Pancytopenia in two national ethnic groups of baluchista

Background: Pancytopenia is a recognisable haematological problem with common categorises diagnosis but best possible diagnostic approach is still to be defined. Objective: The aim of this study was to determine the frequent causes and clinical presentation of pancytopenia in relation to age and sex in different ethnic groups of two national [Pakistani and Afghan] living in Baluchistan province. Methods: This is a cross sectional descriptive type of study was carried out on patients [n=180] for two years [July 2009–June 2011]. Cases were successively registered in 2 provincial government hospital and 2 private clinics in Quetta with diagnosis of pancytopenia. Results: The most frequent causes of pancytopenia in both national ethnic groups were malaria [29.44%] fallowed by tuberculosis [17.22%], leukaemia [16.67%], aplastic anaemia [13.33%], hepatitis [12.22%], other diseases [7.22%] and iron deficiency anaemia [3.89%]. Overall, 63.89% male subjects were observed pancytopenia as compared to 36.11% female patients. The results also showed that patients with age >41 years were highly [50%] affected by pancytopenia followed by 21–40 years [30.66%] and <20 years [19.44%]. Moreover, leukaemia cases were observed significantly higher in Afghan subjects [>41 years]. The most common symptom of patients was [71.11%] fever followed by Pallor [42.22%], fatigue [38.33%], weight loss [26.11%] and dizziness [25.56%]. Leukaemia and aplastic anaemia were found to be the most serious causes of pancytopenia in Afghan ethnic group. Conclusions: Malaria, tuberculosis, aplastic anaemia, and leukaemia were the leading causes of pancytopenia in Pakistani and Afghan ethnic groups. Severe pancytopenia has significant relation with the clinical conclusion and can be used as a prognostic marker

Application of an external fixator to the open diaphyseal fractures of femur

The study on 30 cases of open diaphyseal femoral fractures has been done between January 2008 to November 2008 on patients coming to Orthopaedics Department at Bolan Medical complex Hospital Quetta attached to Bolan Medical College, Quetta. It is a prospective study, which includes 30 patients with open diaphyseal fractures of femur. They were operated after stabilization of general condition using external fixator. It is a valuable clinical treatment option, providing surgeons with the spatial relationship of tissues both statically and dynamically via minimally, technique. The study shows union occurred in 24, 80% cases. There was an established non-union in 06 [20%] cases. All were Type III-A and III-B. The average time of union was from 8-20 weeks. The overall incidence of deep infection was 38% and was limited to type III-A and III-B. Pin crack infection was seen in 36% and was controlled with standard management. The average hospital stat was 15 days On the basis of this study it is evident that treatment by external fixator is very satisfactory, cost effective and there are no major complications and can be used with full confidence. Above all good results can be achieved by aggressive and repeated debridement, irrigation and early soft tissue coverage of the-bone

Fixation of distal femoral fractures in adults by dynamic condylar screw

To analyze the role of Dynamic Condylar Screw and the early functional outcome and complications associated with surgical management of Distal Femoral Fractures in Adult using DCS in our circumstances. This descriptive study was carried out in Orthopaedics Department Bolan Medical Complex Hospital Quetta from March 2007 to April 2008. The study included management of 25 cases of Distal Femoral Fractures treated by Dynamic Condylar Screw. These fracture are complex injuries, which are often unstable and comminuted. Despite advances in surgical Technique and improvement in implant, treatment of Distal Femoral Fractures remains a challenge in many situation, if not treated correctly may lead to permanent disability. There were 25 cases selected, 23 males and 2 females with in average age of 32.2 years, ranging from 20 years to 60 years. The cause of injury was high-energy trauma in majority of cases. These were of A1, A2, A3, and C1 and C2 type fractures. 21 out of 25 cases gained knee flexion more than 90°. The limb shortening of 2cm was noted in 03 cases, in 20 patients fractures united in 10-12 weeks. Bone graft was used in 05 cases. The average follow up was about 10 months. At the end of the study results shows that DCS is a good method of treating closed type, A1, A2, A3, C1 and C2 fractures. DCS provides rigid fixation and good purchase in Osteoporotic bone. Early mobilization prevents knee stiffness

Management and outcome of posterior fossa extradural hematoma and management outcome

Presentation of patients with CT proven extra dural hematoma their management and out come. 12 patients of posterior fossa extradural hematoma were included in the study. Excellent recovery was found in 50% good in 25% and poor in 16.6% and 8.33% was died

Conservative and surgical management of depressed, skull fractures

The aim of the study is to examine the efficacy of a conservative and surgical management of depressed fractures skull. A prospective study of 120 patients with depressed skull fractures treated at Bolan Medical Complex Hospital from December 2003 -2007. There were 108 males and 12 females, age range was 12 month to 80 years, and the mean age was 40 years. All patients underwent X-ray and cranial CT scan. Depressed fractures due to missile injuries were excluded from the study. Object fall on the head was the cause of depressed fracture in 30% of our patients, fall from a height in 19%, road traffic accident in 20%, sports injury in 10%, assault in 19.8% and suicidal attempt in 1.2%. Parietal bone was injured in 44%, frontal bone in 32%, temporal bone in 18% and occipital bone in 6%. Seventy-two percent were compound depressed fractures and 28% were simple depressed fractures. Eighty-four patients were managed conservatively, 56 patients with compound fractures [66.7%] and 28 patients [33.3%] with simple fractures. Significant extra-axial haematoma was the indication for elevation of the fracture in 40% of the surgical group, significant wound contamination, brain tissue and CSF in the wound in 5%, frontal sinus involved in 15%, cosmetic deformity in 25%, fracture on the superior sagittal sinus in 10% and right sided hemiplegia in 5%. Our study demonstrates that 70% of patients with depressed skull fractures can be safely managed conservatively without major surgical intervention