RESUMO
Introduction: Atherosclerosis is a systemic disorder that often involves multiple arterial beds such as carotid, coronary and peripheral arteries. The progressive simultaneous increase in the degree of carotid artery stenosis [CAS] with CAD [Coronary Artery Disease] has raised the valid speculations of a same mechanism of stenosis in both the arterial fields
Objective: The objective of this study was to correlate CAS severity with CAD severity by comparing Ultrasound measurements of CAS in study group subjects with evidence of significant CAD on coronary angiography and control group subjects with normal coronaries or non-significant CAD coronary angiography
Methodology: This case control study was conducted at Cardiology Department/Punjab Institute of Cardiology Lahore, Punjab, Pakistan from 1/2/2016 to 30/7/2016. In this study the Non Probability consecutive sampling technique was used. The Sample size was 86 with 43 case and 43 control population
Results: The average age of the patients was 53.45+/-10.16 years. The female to male ratio was 1:1.9. In this study 46 percent had normal carotid arteries with no evidence of atherosclerotic plaque. Clinically significant Carotid artery stenosis [>50 percent] was found in 0 percent of patients with normal coronaries and in 4.3 percent of patients with non-significant CAD. Similarly, clinically significant CAS was found in 10 percent, 20 percent, 50 percent, and 45.5 percent of patients with 1 VD, 2 VD, 3 VD and LMD, respectively. In this study there was the positive correlation between the CAS and CAD severity while comparing cases and control groups
Conclusion: The principle result of this study is that the degree of carotid artery disease is positively correlated to the severity of CAD
RESUMO
Introduction: Celiac disease [CD] is a gluten sensitive enteropathy characterized by villous atrophy of the small intestine in genetically susceptible individuals. Anemia is frequently seen in celiac disease owing to greatly reduced iron, folic acid and B12 absorption
Objectives: To determine the frequency of celiac disease in patients presenting with nutritional anemias
Study design: Descriptive cross-sectional
study Setting: department of Internal Medicine, Services Hospital Lahore
Duration of study: Seven months from May 2017 to December 2017
Sample size: The calculated sample size is 100 cases
Sampling technique: Non-probability purposive sampling
Data collection procedure: 100 consecutive patients presenting with nutritional anemia were enrolled. Complete hematologic workup was done including blood complete picture [CP], peripheral smear, iron, folate and B12 levels. Anemia was defined as Hb<13 g/dL in males and <12 g/dL in females. Only cases with anemia secondary to iron, folate or B12 deficiency i.e. nutritional causes were included in the study Patients were then subjected to anti-tTG antibody testing. Jejunal biopsy was taken in all those cases which tested positive for anti tTG antibody. A diagnosis of CD was established upon positive histopathology findings All the data was recorded on a pre-designed proforma and analyzed by SPSS version 21.0
Results: The prevalence of Celiac disease was found to be 12 percent.10 out of 12 celiac disease cases were having IDA; 1 each showed dimorphic picture and concomitant B12 + folate deficiency respectively with none of the CD patients having folate or B12 deficiency alone
Conclusion: Celiac disease may be found in up to 12 percent of Pakistanis presenting with nutritional anemia. Hence, all those patients not responding to standard anemia treatment should be screened for celiac disease
RESUMO
Objective: To find out risk factors of heart failure after ST Elevation Myocardial Infarction [STEMI] and to see the most commonly involved vessels in myocardial infarction responsible for heart failure
Methodology: This cross-sectional study was conducted from June 2013 to November 2013. 225 patients of heart failure [HF] following STEMI who came in the emergency department of the hospital were included. The selected patients were followed till the angiography reporting. Statistical analysis was done in SPSS version 16
Results: Mean age of patients was 51.42 +/-11.78 years. 49.0% patients were hypertensive, 37.3% patients were diabetic, 44.0% were smokers and 18.2% had positive family history. In this study, anterior wall MI was predominant and found in 30.7% patients. 46.7% patients had triple vessel disease [TVD]. There was 33.7% involvement of Left main stem [LMS]
Conclusion: Hypertension and smoking are most common risk factors of heart failure. The patients who present with heart failure are most who have involvement of triple vessel coronary artery disease. Left main stem [LMS] is most commonly involved vessel in these patients
