Phenotypic manifestation of congenital transverse amputation of autopod in Pakistani subjects

Terminal transverse deficiency of forearm is a very rare limb malformation. Most of the cases have traumatic etiology and congenital presentation is less common. A series of six individuals with transverse deficiency through the hands is presented in this communication. The cases were congenital, morphologically similar and showed loss of four fingers, most often postaxial. The affected arm was reduced in size compared to the contralateral limb and there was distortion of palmer creases. All cases were sporadic and nonsyndromic in nature. The characteristics of these cases were concordant with the symbrachydactyly type III or monodactylous type, when classified according to the scheme proposed by Blauth and Gekeler [1973]. The malformation resulted in permanent quality-of-life impairment in these subjects and warrant prosthetic management. Detailed physical and phenotypic features of the patients have been presented

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

Pathology of high altitude pulmonary oedema

To describe autopsy findings in fatal cases of high altitude pulmonary oedema. Descriptive study. The study was carried out between 1999 and 2002 at an army field medical unit in Baltistan, Armed Forces Institute of Pathology, Rawalpindi and Army Medical College, Rawalpindi, Pakistan. Autopsies were performed in 17 fatal cases of High Altitude Pulmonary Edema [HAPE] occurring among soldiers serving in Siachen. All cases were males with a mean age of 26.8 years [19-35]. The mean altitude at which HAPE occurred was 5192 meters [2895-6492], and the mean duration of stay at these altitudes was 15.3 days [1-30]. Eleven individuals had undergone proper acclimatization. The commonest clinical findings were cough [70%] dyspnoea [53%], nausea [47%], headache [41%], vomiting [35%], chest pain [35%] and tightness in chest [24%]. Cyanosis and frothy secretions in the nostrils and mouth were present in all but one case. Mean combined weight of lungs was 1470 grams [1070-1810]. There was marked congestion of outer and cut surfaces. Interstitial oedema was present in all cases. RBCs and leukocyte infiltrates were seen in 13 and alveolar hyaline membranes in 9 cases. Thrombi were seen in 2 cases. Cerebral oedema was present in 9 cases. HAPE can occur after more than two weeks of stay at high altitudes despite proper acclimatization. Concomitant cerebral oedema is frequently present. Our autopsy findings are consistent with what has been reported previously

Frequency, causes and effects of temporomandibular pain dysfunction syndrome among patients seen at Nishtar institute of dentistry, Multan

Temporomandibular joint pain dysfunction syndrome is the second most frequent cause of facial pain. The objective of this study was to find out most common etiological factor of TMD, its clinical symptoms, and distribution among gender. Etiology was multifactorial. All patients [100%] with TMD were having malocclusion and stress [100%]. Third most common factor was increased pain threshold [37%]. Out of 160 patients 82 [51%] were females and 78[48%] were males. Most patients were between 20-30 years of age group 51/160 [31.8%]. Most common presenting symptom was pain followed by clicking sounds in joint and then limited mouth opening. All these symptoms were more common in females

comparison of single versus multimodel analgesia in ablative maxillofacial surgical procedures

Objectives of this study was to evaluate the analgesic effect of single vs multimodal analgesics in postoperative pain in ablative maxillofacial surgery and to investigate whether prophylactic treatment with multimodal nociceptive blockade will delay the onset of postoperative pain, decrease analgesic requirement, speed recovery time and facilitate early discharge in this surgical group. This experimental comparative study was conducted in Maxillofacial Operation Theatre of Nishter Institute of Dentistry, Multan during the period from August 2013 to Feb 2014 equal groups of 30 each using non probability convenience sampling technique. In Group A patients an intramuscular injection of Ketorolac 0.5mg/kg was given 45 min before induction of anaesthesia preoperatively. In group B patients intramuscular injection of 0.5mg/kg ketorolac + 2mg/kg body weight of Tramadol [IM] was given 45 min before induction of anaesthesia preoperatively + local infiltratration of 0.5% injection bupivacaine was done 10 min before giving incision. In Group A patients, 17 patients [56.6%] had mild pain, 6 patients [20%] had moderate, 5 patients [16%] had severe and 2 patients [6.66%] had no pain. While in group B who received multimodal analgesia, the degree of postoperative pain was greater than in the group A in which 15 patients [50%] had mild pain, 2 patients [6%] had moderate pain and 13 patients [43.3%] had no pain. In group B, no patient suffered from severe pain. It was concluded that multimodal analgesia showed greater advantage over single analgesia in patients undergoing ablative maxillofacial surgical procedures

Identification of tooth shade in various age groups of pakistani population using vita easyshade

The aim of the present investigation is to identify tooth shade among a group of Pakistani patients. Total number of patients was 227. Participants age ranged from 16 to 65 years, which, was divided into four groups. The tooth included in the study was sound maxillary right or left central incisors. Vita Easyshade was used to select the tooth shade. Most common classical shade was B2 with highest incidence in between ages 26-35 years and shade A spreads widely among the groups. B2 was the most common classical tooth shade in Pakistani population. Health education regarding oral hygiene should be given at school level

