Bilateral spontaneous anterior shoulder dislocation: A missed orthopedic injury mistaken as proximal neuropathy / 中华创伤杂志(英文版)

A number of orthopedic injuries can occur during epileptic seizures. Anterior shoulder dislocation is one such orthopedic injury that is quite rare. The shoulder dislocation may injure the brachial plexus. Besides seizures, the nerves can also be damaged by anticonvulsive therapy. Muscle wasting following a seizure can misguide a clinician to investigate only neural or muscular pathologies. We report here an individual with epilepsy who was referred to us for electrodiagnostic evaluation of proximal muscle wasting related to a suspected proximal neuropathy. He was found to have a normal electrodiagnostic evaluation and later on discovered to have had bilateral shoulder dislocation on X-rays. This report advocates a thorough clinical appraisal, radiographs, and electrodiagnostic evaluation in a case with muscle wasting following a seizure.

Frequency of pressure ulcers in patients with spinal cord injury

Objectives: To determine the frequency of pressure ulcers in patients with spinal cord injury. To compare frequency of pressure ulcers in complete and incomplete spinal cord injury using ASIA impairment scale

Study Design: Cross sectional study

Place and Duration of Study: Departments of Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Jun 2013 to Jan 2014

Material and Methods: After permission from the hospital ethical committee and informed consent, spinal cord injury [SCI] patients were included from the outdoor and the indoor departments of Armed Forces Institute of Rehabilitation Medicine Rawalpindi from June 2013 to January 2014. Patients were divided in two groups of complete SCI and incomplete SCI on the basis of American Spinal Injury Association [ASIA] impairment scale. SPSS version 17 was used for data analysis

Results: Total 62 SCI patients were included. Mean age of patients was 36 +/- 0.93 SD. Males were more in number 79% [49]. On ASIA scoring 51.6% [32] were in ASIA 'A' followed by 19.4% [12], 17.7% [11] and 11.3% [7] patients in ASIA 'B', 'C and 'D' respectively. SCI was complete in 51.6% [32] and incomplete in 48.4% [30]. PU were present in 32.3% [20] patients. PU were in stage 4 in 30% [6] patients. PU were more frequent in ASIA [A] injuries followed by [B], [C] and "D" involving 43.8%, 25%,18.2% and 14.3% of patients respectively. Pressure ulcers [PU] were common in complete injuries involving 43.8% [14] than in incomplete injuries 20% [6] [p=0.041]

Conclusions: Pressure ulsers were more common complication detected after spinal cord injury with more frequency in complete spinal cord injury

Clinical assessment of coded Unani formulation D-worm and mebandazole for the treatment of hook worm, roundworm and whip worm

A case control, multicenter, prospective randomized two arm parallel group clinical trials was conducted on 190 patients. The main objective of this study is to provide comparative efficacy results of both trialed medicines. The comparison was done in between herbal medicine D-Worm and Mebandazole allopathic drug for the treatment of helminthiasis. All the rules of GCP [Good Clinical Practices] were followed including clinical history, clinical presentation, examination findings and stool tests. Stool D/R and Parasite antigen tests were performed before and after treatment. The comparison of symptoms were also done including the improvement in abdominal pain, worms in stool, anal itching, nausea and vomiting, loss of appetite, and fatigue etc. The data on clinical proforma was gathered and subjected to statistical analysis. Parasite specific antigen test and stool D/R is considered as gold standard test for the diagnosis and confirmation of helminthes infection. Different parameter i.e. age, sex, and other clinical sign and symptoms were studied and compared between two treatment groups [Control and Test groups] at baseline and end of therapeutic application. Consent of patient was taken at first before the start of examination. Majority of the patients [90%] included in this study group get cured after herbal treatment. The statistical analysis used for the assessment of the effect of the treatment also showed significant improvement after treatment