RESUMO
Objective: To assess the proportion of non urgent patients presenting to the emergency department and to compare urgency evaluation between patients and doctors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Emergency department Combined Military Hospital [CMH] Jhelum, from November 2015 to December 2015
Material and Methods: All the patients presenting to the emergency department after working hours between 4-6 pm were documented for 16 consecutive working days. They were assessed as to the urgency of their condition by the doctor. The patients or guardians in case of children were also required to rate the level of urgency of their medical condition. The level of urgency was graded on visual analog scale from 0-10. A 5 and above score was labeled as urgent while a score of less than 5 was considered non urgent
Results: A total of 205 patients reported in 32 hours over 16 days, to the emergency department. Of these 31 [15.12%] were assessed as emergencies by doctors while 49 [24%] were thought to be emergencies by patients. The p-value for this difference was 0.021. The largest group of patients visiting the emergency department was pediatric and they comprised the largest group of non urgent visits to the hospital as well
Conclusion: Actual emergencies comprise a small proportion of visits to emergency departments while the main bulk consists of non urgent visits
RESUMO
Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries
Objective: To determine the levels of vitamin D in trauma patients above 18 years of age
Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16
Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake
Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment
RESUMO
Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options
Objective: To determine the outcome of sural artery flap for wound coverage around ankle
Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16
Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%
Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome
RESUMO
Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score
Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD
Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years
Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD
RESUMO
Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia
Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment
Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters
Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia
RESUMO
Objective: To see the role of Vitamin D supplementation on physical status of patients suffering from Congestive Heart Failure [dilated cardiomyopathy]
Methods: In this nonrandomized clinical trial, Forty three Patients with dilated cardiomyopathy who were not showing any significant improvements in physical performance on optimal treatment of heart failure were included. Vitamin D [200,000 IU] supplementation on weekly basis for a period of 12 weeks was added to heart failure treatment. And its effect was seen on 6 minutes' walk distance and Pro-BNP levels. SPSS version 19 was used for data analysis. Dependent sample t-test was used to see the significant effect of vitamin D supplementation on pre-intervention vitamin D levels, 6MWD and Pro-BNP. Taking p-value <0.05 as significant
Results: On clinical assessment most of the patients were in NYHA class II [65%], the percentages of NYHA Class I, III and IV was 19%, 9% and 7% respectively. The baseline mean vitamin D level of the study group was 16.59 +/- 3.54ng/ml and it raised to 31.97 +/- 3.64ng/ml after 12 weeks of supplementation with vitamin D, p value <0.0005. The mean distance travelled by the study group before the intervention was 806 +/- 380ft while it increased to 945 +/- 393ft after the intervention, p value of 0.008. The mean of pro-BNP level of the study group before the intervention was 1024 +/- 635 while it improved to 159 +/- 80 after the intervention with a significant p value <0.0005
Conclusion: Vitamin D supplementation decreases the severity of HF as reflected by reduction in serum pro-BNP levels and significant increase in six minutes' walk distance
RESUMO
Background: Isolated gastric varices [IGV] are one of the major causes of upper gastro intestinal bleeding in cases with liver cirrhosis. They are difficult to manage and N butryl cyanoacrylate is one of the options
Objective: To determine the efficacy of N butryl cyanoacrylate in cases with isolated gastric varices due to liver cirrhosis
