Evaluation of Madigan Procedure in the Treatment of Habitual Dislocation of Patella

This was a clinical trial (quasi experimental) study carried outat the National Institute of Traumatology and OrthopedicRehabilitation (NITOR), Dhaka, between July 2004 to June2006, involving 16 patients with habitual dislocation of thepatella. All these cases were managed by Madigan operativeprocedure. Aim of this study was to evaluate the effectivenessof the madigan procedure in the treatment of habitualdislocation of the patella. Out of these 16 patients 2 weresubsequently lost from follow up. So, the study finally consistedof 14 patients. In this study non-random purposive techniqueas per inclusion and exclusion criteria was followed irrespectiveof sex. Most common age group in this study was 6-10 years(62.5%). The mean age of occurrence was 8.25 years.Repeated intramuscular injection on the thigh was thecommonest cause of dislocation found in 37.5% cases. Thesecond most common cause of dislocation was history of boil.Abscess or cellulitis on the thigh followed by contracture of thequadriceps muscles. Various postoperative complications likehypertrophic scar constituted (18.75%), stitch granuloma(6.25%), restriction of knee motion (6.25%) and re-dislocationoccurred in (6.25%) cases. Functional outcome in themanagement of habitual dislocation of the patella wasanalyzed by using the Hospital for Special Surgery (HSS) kneescore. Regarding the final or overall results in this series, therewere 71.43% cases were found satisfactory and the remaining28-57% were found unsatisfactory result.

Isolation, Identification and Molecular Characterization of Highly Pathogenic Newcastle Disease Virus From Field Outbreaks

ABSTRACT Newcastle disease (ND) is a major infectious disease of the poultry caused by a virulent strain of Avian Paramyxovirus - 1, that is a single strand non-segmented negative sense RNA virus. ND virus is major threat to the poultry industry in many countries of the world. The study was aimed to isolate and identify Newcastle disease virus (NDV) by using a haemagglutination inhibition (HI) test and reverse transcription-polymerase chain reaction (RT-PCR) assay. A total 100 samples of infected and dead birds were collected from different poultry farms. The weight of the birds was ranged 1000-1200g. The birds were divided into 3 groups. Haemagglutination assay (HA) was performed to detect the presence of NDV in suspension of infected homogenized tissues and it was found that HA is not the best method to detect the virus when it is in trace amounts. RT-PCR using NDV specific primers analyzed different clinical and postmortem samples. Reverse transcriptase polymerase chain reaction and specific primers was used for determining the presence of viruses. It was found that the virus was present in most of the infected samples except the serum of infected birds. During multiple sequence alignment (MSA) it was found that, our isolates have high homology (98%) with other reported NDV isolates. Phylogenetic analysis revealed that our isolate was closely related with viscerotropic velogenic types of NDV, which are highly pathogenic Newcastle disease virus.

Evaluation of the Tuberculosis Surveillance System in District Hyderabad, Province Sindh-Pakistan, 2012.

Aims: To identify strengthens and weaknesses of Tuberculosis (TB) surveillance system of District Hyderabad and suggest recommendations for improvement. Study Design: Descriptive evaluative study Place and Duration of Study: This research work was conducted in Provincial directorate of health, district health offices, and TB sentinel sites of District Hyderabad, between February and March, 2012. Methodology: A total of 26 stakeholders were identified by using purposive sampling technique based on their involvement in and relevance to the TB surveillance system. Data was collected by review of medical records and stakeholder interviews by using “Centers of Disease Control (CDCs) Updated Guidelines for the Evaluation of Surveillance Systems. Attributes were rated as good, fair and poor on the basis of obtained score. Results: System was good in simplicity and flexibility due to simple case definition and adaptation of new changes. Presence of laboratory component and 90% completeness of forms led to good rank in data quality. The system covered limited (n=12) health facilities which caused fair representativeness. The staff was highly motivated to provide accurate, consistent and complete information and suggested good acceptability of system. Due to quarterly reporting, timeliness was poor and led to delays in outbreak identification and mitigation responses. Sensitivity and positive predictive value were 26% and 56.8% respectively. The system was fair in stability as supported by ministry of health with multinational donors. Conclusion: The TB Surveillance system was satisfactory in all attributes except representativeness, sensitivity, and timeliness. Increased establishment of sentinel sites at public and private health facilities and added frequency in reporting time were recommended.