Postoperative analgesia; comparison of caudal bupivacaine and bupivacaine - tramadol in children with inguinal hernia repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinal hernia repair. Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. August 2008 to May 2009. A total of 100 children aged between 2-5 years were included in the study. The duration of analgesia was significantly prolonged in group-A patients [P= 0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group-A and 6.7% in group-B [P=0.64]. No respiratory depression, flushing and pruritis were observed. Low dose combination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects

Treatment outcomes of reconstruction with iliac bone graft and rib graft in patients with mandibular defects

Iliac bone graft can be used to reconstruct alveolar defects or bone defects under 5 cm. Rib grafts have proven ideal for condylar reconstruction. Objective of this study was to assess the functional and aesthetic outcomes and post operative complications of the reconstructive method. In this study iliac bone alone or combined with rib graft was used for reconstruction of mandibular defects. Sampling technique was non probability purposive. This study was conducted in the Department of oral and maxillofacial surgery, Nishter Institute of Dentistry, Multan from March 2010 to march 2012. A total of 15 patients of hemimandibulectomy were reconstructed by iliac bone alone or combined with rib bone graft. In 3 cases iliac bone was combined with rib bone graft. There were 6 [40%] male and 9[60%] females. Mean age was 23.86+2.69y [range 20 -30y]. There were no significant post operative complications. Reconstruction with iliac bone graft combined with rib graft is an excellent method of reconstruction in patients with mandibular defects

Streptokinase study on ST segment resolution in patients age less than 40 years with myocardial infarction

Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. The study was conducted at national institute of cardiovascular diseases [NICVD] of Pakistan, Karachi. All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECO recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Streptokiriase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124 +/- 3.32 and 112 +/- 3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant [P<0.001]. The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80 +/- 2.70 and 72 +/- 1.91 before and after the Streptokinase therapy's, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69% respectively. The P values were highly significant [P<0.001]. Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis

Myocardial infarction; streptokinase study on ST-segment resolution in patients age less than 40 years

Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. The study was conducted at national institute of cardiovascular diseases [NICVD] of Pakistan, Karachi. Subject and All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECG recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Streptokinase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124+3.32 and 112+3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant [P<0.001]. The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80+2.70 and 72+1.91 before and after the Streptokinase therapy's, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69% respectively. The P values were highly significant [P<0.001]. Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis

Double blind placebo controlled study on "efficacy of lignocaine pretreatment in reducing pain during injection of propofol" in patients undergoing elective maxillofacial surgeries

This study was undertaken to evaluate the incidence and severity of pain on Injection of Propofol and to find the efficacy of lignocaine pretreatment in reducing such pain. 150 patients undergoing different Maxillofacial Surgeries with American Society of Anesthesiologists class 1 and 2 [ASA 1 and 2] were randomly allocated in two groups, Group A [Saline group] and Group B [Lignocaine group] who received saline and lignocaine as pretreatment respectively. Another anesthetist who was blinded to study recorded pain on a 4-point pain scale. The incidence of pain on giving Propofol was 57.33%. There was reduction of pain by 32% in the patient group who received Lignocaine pretreatment. It was concluded that lignocaine is an effective measure to decrease the incidence and severity of pain on injection of Propofol

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

Comparison of electromyography / nerve conduction studies and magnetic resonance imaging in diagnosis of lumbosacral radiculopathy

To compare EMG/NCS with MRI in diagnosis of lumbosacral radiculopathy. Cross-sectional comparative. The study was carried out at Armed Forces Institute of Rehabilitation Medicine, for a period of six months, from January 2007 to June 2007. Fifty consenting patients with clinical lumbosacral radiculopathy were included, they underwent MRI and NCS/EMG, and then both procedures were compared for diagnosis of radiculopathy. MRI and NCS/EMG had comparable sensitivity but MRI was less accurately correlated with clinical estimated level of radiculopathy. Both NCS/EMG and MRI are time sensitive investigations which provide different information regarding the pathology. NCS/EMG reveal physiological etiology of radiculopathy, compared to MRI, which gives the anatomical information. Every patient with clinical lumbosacral radiculopathy should undergo NCS/EMG for confirmation of diagnosis. However, when anatomical lesion is suspected, or surgical intervention is planned, MRI should complement it