Methodology: This cross-sectional study was conducted at Endoscopy unit of Hamza Medicare Hospital, Rahim Yar Khan from 1st January 2015 to 31 th July 2016. The cases presenting with upper GI bleedy and history of liver cirrhosis [documented by presence of jaundice, ascites, hepatic encephalopathy, deranged LFTs, i.e. serum bilirubin, PT, albumin] irrespective of etiology and the child pugh class were included. The endoscopy was done by Olympus GIF-XQ140 and the site of bleeding varices were documented. The cases of isolated gastric varices of any type or severity were considered. Then glue comprising N butryl cyanoacrylate with lipoid solution in a ratio of 5:8 was injected into the varices in a dose of 2.5 to 5 cc and were then followed for next 5 days for any re bleeding episode and control of homeostasis. The cases, in which no such event was noted, were labeled as with positive efficacy. The data was entered and analyzed by using SPSS version 21
Results: In this study out of total 54 cases of IGV, there were 34 [62.96%] males and 20 [37%] females. The mean age was 58.50 +/- 15.54 years. There were 47 cases with hepatitis C and 7 has hepatitis B. Efficacy was seen in 52 [96.30%] out of 54 cases. Thirty-three out of 34 males and 19 out of 20 females has shown efficacy with p value of 0.80. The efficacy was better seen with age group of 15 to 35 years with cure in 5 [100%] out of 5 cases as compared to lower rate in others with p= 0.27. The cases with Child pugh class C contained the both failure cases with significant p= 0.04. There were one case each with hepatitis B and C with failure with p= 0.39
Conclusion: N butryl cyanoacrylate has a high efficacy rate in shortterm relief for bleeding and Child pugh class C is significantly associated with lower success rate
RESUMO
Background: Liver cirrhosis, associated with upper gastrointestinal [GI] bleed, is one of the leading cause of morbidity and mortality. Esophageal and isolated gastric varices, both are common but the later is the more difficult to treat
Objective: to determine the frequency of isolated gastric varices in cases with liver cirrhosis presenting with upper gastrointestinal bleeding
Methodology: This cross sectional study was conducted at Hamza Medicare Hospital, Rahim Yar Khan from 1 January 2015 to 31 July 2016. The cases with upper GI bleeding due to liver cirrhosis [assessed by presence of ascites, splenomegaly and deranged liver functions like LFTs, PT] were included in this study. Sociodemographic data was collected like age, gender and other data like type of viral hepatitis and other examination to label for their child pugh class. The cases then underwent upper GI endoscopy with Olympus GIF-XQ140 and were assessed for presence of ulcers or varices from esophagus to stomach. The cases with varices of any size or type only in the gastric area were labeled as isolated gastric varices [IGV]. The data was entered and analyzed by SPSS version 21
Results: In this study there were total 662 cases of liver cirrhosis out of which 180 [27.19%] were females and 482 [72.81%] males. The mean age was 58.50+/- 15.51years. There were 495 [74.77%] cases with hepatitis C and 167 [25.23%] with hepatitis B virus. Isolated gastric varices. [IGV] were seen in 54 [8.17%] cases. All the cases were in GV1 class and all has size of more than 10 mm. IGV were seen in 34 [7.05%] males as compared to 20 [11.11%] females [p value= 0.53]. There was no significant association of GV with any age group with p= 0.17. There was significant association of IGV with child pugh class C [p=0.03]. There was no significant association with type of hepatitis with IGV [p=0.21]
Conclusion; Isolated gastric varices are common entity and every twelfth case of liver cirrhosis develops this. Child pugh class C is significantly associated with isolated gastric avarices
RESUMO
Background: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic gallstones disease. Open cholecystectomy results mainly in parietal pain while laparoscopic cholecystectomy causes visceral pain
Objective: To compare post-operative visceral pain at 24 hours in patients undergoing laparoscopic cholecystectomy with and without intra peritoneal instillation of bupivacaine
Methodology: Setting: Surgical Unit II, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Duration of Study: 1 July to 31 December 2015. Study design: Randomized controlled trial [RCT]. A total of 60 patients having symptomatic gallstones disease were included in this study. Patients were randomly divided into two groups. Thirty patients in group Awere treated with bupivacaine 0.5 % instillation. For the patients in group B, the dose was not instilled in the gall bladder fossa and right and left sub diaphragmatic spaces. Postoperative pain was assessed up to 24hours after surgery using Visual Analogue Scale [VAS]. The data was entered and analyzed by using SPSS version 16
