5%] of the symptomatic cases. The study revealed that majority of respondents who were exposed to silica dust for ten years or more, had respiratory problems. The severity of the problems was directly proportional to the duration of exposure to silica dust, density of dust [maximum in stone crushing], hours of daily exposure and other contributory factors like tobacco smoking and increasing age

Experience with temporalis muscle transfer for dynamic reanimation of paralyzed face in long-standing cases of facial palsy

Paralysis of facial nerve leads to a severe deformity which seriously handicaps the patients, both aesthetically and functionally. Anderson's modification of Gilles' technique involves the use of ipsilateral temporalis muscle lengthened by the slips of its overlying temporalis fascia to restore function and rehabilitate the patient with typical deformity. A total of 28 patients underwent facial reanimation with this technique at the Department of Plastic Surgery, Mayo Hospital, Lahore from January 1990 to June 1998. The mean age was 23.25 years and mean duration of facial palsy was 14.5 years at the time of presentation. The results were evaluated in terms of aesthetic and functional improvement. The aesthetic appearance of eye was excellent in 3 patients, good in 23 patients. Functional recovery was excellent in 15 patients, good in 12 patients and satisfactory in one patient. Aesthetic improvement in the region of cheek and oral sphincter was excellent in 4 patients, good in 17 patients, satisfactory in 5 patients and poor in 2 patients. Functional gain In this region showed excellent results in 7, good in 15, satisfactory in 5 patients and poor in one patient. The results reaffirm the role of dynamic reanimation, in long standing cases of facial palsy, by temporalis muscle transfer