Presentation of maxillofacial injuries in the 2005 earthquake victims

Earthquakes cause a lot of damage to life and property. Maxillofacial injuries constitute an important proportion of injuries in earthquakes and some 13% of the trauma patients after the earthquakes suffer from maxillofacial injuries. The objective of this study was to assess the presentation of maxillofacial injuries in earthquake victims. This descriptive study was conducted at the Department of Oral and Maxillofacial Surgery, Dental Section Ayub Teaching Hospital, Abbottabad from October 8[th], 2005 to January 8[th], 2006. Three hundred and seventy-eight patients were included in this study in the three months following the October 8[th], 2005 earthquake on consecutive nonprobability sampling basis. Isolated facial bone fractures rather than the multiple bone fractures were the commonest type of fractures in earthquake victims. A significant number of patients presented with only soft tissue injuries and no bony fractures. Although considerable number of patients with fracture of multiple facial bones were present in the earthquake victims but isolated facial bone fractures and soft tissue injuries were the commonest type of injuries

4-year study of lymph node biopsy in the patients belonging to the Labour class

To evaluate the rate of tuberculosis and other diseases in the patients having lymphadenopathy and find out the value of lymph node biopsy in various diagnoses. Retrospective study. This study was conducted at the Department of surgery, Sindh Employees Social Security Hospital Landhi, Karachi and Kulsoom Bai Valika Social Security Hospital S.l.T.E, Karachi, from April 2010 to July 2013. A retrospective study of the case sheets and biopsy reports was done. The reports of the patients of all age groups ranging from 1 to 70 years who underwent lymph node biopsy were evaluated. The patients were initially treated by local G.Ps for various complaints associated with superficial lymphadenopathy. After the failure of relief by the treatment of variable period, they were referred to our hospitals. All of our patients belonged to socio-economically low labor class. Out of 55 operated patients of lymph node biopsy included in this study, 19 [34.54%] were males and 36 [65.45%] were females. The majority of the patients 42 [76.36%] were those having cervical lymphadenopathy. Others were having axillary 08 [14.54%], inguinal 02 [3.63%] and mesenteric 03 [5.45%] lymphadenopath. Twenty three [41.81%] had reactive changes, 27 [49.09%] had TB, 02 [3.63%] had malignancy and 03 [5.45%] had other lesions. TB infection is alarmingly high in our society which is affecting the young generation. Health care authorities should address the issue. Moreover, the common tools like FNAC should be used prior to excision biopsy as it is easy, cheap and with fewer complications. It can give accurate diagnosis in many of the cases of superficial lymphadenopathies

comparison of disease caused by Shigella and Campylobacter species: 24 months community based surveillance in 4 slums of Karachi, Pakistan

Despite the efforts of the international community diarrheal diseases still pose a major threat to children in children less than five years of age. Bacterial diarrhea has also emerged as a public health concern due to the proliferation of drug resistant species in many parts of the world. There is a paucity of population-based data about the incidence of shigellosis and Campylobacter infections in Pakistan. We report country specific results for Shigella diarrhea that were derived from a multicenter study conducted in six Asian countries. Disease surveillance was conducted over a 24 month period in urban slums of Karachi, Pakistan, a city with a population of 59,584. Cases were detected through passive detection in study treatment centers. Stool specimens or rectal swabs were collected from all consenting patients. Between January 2002 and December 2003 10,540 enteric infection cases were detected. The incidence rate of treated diarrhea in children under 5 was 488/1000/year. In children, 5 years and older, the diarrhea rate was 22/1000/year. 576 [7%] Campylobacter isolates were detected. The pre-dominant Campylobacter species was C. jenuni with an increase of 29/1000 year in children under 5 years. Shigella species were isolated from 394 of 8032 children under 5 years of age. Shigella flexneri was the dominant species [10/1000/year in children under 5 years] followed by Shigella sonnei [3.9/1000/year], Shigella boydii [2.0/1000/year] and Shigella dysenteriae [1.3/1000/year]. Shigellosis and Campylobacter infection rates peaked during the second year of life. The incidence rate of shigellosis increased in old age but such a trend was not observed in Campylobacter infections. Of 394 shigellosis patients 123 [31%] presented with dysentery in contrast to only 54 [9%] of 576 patients with Campylobacter infections [p < 0.001]. Both Campylobacter infections and shigellosis are common in community settings of Pakistan but shigellosis presented more frequently with abdominal pain and dysentery than Campylobacter infections indicating that shigellosis may be a more severe illness than Campylobacter infections. Due to the increased and disease severity, drug resistant shigella have become a significant health problem; moreover it is a disease of poor and impoverished people who do not have the access to standard water and sanitary conditions, health care services or optimal treatment. In the face of these facts it is empirically important to develop a low cost effective vaccine that can protect these populations for a longer duration

Response to standard interferon alpha2b and ribavirin combination therapy in chronic hepatitis C treatment naive patients