Results: The mean age of the patients was 35 +/- 8 years in group A, and 37 +/- 8 years in Group B. Post operative pain at 24 hours was significantly low in group A than in group B [33.3% vs. 70%; p=0.004]
Conclusion: Intraperitoneal bupivacaine instillation after laparoscopic cholecystectomy reduces pain in the initial postoperative period. It is easy to administer with no adverse effects and may become a routine practice for this procedure
RESUMO
Background: Tibia fractures in skeletally immature patients are usually treated conservatively but sometimes operative treatment becomes essential
Objective: To determine the outcome of closed titanium elastic nailing in pediatric tibia diaphyseal fractures in terms of union and range of motion at knee and ankle joints
Methodology:Across sectional study was conducted at Orthopedics Department of Lahore General Hospital, Lahore. A total of 35 patients ageing between 6-12 years with unilateral, isolated, closed displaced diaphyseal fractures of tibia were included in this study. Patients were followed in outpatient department after 15 days for operative wound examination and then were followed after every 2 months to determine the progress in union and range of motion. The collected information was entered in PASWStatistics 18 and analyzed
Results: The minimum age was 6 and maximum was 12 years. There were 19[54.3%] males and 16[45.7%] females. According to Hammer classification of fracture healing, at 2nd week post operative all patients has Grade-V. At 2nd Month follow up 12[34.28%] patients has Grade-II and 23 [65.72%] patient has Grade-III fracture healing. At 4th month follow up 30[85.71%] patients has Grade-I and 5[14.2%] patients has Grade-II union. At 6th month follow up all 35[100%] patients has Grade-I fracture healing
Conclusion: Treatment of diaphyseal fractures of tibia in children with closed elastic intramedullary nailing is a rapid and effective method in terms of bone union and range of motion of the ankle and knee joints
RESUMO
Background: Fractures of patella are common and it constitutes about significant proportion of all skeletal injuries resulting from either direct or indirect trauma
Objective: To evaluate the outcome of inferior pole fractures of patella treated with tension band wiring and resection of avulsed fragment and re-attachment of ligament to patella
Methodology: This was an comparative study, carried out in Department of Orthopaedic surgery of Lahore General Hospital, Lahore from 16[th] June 2012 to 15[th] June 2014. A total of 20 patients were included in this study. These patients were randomly divided into two groups. In Group-A patients were treated with open reduction and internal fixation with tension band wire and in Group-B patients were treated by resection of the avulsed fragment and reattachment of the patellar ligament to the patella. Patients were followed up for surgical site infection and functional outcome at 1[st], 7[th], 15[th], day one month, three months and six months post operatively. Final outcome was assessed by using Bostman criteria. Data entry and analysis was done by using SPSS version 17
Results: Mean age of all 20 patients was 34.20 +/- 12.13 years. Although both treatment groups had statistically same rate of surgical site infection from 1[st] day till 15[th] day post operatively. From 1[st] month till 6[th] months follow up time period none of the patients had surgical site infection in both treatment groups. At 1[st] month and 6[th] month post operatively in Group-B outcome was statistically better as compared to Group-A patients. But at 2[nd] month outcome of patients was statistically same in both treatment groups
Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had good outcome according to the Bostman criteria as compared to open reduction and internal fixation with tension band wire
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fraturas Ósseas , Fixação Interna de Fraturas , Fios Ortopédicos , Avaliação de Resultados da Assistência ao PacienteRESUMO