Frequency of low bone mass in a cohort of mixed pakistani population

To determine the frequency of low bone mass in a multiethnic group of Pakistani population at Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. Cross-sectional comparative study. Outpatient Department of Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from October 2010 to March 2011. A total of 400 patients, both male and female, were sampled according to inclusion criteria by non-probability purposive sampling. Bone density was measured by DXA scan model Hologic [Discovery A], focused at neck of femur and spine. Four hundred patients were included in the study. Average age of the patients was 59.24 years [SD = 10.38] with 258 [64.5%] females. Two hundred and thirty two [58%] were Punjabi, 77 [19.3%] were Pathan, 64 [16%] were Kashmiri, 20 [5%] were Sindhi and 7 [1.8%] were Balochi. Average BMI was 26.45 [SD = 5.31]. Average T-score was -2.037 [SD = 1.40]. Out of 400 patients, 134 [33.5%] patients had normal BMD, 140 [35%] had osteopenia and 126 [31.5%] patients had osteoporosis. Frequency of osteopenia was higher in males than females i.e. 40.8% vs. 31.8% whereas frequency of osteoporosis was higher in females than males i.e. 32.9% vs. 28.9% [p = 0.191]. Similarly association between ethnicity and BMD was also observed to be insignificant [p =0.714]. The study showed high prevalence of low bone mass in Pakistani population in females as well as in males. The results in various ethnic groups are comparable, however, due to availability of smaller number of Sindhi and Balochi people, further multicentre studies at larger scale are recommended

Intercomparison of environmental gamma doses measured with A NaI (Tl) survey meter and thermoluminescent dosimeters (TLDs) in the Poonch division of Azad Kashmir, Pakistan / 生物医学与环境科学（英文）

This study presents the intercomparison of the outdoor environmental gamma dose rates measured using a NaI (Tl) based survey meter along with thermoluminescent dosimeters (TLDs) and estimation of excess lifetime cancer risk (ELCR), for the inhabitants of Poonch division of the Azad Kashmir, Pakistan. CaF2: Dy (TLD-200) card dosimeters were installed at height of 1 m from ground at fifteen different locations covering the entire Poonch division comprising of three districts. During three distinct two month time periods within the six month study period, all the installed dosimeters were exposed to outdoor environmental gamma radiations, retrieved and read out at Radiation Dosimetry Laboratory, Health Physics Division, PINSTECH laboratory, Islamabad. The ambient outdoor gamma dose rate measurements were also taken with NaI (Tl) based portable radiometric instrument at 1 m above the ground. To estimate the annual gamma doses, NaI (Tl) based survey data were used for one complete year following the deployment of the dosimeters. The mean annual gamma dose rates measured by TLDs and survey meter were found as 1.47±0.10 and 0.862±0.003 mGy/y respectively. Taking into account a 29% outdoor occupancy factor, the annual average effective dose rate for individuals was estimated as 0.298±0.04 and 0.175±0.03 mSv/y by TLDs and survey meter, respectively. For outdoor exposure, the ELCR was calculated from the TLD and survey meter measurements. The environmental outdoor average annual effective dose obtained in present study are less than the estimated world average terrestrial and cosmic gamma ray dose rate of 0.9 mSv/y reported in UNSCEAR 2000. The possible origins of gamma doses in the area and incompatibilities of results obtained from the two different measurement techniques are also discussed.

Role of pulsed electromagnetic therapy in the management of backache: a study conducted at armed forces institute of rehabilitation medicine, Rawalpindi

To determine the role of pulsed electromagnetic therapy in providing pain relief for backache. This was a quasi experimental study. This study was conducted at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan from Jan 2012 to June 2012. This study included 65 consecutive patients with backache. The pain was assessed on 11 points [0-10] Numeric Rating Scale [NRS] and patients with score >1 were included in the study. Detailed history was obtained and examination was performed. All patients were subjected to pulsed electromagnetic therapy. The pain was assessed at first week, 2nd week, third week and six week after start of the pulsed electromagnetic therapy. Data was compiled and analysed using SPSS version 17. A p-value < 0.05 was considered as significant. There was marked reduction in pain of patients with backache after treatment with pulsed electromagnetic therapy. Reduction in pain as calculated by the NRS [numeric rating scale] value after 1[st] week was 25.35% [p=0.002], after 2[nd] week was 43.66% [p=0.001], after 3[rd] week was 50.7% [p=0.001] and after 6 weeks was 71.83%[p=0.001]. Pulsed electromagnetic therapy is very effective in relieving pain in patients with backache