Treatment of Chronic Hepatitis C is now well established with conventional interferon or pegylated interferon in combination with ribavirin. Peginterferon Alfa and Ribavirin for 6 to 12 months is currently approved initial therapy, which is expensive. Response of our patients to standard Interferon-alpha-2b and ribavirin for 24 weeks have been studied. The objective of this study was to asses Sustained Viral Response [SVR] with standard Interferon alpha2b and Ribavirin combination treatment in chronic Hepatitis C patients. This quasi-experimental study was conducted at Combined Military Hospital, Quetta from Jan 2006 to Jun 2007. One hundred and three patients, with 20-60 years of age suffering from chronic Hepatitis C were selected on the basis of raised ALT, positive anti-HCV antibodies, evidence of viraemia by quantitative PCR for HCV RNA and liver biopsy. All patients were started on same brand of Interferon alpha-2b, 3 MIU subcutaneously, thrice weekly and oral Ribavirin [1,000-1,200 mg/day] for 24 weeks. End treatment response [ETR] after completion of treatment and SVR six months after ETR were recorded. The 103 patients, 85 males and 18 females with mean age of 21-48 years completed the treatment for 24 weeks. Mean ALT was 96.17 [SD +/- 49.98]. End treatment response [ETR] was 89.3% [p=0.032]. Sustained Viral Response after 6 months of treatment was 86.4% [p=0.034]. Standard Interferon and Ribavirin had excellent SVR. It is effective as well as economical treatment in Chronic Hepatitis C patients

Acute postoperative pain management by a surgical team in a tertiary care hospital: patients satisfaction

To assess the acute postoperative pain management by a surgical team and patient satisfaction in a tertiary care teaching hospital. 105 patients, ASA I and II, both sexes, mean age of 35.1 +/- 14.6 years, scheduled for general surgery under routine practice conditions, were included in the study. All patients were assessed 12 and 24 hours postoperatively by two numerical visual analogue scale [VAS 0-10], related to rest and dynamic pain. Patients were also requested to indicate their satisfaction level with the help of VAS. Data was analyzed by SPSS version 10. Student t test was applied to find significant differences between the groups. At 12 hours postoperatively mean rest and dynamic pain scores were 3.85 +/- 2.45 and 5.32 +/- 2.61 respectively. At 24 hours postoperatively mean rest and dynamic pain scores were 2.84 +/- 1.86 and 4.65 +/- 2.47 respectively. Overall, female patients experienced more pain but there was no statistically significant difference apart from rest pain at 24 hours. Forty-seven [44.8%] patients were very satisfied, 42 [40%] moderately satisfied and 16 [15.2%] patients were mildly satisfied with the pain management. Overall management of acute postoperative pain by surgical team in a tertiary care hospital was satisfactory. Most of patients were moderately to very satisfied by the care provided

Mechanical intestinal obstruction: etiology and management in adults at civil hospital, Karachi

To determine the etiological factors, management and outcome of mechanical intestinal obstruction in adults at Civil Hospital, Karachi. The hospital records of all patients operated on for mechanical intestinal obstruction in Civil Hospital, Karachi, over a period of one year [July 2006 to June 2007] were reviewed. Signs and symptoms with duration, etiology, surgical management, morbidity and mortality, apart from demography, were recorded. Patients were followed until their discharge. A total of 119 patients, 74 male and 45 female, with a mean age [ +/- SD] of 37.29 [ +/- 16.08] years were operated on during the study period. Their mean [ +/- SD] duration of symptoms was 4.1 [ +/- 3.9] days. Obstructed external hernias were the most common cause of intestinal obstruction, seen in 36 [30.2%] patients, followed by intestinal tuberculosis in 24 [20.2%] patients. Stoma formation was the most common surgical procedure performed in 40 [33.6%] patients followed by hernia repair, with or without resection, and anastomosis of bowel in 36 [30.2%] patients. Complications were documented in 34.4% of patients. Mortality was 9.2% during the hospital stay. Obstructed external hernias were the commonest cause of intestinal obstruction followed by intestinal tuberculosis. Stoma formation was the commonest surgical procedure performed. During the first year of surgical training, all residents should master the skills of making an appropriate stoma, while during the second year they should be able to manage obstructed hernias properly

Prevalence of anaemia in Tour Sheher Zarghoon, Balochistan

Instead of communicable diseases, developing countries are now seeing serious increase in non-communicable disease and Anemia is one of major problems in developing countries like Pakistan especially in under developed areas like e.g Balochistan. Anaemia is prevalent in certain area of this continent. Anaemia is little bit prevalent in the Urban area of the Balochistan but rural and high altitude areas are still desire its due attention. The people affected belong to rural areas with low socio-economic status and are unable to afford the even economical iron therapy diagnosis, treatment. In some cases bone marrow aspirates and immunodiagnostic facilities are needed for diagnostic purpose. Results showed that prevalence of anemia was high in less than fifteen years of age group, females suffered more with anemia as compared to males in the area