This study was carried out to determine the frequency of thymoma in different age groups and sexes in thymectomy specimens in Myasthenia Gravis patients. Observational study. The study was carried out in General Surgery Department at PIMS over a period of three years from 2009-2012. PIMS is a tertiary care centre where large population of Islamabad and Surrounding territory, including AJK, Gilgit Baltistan, Hazara division, Peshwar and nearby districts of Punjab gets treatment. A total of 30 patients selected at random, were included in this study. Patients were of different age groups, above 12 and under 52 years of either sex. Patients with poor medical control of disease with no contra indication for surgery. Patients with operable mediastinal mass [thymoma] were included. Generalized myasthenia gravis was diagnosed in patients. Pre-operative plasmaphoresis was carried out in all patients. Transsternal approach was used in all cases although now video assisted thoracoscopic thymectomy is becoming popular. Intraoperative findings were noted with emphasis on gross appearance and an information by histopathological report [frozen section]. In our study 17 % thymectomy specimens turned out to be Thymoma. Male to female ratio was 3:2. Age range was 12 years to 52 years. All patients undergoing thymectomy for Myasthenia Gravis don't have thymoma. Moreover all Thymomas are not associated with Myasthenia Gravis. Ages between 3[rd] to 5[th] decade are affected by thymoma and gender difference is very little
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Timectomia , Miastenia GravisRESUMO
Objective: To determine the frequency of thyroid dysfunction among patients of chronic hepatitis C [HCV] infection receiving combination of interferon-alpha and ribavirin therapy
Study Design: Cross-sectional study
Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from September 2012 to March 2013 over a period of six months
Patients and Methods: In this study, 170 diagnosed patients of chronic HCV [confirmed by anti-HCV and HCV RNA-positive] presenting to medical OPD with normal thyroid functions were recruited. All patients fulfilled inclusion and exclusion criteria. They were prescribed IFN-alpha 2b [3 million units subcutaneously 3 days a week] and oral preparation of antiviral drug ribavirin [800 to 1200 mg daily in divided doses according to weight]. At the end of 12 weeks of combination antiviral therapy, their thyroid profile was worked up. Serum TSH, free T4 and T3 levels were determined by chemiluminescence technique in chemical pathology lab of the hospital. Statistical analysis was done on SPSS 17
Results: Out of 170 patients, 83 [48.82%] were females and 87 [51.18%] were males with the age ranging from 22-46 years [mean +/- SD: 33.86 +/- 5.32]. After 12 weeks of antiviral therapy, thyroid functions were normal in 156/170 [91.76%] patients, whereas in 14/170 [8.24%] cases thyroid dysfunction was observed. Out of those patients having thyroid dysfunction, 10/14 [71.42%] were hypothyroid whereas 4/14 [28.58%] had hyperthyroidism
Conclusion: Managing patients of chronic HCV with combination antiviral therapy comprising IFN-alpha 2b and ribavirin can cause thyroid dysfunction. These patients should be monitored before and during treatment to avoid complications and poor compliance
RESUMO
Background: Blast injuries are common in countries affected by conflict
Objective: To evaluate the outcome of conservative surgical intervention in the blast injuries of limbs in civilian population
Methodology: Study Design: Cross sectional study. Place and Duration of Study: Department of Orthopedic Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] September 2011 to 31[st] March 2013. Fifty patients suffering from blast injuries to upper and lower extremities in civilian population regardless of age and sex were enrolled. Those patients who already had been treated after injury at some other centers were excluded from the study. Only clinical evaluation was used to check the vascular status and viability of the remaining attached tissues. Patients were operated either under general or regional anesthesia. Repeated debridement's followed by skin coverage in the form of split thickness skin graft or rotational flaps were the treatment option for soft tissues and exposed bone respectively. Post operative antibiotics were given for a period of one week at least. Rehabilitation exercises were continued up to six months after discharge from the hospital. The data was entered and analyzed by using SPSS version 15
Results: Mean age of the victims in this study was 22 years. Twenty nine patients had some sort of traumatic amputation at presentation resulting from original injury. Original injuries occurred were as follows; loss of limb below knee 7[14%], loss of limb at ankle region 05[10%], mid foot amputations 08[16%], and hemi foot amputation in 05[10%]. In upper limb injuries pattern was as follows; 01[2%] mid palmer amputation, 02[4%] two fingers amputation, and 04[8%] had soft tissue involvement of hand. Infection rate was 22% in patients who did not have wound dressing by the primary physician while it was 10% in patients who had wound dressing by primary physician before presenting to this institution, the collective infection rate was 32%