Results of distraction compression and compression distraction in segmental defects of tibia with the use of Ilizarov's external fixator

To compare the results of distraction-compression and compression-distraction in segmental loss of tibia by Ilizarov extent fixator and to see the functional end results of each procedure. Comparative study. This study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan from April 2008 to March 2010. A total of 30 cases were included in the study. Gap non-union in tibia is a frequently encountered problem in open tibial injuries. Their treatment have been unsatisfactory until the introduction of distraction histeogenesis by Ilizarov, before the end results were often amputation. Gap non-union of up to 5 cm can be managed by initial compression, later on the LLD is addressed and distraction histeognesis whereas gap of >5 cm are amicably managed by segment transport i.e. distraction and later compression between the transported segment to other end of the fracture. Both methods are excellent if the limitations and principles are followed. Our recommendations are gaps of < 5 cm to be managed and compression-distraction of gaps of >5 cm to be managed with distraction compression mode of treatment

Comparison of adynmic external fixator with dynamic external fixator in the management of the comminuted fractures of distal radius in the patients between 40-45 years age

To compare the treatment outcome of comminuted intra-articular fractures distal radius with adynamic external fixator and dynamic external fixator in patients of 40-65 years of age. Experimental Study. This study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan from Jan 2010 to December 2011. This experimental study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan. A total of 60 patients in both groups were included in the study. Out of the 60 patients, 43 [71.7%] were male and 17 [28.3%] were female with the right hand 35 [58.3%] and left hand 25 [41.7%]. It is concluded that dynamic external fixator is a better method of treatment for the comminuted fractures of the distal radius than adynamic external fixator because it allows early motion of tendons, muscles and adjacent joints and later, of the wrist itself while reduction and especially radial length were maintained in bridging external fixation

Icterus neonatorum in near-term and term infants an overview

Neonatal jaundice is the yellowish discoloration of the skin and/or sclerae of newborn infants caused by tissue deposition of bilirubin. Physiological jaundice is mild, unconjugated [indirect-reacting] bilirubinaemia, and affects nearly all newborns. Physiological jaundice levels typically peak at 5 to 6 mg/dL [86 to 103 micro mol/L] at 72 to 96 hours of age, and do not exceed 17 to 18 mg/dL [291-308 micro mol/L]. Levels may not peak until seven days of age in Asian infants, or in infants born at 35 to 37 weeks' gestation. Higher levels of unconjugated hyperbilirubinaemia are considered pathological and occur in a variety of conditions. The clinical features and management of unconjugated hyperbilirubinaemia in healthy near-term and term infants, as well as bilirubin toxicity and the prevention of kernicterus, are reviewed here. The pathogenesis and aetiology of this disorder are discussed separately

Frequency of axonal variants of guillain-barre syndrome in Pakistan

To determine the frequency of axonal variants in our patients of Guillain-Barre Syndrome. Descriptive study. Department of Neurology, Military Hospital, Rawalpindi and Armed Forces Institute of Rehabilitation Medicine [AFIRM] from 01 Jan 2009 to 30 Jul 2010. Forty adult patients meeting the National Institute of Neurological Disorders and Stroke criteria for Guillain-Barre Syndrome [GBS] were consecutively enrolled in the study. Patient's data, detailed history, examination and electrophysiological studies were carried out and recorded on predesigned proforma. All patients were examined and reviewed by Consultant Physicians and neurologists. Electromyography and Nerve conduction study testing was done by experienced electro-physiologists. Axonal variants of Guillain-Barre Syndrome constituted 16[40%] in our study. The variants of Guillain-Barre syndrome were acute inflammatory polyradiculoneuropathy [AIDP] in 24[60%] patients followed by acute motor axonal neuropathy [AMAN] in 12[30%] and acute motor sensory axonal neuropathy [AMSAN] in 4[10%] patients. We report a high frequency of the axonal variants of Guillain-Barre Syndrome in Pakistan

