Seasonal Influence on Postoperative Complications after Total Knee Arthroplasty

PURPOSE: This study is aimed at investigating whether inpatient complications and surgical site infections (SSIs) occurred more commonly in patients undergoing total knee arthroplasty (TKA) during the summer season. MATERIALS AND METHODS: A total of 725 patients who underwent unilateral or bilateral TKA were included in this study. A total of 241 patients (33.2%) underwent TKA between May and August. Our outcomes of interest were the incidence of postoperative complications and length of stay. RESULTS: May–August surgeries were associated with a higher risk of postoperative inpatient complications (p=0.003). May–August surgeries (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18 to 3.85), postoperative transfusion (OR, 2.46; 95% CI, 1.43 to 4.26), postoperative special care unit stay (OR, 4.68; 95% CI, 1.99 to 11.0) and chronic kidney disease (OR, 3.27; 95% CI, 1.15 to 9.28) were associated with a higher odds of developing inpatient complications. No association was present between summer surgeries and SSIs (p=0.486). CONCLUSIONS: The results of this study show that overall complication rates following TKA exhibit a seasonal trend, with a peak during the summer months. These results may have some implication in clinical practice and stricter approaches to hospital guidelines during the summer months.

Ethnomedicinal, phytochemical and antibacterial activities of medicinal flora of Pakistan used against Pseudomonas aeruginosa-A Review

Medicinal plants have been used from ancient time against different infectious diseases caused by microorganisms across the globe. The present review represents different medicinal plants of Pakistan used traditionally for the treatment of variety of ailments caused by Pseudomonas aeruginosa, their in-vitro activities against/! aeruginosa and phytochemistry. These plants were extracted with different solvents that showed good in-vitro activities against P. aeruginosa, due to the presence of active phytoconstituents including alkaloids, terpenoids etc. Among all the solvents used for extraction process, alcoholic extracts were mostly preferred in Pakistan. However, non-alcoholic solvents like ethyl acetate and chloroform also showed good anti-P aeruginosa activities. Statistically, increase in concentration [mg/ml] of ethyl acetate and chloroform extracts significantly increase [p=0.000 and p= 0.046] inhibitory activity against P. aeruginosa. This review provides scientific validation of the traditional knowledge in using medicinal plants for the treatment of different diseases caused by this bacterium. Reported Pakistani medicinal plants contain variety of phytochemical compounds that could be very useful in the production of new drugs with fewer side effects on living system compared to some allopathic drugs. This review also provides baseline information for future research studies on the phytochemistry of unexplored plants. Further research studies should be carried out on non-alcoholic extracts that could be helpful in the extraction new compounds, which could lead to the development of some novel drugs in the pharmaceutical industries of Pakistan

Association of oral lichen planus with hepatitis-C and diabetes mellitus

The aim of the study is to determine the association of oral lichen planus with hepatitis C and diabetes mellitus

A retrospective cohort study was carried out at the Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar from January 201 1 to July 2015. A total of 34 male and female patients having oral lichen planus were selected with age range 20-60 years and mean age 39.4 +/- 15.8 years. Only clinical features were included to diagnose oral lichen planus which was made through the clinical evaluation of patient's oral cavity by a specialist team at the Department as proposed by van der Meij et al in 2003 based on the WHO definition of oral lichen planus. The data were analyzed through SPSS 22 with significance level ofp-value <0.05 and chi-square statistics were applied for association

The results showed that the data was statistically not significant with p-value >0.05 for all diseases having lichen planus and chi-square statistics revealed that no association exist among lichen planus, diabetes mellitus and hepatitis C. This study fails to find any association between oral lichen planus, hepatitis C and diabetes mellitus

Causes of tooth extraction amongst diabetic patients seen in a dental hospital in Peshawar

The aim of the study was to evaluate the causes of common conditions leading to tooth extraction, male/female ratio in diabetic patients. This was a retrospective cohort study. Data were collected from previous records between January 2011 to July 2015 from the Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar. Among 2,103 total diabetic patients presented to the department, 1,618 diabetic patients have their complete record for tooth extractions. The primary reasons for exodontia specified in the records were Caries, Periodontitis, others. Others include those patients who have extractions either due to preprosthetic purpose, trauma or fracture or any other reason other than caries and periodontitis. The data was analysed through SPSS 22. The mean age presentation was 47.50 +/- 19.82 years and the age range 25-70 years. There were 1,618 extractions carried out in 2,103 subjects [76.94%]. The female diabetic patients predominate n=983 [60.75%] the male patients n=635 [39.25%]. Caries was the dominant cause of tooth extraction in both subjects n= 1042 [64.40%] followed by periodontitis n= 416 [25.71%] and others n=160 [9.90%]. Caries is the dominant cause of extraction in diabetic patients and female diabetic patients predominate male diabetic patients in terms of tooth extraction