Prevalence of anaemia in Feroza district Khuzdar, Balochistan

Instead of communicable diseases, developing countries are now seeing serious increase in non-communicable disease and Anemia is one of major problems in developing countries like Pakistan especially in under developed areas like e.g Balochistan. Anaemia is prevalent in certain area of this continent. Anaemia is little bit prevalent in the Urban area of the Balochistan but rural and high altitude areas are still desire its due attention. The people affected belong to rural areas with low 50cm-economic status and are unable to afford the even economical iron therapy diagnosis, treatment. In some cases bone marrow aspitates and immunodiagnostic facilities are needed for diagnostic purpose. Results showed that prevalence of anemia was high in more than fifteen years of age group, females suffered more with anemia as compared to males in the area

Maternal and neonatal complications in term breech delivered vaginally

To evaluate the maternal and neonatal complications in terms of genital tract trauma to mother, perinatal mortality, Apgar score at 5 minutes and neonatal trauma in all singleton term breech cases delivered vaginally. Case series. Department of Obstetrics and Gynaecology, Bolan Medical Complex Hospital, Quetta, from May 2005 to March 2006. A 100 consecutive patients with singleton breech presentation, whether booked or unbooked, were admitted and delivered vaginally in hospital during the study period. They were studied for maternal and neonatal complications. Maternal complication included any genital tract trauma during delivery while neonatal complications were perinatal mortality, low Apgar score [less than eight at 5 minutes] and birth trauma. There were a total 3977 deliveries during this study period, 145 breech presentation [incidence 3.6%]. Out of those, 100 were included in the study. All were unbooked cases, 87% were multigravida while 13% were primigravida. An Apgar score of eight was recorded in 87% babies while 10% had an Apgar score of less than eight after 5 minutes. There were 3 still births and one neonatal death. Aggregated perinatal mortality rate was 40/1000 live births. Only one baby had birth trauma [Erb's paralysis] during vaginal breech delivery. Ninety seven [97%] mothers had no complications while only 3 [3%] had complications. Out of these, one had cervical tear and 2 had vaginal tears. Offering a trial of vaginal breech delivery to strictly selected and well-counselled patients remains an appropriate option without compromising perinatal and maternal outcome. It also decreases the rate of operative delivery for this malpresentation

Lymphocyte subpopulations in pakistani patients with acid fast bacilli positive and acid fast bacilli negative pulmonary tuberculosis

This study was done to comparethe lymphocyte subpopulations in the peripheral blood of patients of acid fast bacilli positive active pulmonary tuberculosis with similar patients who were negative for acid fast bacilli on sputum examination. After exposure to Mycobacterium tuberculosis, only 15% of the infected individuals develop active tuberculosis while about 90% can control and contain the infection successfully. This ability to control the infections is the function of T lymphocytes. Different profiles of lymphocyte subpopulation possibly reflect the immune status of the individual against tuberculosis infections. This study was carried out to compare the lymphocytes subpopulations in the peripheral blood of patients of AFB negative tuberculosis. A total of forty adult patients of pulmonary tuberculosis having positive sputum smears for acid fast bacilli along with fifteen acid fast bacilli negative patients were included in the study. Peripheral blood samples from the patients of both groups were collected aseptically in EDTA containers. A panel of monoclonal antibodies was used to delineate different lymphocyte subsets by flow cytometry. Haemoglobin levels, total leucocyte counts, absolute neutrophil counts and absolute lymphocyte counts were determined by haematology autoanalyser. Total CD4 count was not significantly different in the two groups but activated CD4+ T cell number was significantly high in smear positive patients. Smear positive patients also showed significantly increased total number of CDS positive T lymphocytes but activated CDS lymphocyte number was significantly decreased. Total number as well as activated fraction of gamma dejta T cells was markedly enhanced in smear negative group of patients. Activation status of CD8+ T lymphocytes along with increased number of gamma delta cells [absolute number as well as activated fraction] make important contributions in limiting the extent of disease in pulmonary tuberculosis

False hepatitis-B antigenaemia

Prevalence of Hepatitis B is very significant in Balochistan. A large number of false positive reports are given by laboratories most of which use the Latex technique. A comparative study was done to evaluate the results of latex and ELISA for hepatitis B surface antigen [HBsAg] in the sera of patients suffering from liver disease. The patients presenting with hepatobiliary disease were selected. The sera were screened for HBsAg by latex technique using the commercially available kits. Positive sera were repeated for HBsAg on Lab system ELISA technique. The non-reactive samples were re-checked by the Sanofi ELISA kit and negativity in both the ELISA kits were taken as 'false positive' on latex. Out of 1160 sero-positive by latex, 980 were confirmed to be positive and 180 negative by ELISA. 15.5% falsepositive results were obtained with latex. These results substantiate this variation of the ELISA assay as a reliable alternative for routine confirmation of I-iBsAg tests