Obesity

To assess frequency of obesity among college adolescent male and female students on BMI-Prime bases through anthropometric. Cross sectional study. At higher secondary colleges located in urban areas of Bahawalpur City. From February 2009 to March 2009 Assessment of obesity among 400 college male and female students equally divided, ages from 16 to 23 years was carried out on BMI-Prime bases. Weight categories so achieved were stratified and labeled. There were 3 [0.75%] severely under weight, 44 [11%] under weight, 273[68.25%] normal, 68[17%] over weight, 9[2.25%] obese and 3[0.75%] were clinically obese. There was no morbidly obese. No statistical gender difference for severely under weight and clinically obese was noted. However females were more under weight [p<0.05] while males were more over weight [P<0.05] and obese [P<0.05] when compared with each other. The adolescent female college students were under weight when compared to their male colleagues. The frequency of obesity was higher among male students

Prevalence of blood pressure and blood sugar in a sample of older people: a situation analysis across different socio-economic neighborhoods in Lahore, Pakistan

The blood pressure and blood sugar levels were measured from a sub-sample of older persons of both sexes across six urban localities of Lahore, Punjab, Pakistan. A survey was conducted on 921 respondents in September 2006 to accomplish our PhD research; 300 respondents aged 50 years and above were tested for blood pressure and blood sugar levels. Systolic and diastolic blood pressures increased with age, as expected, while diabetes was more prevalent in younger cohort of respondents. Exactly 17.6% of the total number of respondents were suffering from hypertension stage-2 [SBP> 160/DBP> 100 mmHg] and 21.0% of them had> 180 mg/dL sugar level. Gender based comparison indicated that women suffered more from hypertension and diabetes than their male counterparts. Both the hypertension and diabetes were more prevalent among the respondents from lower socio-economic strata. These findings are expected to underline the need for the due policy interventions for improving the life quality of our elderly

Electrodiagnosis of thoracic outlet syndrome

This is a prospective study of 50 patients of suspected neurogneic thoracic outlet syndrome [TOS] who were referred to Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. In this article we have presented our 2 years experience [Jul 1998 to Jun 2000] of clinical evaluation and electrophysiological studies of patients between 14 -75 years of age [mean age 39.72]. Nerve conduction studies [NCS] were performed on MS6 system [MEDELEC] and needle electromyography [NEMG] was performed with NEUROPACK electromyography model MEM -7102 K. Final diagnosis made on electrophysiological studies showed 30 cases of TOS, CTS, ulnar tardy syndorme, ulnar compression at canal of Guyon, C8 radiculopathy and normal study. TOS was twice more common in women. It most commonly affected patients in the 3'd and 4"' decade. Most frequent symptoms were pain, paraesthesia and weakness of hand muscles. Roos test was positive in 92% patients. Electrophysiological studies are very useful to confirm the diagnosis, rule out other entrapment neuropathies and decide the mode of treatment in neurogenic TOS

Electrodiagnostic evaluation of diabetic polyneuropathy

In this prospective study, 47 cases of diabetes mellitus [IDDM and NIDDM] suspected of diabetic neuropathy were studied to delineate the underlying pathology and localize lesion. Nerve conduction studies [NCS] were performed with MS 6 [MEDLEC] using surface electrodes. Concentric needle electromyography was done using Neuropack electromyographic model MEM7102K. On the basis of electrophysiological studies 39 patients had diabetic neuropathy, rest of patients had radiculopathies, thoracic outlet syndrome [TOS] and other abnormalities. Electrodiagnostic studies were helpful in confirming the diagnosis, localizing the entrapment neuropathies and in segregating the axonal/demyelinating neuropathies