Historical perpective of shaqeeqa [Migraine] with special reference to contribution of greco-arab physicians

The current practice of medicine indebted much to the knowledge and achievements of the past. It is really surprising that far back Greco-Arab physicians were aware of the various diseases and mentioned them in a scientific manner. Most of the knowledge is still in practice. Modern days practice relies on the fundamentals proposed by them. In the classical text of Unani Medicine, headache is described in detail. The Shaqeeqa [migraine] is described nearly in all classical text of Unani medicine as a disease entity includes definition, aetiopathology, clinical feature and treatment

Locking Compression Plate in Musculoskeletal Oncology 'a Friend in Need'

BACKGROUND: We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture. METHODS: A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends. RESULTS: There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures. CONCLUSIONS: Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.

Orf in a patient of toxic epidermal necrolysis during hospital stay: an unusual scenario

Orf is a zoonotic infection seen in livestock handlers. We report a case of human to human transmission of orf infection in a patient of toxic epidermal necrolysis and his caretakers. To the best of our knowledge this is the first case of orf infection in the patient of toxic epidermal necrolysis

Prophylactic use of antibiotics to prevent flare-up in endodontic treatment

The aim of this study was to assess the effectiveness of giving antibiotics during root canal treatment to reduce pain. Sixty patients with asymptomatic necrotic teeth were included in the study, which was carried out at the Department of Operative Dentistry, Altamash Institute of Dental Medicine, Karachi and was spread over one year. Two groups, A and B, were formed. Thirty patients in group A were given prophylactic antibiotics. Patients in group B formed the study group. Postoperative flare-up pain recorded at 4, 12, 24 and 48 hours was not statistically significant between the two groups. It was concluded that there was no statistical significance of giving prophylactic antibiotics to prevent inter-appointment flare-up. The risk of inappropriate use of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefits

Risk factors for temporomandibular joint ankylosis in different age groups

To identify the risk factors responsible for the development of temporomandibular Joint ankylosis. The study was carried out in the Department of Oral and Maxillofacial Surgery at King Edward Medical University, Lahore, Pakistan from April 2005 to April 2009. Two hundred patients with Temporo mandibular Joint Ankylosis were recruited in this study. To identify the risk factors, patients were divided in different groups according to their age so that the most common risk factor was identified amongst these patients. The groups were A. 6 months to 8 years, B. 9-17 years, C. 18-25 years. D>25 years. Risk factors identified were history of fall, road traffic accident, middle ear infection, autoimmune diseases and no obvious history. The highest percentage of the patients belonged to Group B [50%] and history of fall was the main risk factor in the development of Temporomandibular joint ankylosis [72.5%] with p value < 0.05. Trauma is the major factor of Temporomandibular joint ankylosis in all age groups in Pakistan. In this context, we conclude that this complication is a preventable entity if early post traumatic rehabilitation is instituted

Hazards of pressure pack

The purpose of this study was to find out how the patients disposed off the pressure packs placed on the socket after tooth extraction. The study was conducted on 260 patients who had undergone dental extraction from November 2010 to April 2011. Pressure packs were placed on the socket to stop post operative bleeding. Every study patient was asked where he/she threw his/her pack after use and whether he/she touched it for adjustment before it was finally discarded. 42.3% of the patients threw the packs on the road, and 19.2% did this within the hospitals area, like corridors and toilets. Majority of patients admitted that they touched the pack for adjustment before it was finally discarded. The risk of spread of infection is increased by first touching the blood contaminated pack and then touching the doors, chairs, and tables in the waiting areas. Patients must be informed and educated about the proper handling of the packs to minimize the chances of cross infection

Community mental health in Peshawar, the need to reform

Community mental health is a neglected field in many developing countries including Pakistan. Common mental disorders are high in prevalence, particularly in women. Community mental health services are lacking in Peshawar, which faces a number of challenges owing to sociopolitical instability. The aim of this literature review is to evaluate and interpret current research relevant to community mental health reform, including a review of the evidence regarding community mental health service. A selected review of published literature was undertaken using the PubMed, PsychINFO and Cochrane Database of Systematic Reviews databases. The intervention studies included in this review demonstrate that community based mental health services closely aligned with primary care services have the potential to facilitate improvements in access to care and also improvements in mental health outcomes. It concludes that lack of proper mental health policy and non-integration of mental health in primary health care adversely affects the outcome of mental health progress in community

Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy

To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections [ESIs] and conservative management in patients with lumbar radiculopathy. Quasi-experimental study. The Postgraduate Medical Institute of Hayatabad Medical Complex, Peshawar, from April 2005 to March 2007. Fifty elective patients fulfilling the inclusion criteria were randomly divided into two groups. Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline in the lumbar epidural space, while patients in the conservative group were treated with bed rest, non-steroidal anti-inflammatory agents, muscle relaxants, and opioids. All the 50 patients in the two groups were regularly assessed at 2 weeks, 1 month, 3 months and 6 months of periods for pain score by the Visual Analogue Scale [VAS], patients satisfaction score and any unwanted side effects. A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group. Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month [p <0.05]. The difference in Visual Analogue Scale [VAS] and patients satisfaction score was non-significant in chronic stages of treatment in both groups [p > 0.05]. Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with hypospadias repair. Randomized controlled trial. The Department of Paediatric Anaesthesia, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, from April to September 2006. Sixty children aged between 13-53 months coming for hypospadias repair were divided randomly into two groups A and B. A caudal block was performed immediately after induction of general anaesthesia. The patients in group A received 0.125% bupivacaine 1 ml/kg with tramadol 1 mg/kg body weight caudally. Group B patients received 0.25% bupivacaine 1 ml/kg body weight caudally. Anaesthesia was discontinued after completion of surgery. In the recovery area, ventilatory frequency and pain scores were recorded at 1 hourly interval for first 6 hours and then every 2 hours for next 6 hours postoperatively. A modified TPPPS [Toddler-Preschool Postoperative Pain Scale] was used to assess the pain. Episodes of vomiting, facial flush and pruritus were noted, if present. The duration of analgesia was significantly prolonged in group A patients [p-value=0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group A and 6.66% in group B [p-value=0.64]. No respiratory depression, flushing and pruritus were observed. Low dose combination of bupivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects. The risk of toxicity from bupivacaine decreased when combined with tramadol in low doses

Midazolam with bupivacaine for improving analgesia quality in brachial plexus block for upper limb surgeries

To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. Randomized controlled clinical trial. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2005 to June 2007. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 micro g.kg-1. Hemodynamic variables [heart rate, noninvasive blood pressure, oxygen saturation], pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A [p < 0.001]. Pain scores were significantly lower in group B for 24 hours postoperatively [p < 0.001]. Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine [0.5%] in combination with Midazolam [50 micro gúkg-1] quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine [0.5%] in equal volume

Induction and emergence characteristics of propofol in two different concentrations in day case eye surgery in children

To compare the induction characteristics of two different concentrations of propofol i.e. 1% and 2% in children undergoing eye surgeries. Material and In this cross-sectional comparative study 100 consecutive patients of ASA status 1 and II coming for elective eye surgeries were divided into two groups of 50 each. Group A were given propofol 1% while patients in Group B were given propofol 2% for induction of anaesthesia and were maintained with 1% isoflurane and 60% nitrous oxide in oxygen. Induction characteristics i.e. loss of consciousness or onset time of anaesthesia, pain on injection, spontaneous or purposeless movements, spasm just after intubation and conditions of intubation were assessed and compared in two groups. Student't test and chi- square test were applied. Loss of consciousness was more rapid with propofol 2% compared with propofol 1% [40s Vs 48s; P = 0.02]. Pain on injection occurred in 5[10%] and 10 [20%] patients [P = 0.09] after propofol 1% and 2% respectively. Spontaneous movements during induction occurred in 8 [16%] and 12 [24%] patients [P=0.18]; satisfactory intubation was done in 40 [80%] and 45 [90%] patients [P=0.19], while spasm just after intubation was noticed in 1 [2%] and 3 patients [6%], receiving propofol 1% and 2% respectively. Haemodynamic changes were not different in the two groups. Propofol 1% and propofol 2% are equally effective and safe for induction of anaesthesia in children undergoing eye surgeries

Induction characteristics of two different concentrations of propofol in children undergoing eye surgeries