Diffusion weighted mr imaging [DWI] and ADC values in endometrial carcinoma

To determine the sensitivity of MR imaging utilizing diffusion weighted imaging [DWI] in detection of endometrial cancer and to compare the Apparent Diffusion Coefficient [ADC] values of malignant and normal endometrium. Cross-sectional analytical study. Radiology Department, Aga Khan University Hospital Karachi, from January 2007 to December 2009. Patients were defined as undergoing MRI for suspected endometrial malignancy, and the controls were female subjects who underwent MRI examination for indications other than endometrial malignancy. Studied variables included the signal characteristics of the endometrium and ADC values. The sensitivity of DWI for the detection of endometrial carcinoma was calculated using histopathology as the gold standard, and the ADC values of the endometrium in patients and controls were recorded. The mean ADC values were compared using two-sided t- test with significance at p < 0.05 at 95% confidence interval. Out of 52 patients, 10 had hyperintense, 40 had hypointense and 2 had isointense endometrium on T2 weighted imaging. On DWI, 42 patients had hyperintense and 10 patients had hypointense endometrium. In comparison, 40 controls had hypointense endometrium on DWI and 12 had hyperintense endometrium. The mean ADC value for abnormal endometrium was 0.730 +/- 0.215 x10-[3] mm[2]/sec and of normal endometrium was 1.265 +/- 0.305 x10[3] mm[2]/sec [p < 0.001]. The sensitivity for detection of endometrial carcinoma on DWI was 77.77%. False positive cases were found to be due to secretory and hyperplastic endometrium. False negative findings were found in a few cases of adenocarcinoma, endometroid carcinoma and clear cell sarcoma. In patients with suspected endometrial carcinoma, MRI examination utilizing DWI was a sensitive tool in detecting endometrial cancers with significantly lower ADC values for carcinoma in general. Physiological and histopathological variants may be responsible for a few false results

Magnetic resonance imaging findings in patients with schizophrenia

To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging [MRI]. Comparative study. The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008. Thirty-three cases of schizophrenia [n=33] and thirty-three age-matched controls, [n=33] were enrolled for this study. Screening Magnetic Resonance Imaging [MRI] of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p <0.05. Among the total of 66 [n=66] MRI films studied for brain abnormalities, brain atrophy, presence of septum pellicudum and enlarged Virchow-Robins spaces were significantly associated with schizophrenia [p<0.001]. There was no significant difference between cases and controls for ventricular dilatation [p=0.5]. Sinusitis was mostly associated with controls and well correlated with their symptoms [p<0.001]. Brain atrophy was the most commonly seen brain change in the studied sample of patients with schizophrenia. MRI brain can be used to identify structural abnormalities in patients with schizophrenia

Various surgical options in the management of basal cell carcinoma in Nishtar hospital, Multan

To describe the prevalence, mode of presentation and various surgical options of reconstruction in the management of basal cell carcinoma [BCC] with a local perspective. The present descriptive study was conducted at Nishtar Hospital, Multan from 2006 to 2009. A separate file was maintained for each patient. A thorough history and full physical examination was conducted, relevant investigations were carried out. All this was recorded in data collection for and data analysed to find frequencies and percentages using SPSS-10. Out of sixty cases, 50 [83%] were male and 10 [17%] were female. Majority of the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to female ratio was 5:1. Out of 60 cases 26 [20 male, 6 female] 43.3% were farmer, 16 [all male] 26.6% wee construction workers, 10 [8 male, 2 female] 16.6% were unemployed and 8 [all female] 13.3% were household. No patient presented before 5 years after the development of the lesion. 34 [30 male, 4 female] 56.6% for the last 6-10 years, 20 [16 male, 4 female] 33.3% for the last 11-15 years, 2 [all male] 3.3% for 16-20 years and 4 [2 male, 2 female] 6.6% had lesions for> 20 years. All the lesions encountered in present study occurred on exposed head and neck region as. Most of the patients had the nodular pigmented type of BCC and majority of them were male. None of them have Gorlin's syndrome. Delay in presentation has an overall negative effect on the outcome. A simple excisional biopsy technique ensure margins clearance and give surgeon more freedom for reconstruction

Carotid artery disease in patients undergoing elective coronary artery bypass surgery

To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting [CABG] using Doppler sonography. Observational study. Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent "t" test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. A total of 176 patients [85% male, mean age=65 years] undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease [> 50% stenosis], 6% had critical stenosis [> 75% stenosis] and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease [p < 0.05]. A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease

Isolated tuberculosis thyroiditis as solitary thyroid nodule

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan

Cleaning methods for ultrasound probes

To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Experimental study. Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A [n = 25], group B [n = 25] and group C [n = 25] respectively. Number of Colony Forming Unit [CFU] of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning [p < 0.001], however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods [p < 0.001]. The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes

Film retakes in digital and conventional radiography

To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method. Comparative study. Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006. X-rays of different body parts, conducted during the year 2004, with conventional radiography [n=170300], and in 2006 with digital radiography [n=174550], were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, grid cut-off, and others [i.e. equipment related] due to which X-ray quality was questionable. Results were expressed in percentages. A total of 9423 X-rays [5.5%] were repeated in conventional radiography [n=170300] due to underexposure [38%], overexposure [28.5%], positioning errors [25%], portable procedures [4%], patient movement [2%], grid cut-off [0.5%], and others [2%]. Underexposure was the most frequently responsible factor for the X-ray repetition as compared to other factors [p<0.001]. In digital radiography [n=174550], 1464 X-rays [1%] needed to be repeated, which was significantly less in comparison to X-ray repetition in conventional method of radiography [5.5%] [p<0.001]. In digital radiography, the most frequent factor for X-ray re-take was positioning error [435, 30%]. Digital radiography is associated with significantly lesser number of re-take X-rays as compared to conventional radiography, hence minimizes the exposure of the patients to unnecessary radiations due to re-take X-rays. Positioning error remains a problem even in digital radiography, emphasizing training need for technologists