Conclusion: Conservative wound debridement, early skin coverage, preserving maximum soft tissues and bone results in functionally and cosmetically better limb in blast injuries
RESUMO
Background: Congenital Talipes Equino Varus [CTEV] is a common complex congenital deformity of the foot. Treatment still continues to challenge the skills of the pediatric orthopedic surgeon as it has a notorious tendency to relapse, irrespective of whether the foot is treated by conservative or operative means
Objective: To evaluate the short term outcome of Ponseti method of serial manipulation and casting in Congenital Talipes Equino Varus [CTEV] in children up to 6 months of age
Methodology: A descriptive case series study was carried from 16[th] February to 15[th] August 2012 in the department of orthopaedic surgery, Sheikh Zayed Medical College/Hospital Rahim Yar Khan. A total of 200 feet were included in this study. The first cast application corrects the cavus deformity by aligning the forefoot with the hind foot, supinating the forefoot to bring it in line with the heel, and elevating the first metatarsal. One week after application, the first cast was removed, and after about 2-3 minutes of manipulation, the next toe-to-groin cast was applied. Manipulation and casting continued weekly for the next 5 to 6 weeks
Results: Mean age of patients was 3.9 +/- 1.7 months. Ninety one patients [62.3%] were male while remaining 55 patients [37.7%] were female. Left foot deformity was seen in 48 [33%] patients, right foot deformity was found in 34 [23%] patients and 64 [44%] patients were suffering from bilateral deformity. Percutaneous tenotomy of Tendo-Achilles was performed in 167 patients [83.5%]. Out of 200 feet, correction was achieved in 177 feet [88.5%] with zero Pirani score
Conclusion: Ponseti's method is simple, easy to learn, effective and reproducible method for correction of Congenital Talipes Equino Varus [CTEV] deformity in children
RESUMO
Nutritional quality and antioxidant capacity of three edible wild berries [Rubus ellipticus Smith, Rubus niveus Thunb, Rubus ulmifolius L.] from Lesser Himalayan Range [LHR] were evaluated. Their edible portion was assayed for moisture, fats, ash, carbohydrates, proteins, fibers, essential minerals [Ca, P, Mg, K, Na, Cl, S, Mn, Zn, Fe, Cu, Se, Co, Ni] and DPPH free radical scavenging activity was applied to determine the antioxidant potential. The fruit of Rubus ulmifolius L. [blackberry] possessed the highest values of energy [403.29 Kcal], total protein [6.56g/100 g], Nitrogen [N] content [1500mg/100g], K [860.17mg/100g], Ca [620.56mg/100g], Zn [17.509mg/100g] and the strongest antioxidant activity [98.89% inhibition]. While the raspberries [Rubus ellipticus Smith, Rubus niveus Thunb.] exhibited more significant contents of dietary fiber [5.90g/100g], carbohydrates [86.4 g/100 g] and Fe [4.249mg/100g]. Significant variation was observed among the tested samples in all the investigated features. The combination of bio elements and active antioxidants clearly showed the applicability of these berries as a nutraceutical supplement
Assuntos
Valor Nutritivo , Plantas Medicinais , Antioxidantes , FrutasRESUMO
The aim of this study was to assess the frequency of various forms of in-law perpetuated reproductive control asserted on the female and any possible factor such as education level or early age of marriage which might be responsible for it as various studies have demonstrated that violence against women has been documented to be perpetuated not only by male partners but also by the family members of male partners. This multi-centric cross sectional observational study was carried out on 424 consecutive patients in 6 hospitals. The mean age [+ S.D] was 33.7+7.8 years and age of marriage [+S.D] was 21.3+2.8 years. 116[27.4%] were uneducated, 142[33.5%] had obtained education till primary level, 124[29.2%] had secondary education and 42[9.9%] had higher level of education. Upon asking about any life time in-law perpetuated reproductive control 205 [48.3%] of the females answered one or more than question as yes and 142 [33.5%] of the participating females said that the in-laws advised their husbands to go for a second marriage if they did not become pregnant. The more uneducated the participants of the study were, more abuse was faced at the hands of her in-laws [p-value <0.005]. The most common form of reproductive control asserted by the in-laws was telling the husband to go for a second marriage if the female did not become pregnant and this was most commonly seen in the less educated females [p-value <0.005].In conclusion increased efforts are needed to involve the in-laws in programs that seek to improve women's reproductive health