To compare the induction characteristics of two different concentrations of propofol [i.e. 1% and 2%] in children undergoing eye surgeries. This cross-sectional comparative study was conducted at LV Prasad Eye Institute Hyderabad India. Hundred consecutlve patients of American soclety of Anaesthesiologist [ASA] status I and II coming for elective eye surgeries were enrolled in the study. Patients were divided into two groups of 50 each. Group A were given propofol 1% while patients in Group B were given propofol 2% for induction of anaesthesia and were maintained with 1% isoflurane and 60% nitrous oxide in oxygen. Induction characteristics were assessed and compared in two groups. Student's t test and chi- square test were applied. Loss of consciousness was more rapid with propofol 2% compared with propofol 1% [40s Vs 48s; P = 0.02]. Pain on injection occurred in 5 patients [10%] and 10 patients [20%], P = 0.09 after propofol 1% and 2% respectively. Spontaneous movements during induction occurred in 8 patients [16%] and 12 patients [24%, P=0.18]. Satisfactory intubation was done in 40 patients [80%] and 45 patients [90%, P=0.19], while spasm just after intubation was noticed in 1 patient [2%] and 3 patients [6%] receiving propofol 1% and 2% respectively. Hemodynamic changes were not different in the two groups. Propofol 1% and propofol 2% are equally effective and safe for induction of anaesthesia in children undergoing eye surgeries

Serum leptin and pituitary thyroid axis in hyperthyroid male patients

To see the correlation of serum leptin with pituitary-thyroid axis in hyperthyroid male patients and in euthyroid lean and obese control subjects. Four groups of males were included in the study, they comprised of 22 newly diagnosed, untreated hyperthyroid patients, 24 age, gender, BMI matched euthyroid lean subjects, 27 euthyroid obese subjects. Clinically and biochemically confirmed hyperthyroid patients were selected from the thyroid OPD of Atomic Energy Medical Centre, JPMC, Karachi. Healthy, age, gender, matched euthyroid [lean and obese] controls were selected from general population after checking their thyroid profile and clinical examination. Patients and controls suffering from diabetes or other endocrinal diseases and /or taking treatment for hyperthyroidism or steroids were excluded from the study. Ten ml of blood was drawn after an over night fast from each patient and control. Serum leptin was measured by EL1SA and FT4, FT3 and TSH were measured by radioimmunoassay [RIA], fasting blood sugar [FBS], triglycerides [TG], total cholesterol [TC], high density lipoprotein cholesterol [HDL-C] were checked by kit methods. Low density lipoprotein cholesterol [LDL-C] was calculated by the Friedwald's formula. The mean +/- SEM values of leptin in male hyperthyroid patients wasl.71 +/- 0.45 ng/ml, while in lean and obese control group it was 8.27 +/- 1.91 and 21.34 +/- 3.4 ng/ml respectively. In hyperthyroid patients, significantly low levels of serum leptin were found as compared to age, gender, BMI matched lean [p<0.005] and obese control group [p<0.005]. Obese control group had significantly higher values of leptin as compared to lean group [p<0.05]. No significant correlation of leptin was found with T4, T3, and TSH in hyperthyroid patients and lean and obese control subjects. Triglycerides [TG, p<0.005], total cholesterol [TC, p<0.005] and low dentistry lipoprotein cholesterol [LDL-C, p<0.05] were significantly lower in hyperthyroid patients as compared to control groups. Serum leptin level significantly correlated with the BMI [p<0.005], in hyperthyroid patients and euthyroid lean and obese control groups. There appears no relationship between serum leptin and pituitary thyroid axis in dysthyroid patients as well as in euthyroid subjects but it is strongly related with BMI in all subjects

Spinal surgery in earthquake victims

Objective of present paper is to document the operations performed in earthquake spinal injury patients and to analyze the results of surgery. This is a quasi-experimental study. This study was conducted at the department of Orthopaedic and Spinal surgery at Combined Military Hospital [CMH], Rawalpindi. Study started after earthquake in Pakistan on 8[th] of October 2005 and ended in August 2006. 250 patients with spinal injury were admitted at the three main army hospitals at Rawalpindi [CMH, MH and AFIRM] after earthquake on 8[th] October 2005. Out of these, 110 patients underwent 120 major spinal operations. 12 patients were received from other units for revision surgery. 75% of the patients were civilians and 25% were army personnel and their families. Average age was 28 years and range was 8-65 years. 56% patients were females and 44% were males. 46% patients had complete neurological deficit and 54% had incomplete neurological deficit. Most common associated injuries were fractures of tibia and fibula. Most common level of injury was at T12/L1 [55%]. After surgery almost all patients had rehabilitation at AFIRM. Post-operatively excellent [>75%] or good [50-75%] correction of deformity was achieved in 90% of patients. 92% patients had mild or no pain, post-operatively. Neurological improvement was seen in all patients with incomplete deficit except four. Some patients with complete deficit also showed improvement. Overall there was 1.5 AIS improvement per patient. At last follow up 46% patients were walking independently and 51% were independent in wheel chair. Spinal surgery in patients with unstable spines after major disaster should be carried out by properly trained surgeons as soon as possible and in a setup where facilities for proper rehabilitation are available as it carries best prognosis for these high risk and at times paralyzed patients