Efficacy of Ibuprofen after Total Hip Arthroplasty to Prevent Heterotopic Ossification: Systematic Review and Meta-Analysis / Eficácia do ibuprofeno após artroplastia total de quadril para prevenção de ossificação heterotópica: Revisão sistemática e metanálise

Abstract The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well as the optimum dose and duration of therapy, in preventing the incidence of heterotopic ossification (HO) after primary total hip arthroplasty (THA). A literature search was performed using the PubMed/MEDLINE and Cochrane Library databases for RCTs that compared the use of ibuprofen versus placebo as prophylaxis for HO in patients after THA. The main outcomes for this study were overall occurrence of HO, occurrence according to the Brooker classification, and gastrointestinal complications. A total of 27 potential articles were identified from the database. Eventually, four trials with 1,153 patients were included in the final analysis. When compared with placebo, the use of ibuprofen is associated with a reduction in the incidence of HO at the 3- and 12-month follow-up appointments, as well as the incidence of Brooker II and III HO (p < 0.05). However, there was no significant difference between the ibuprofen and placebo groups in terms of treatment discontinuation due to gastrointestinal complications or the incidence of Brooker I and IV HO (p > 0.05). The existing data indicates that ibuprofen is safe and efficacious in reducing the total incidence of HO along with Brooker II and III HO at follow-up. However, due to the small number of studies, the conclusions are limited; therefore, more high-quality clinical trials are required to develop guidelines for optimal dose and duration of therapy.

Resumo O objetivo deste estudo foi realizar uma revisão sistemática e metanálise de estudos clínicos randomizados (ECRs) relevantes para determinar o papel do ibuprofeno, sua dose ideal, e a duração do tratamento na prevenção de ossificação heterotópica (OH) após a artroplastia total primária do quadril (ATQ). Uma pesquisa bibliográfica foi feita nos bancos de dados PubMed/MEDLINE e Cochrane Library para a obtenção de ECRs quecomparassem ouso de ibuprofeno edeplacebo como profilaxiaparaOHem pacientes submetidos à ATQ. Os principais desfechos deste estudo foram ocorrência geral de OH, classificação de Brooker da OH, e complicações gastrintestinais. No total, 27 artigos foram identificados nos bancos de dados e 4 estudos, com 1.153 pacientes, foram incluídos na análise final. Em comparação ao placebo, o uso de ibuprofeno reduziu a incidência de OH aos 3 e 12 meses de acompanhamento e a incidência de OH Brooker II e III (p < 0,05). No entanto, não houve diferença significativa entre os grupos que receberam ibuprofeno e placebo em termos de interrupção do tratamento devido a complicações gastrintestinais ou da incidência de OH Brooker I e IV (p > 0,05). Os dados existentes indicam que o ibuprofeno é seguro e eficaz na redução da incidência total de OH e de OH Brooker II e III durante o acompanhamento. No entanto, as conclusões são limitadas devido ao pequeno número de estudos; logo, mais estudos clínicos de alta qualidade são necessários para o desenvolvimento de diretrizes em relação à dose e duração ideal da terapia.

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients

SUMMARY OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Is the COVID-19 disease associated with de novo nephritic syndrome?

SUMMARY INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors. METHODS: All ward patients with COVID-19 pneumonia were investigated. After determining the inclusion and exclusion criteria, the study population was identified. The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed. Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19. The mean age of the patients was 42.2±8.8 years, and 71.4% of them were male. The mean duration of follow-up was 28.4±9.3 days. The urine RT-PCR test was positive in one patient (4.8%). Improvements were observed in hematuria by 71.4%, and proteinuria by 85.7% at the end of the follow-up. A significant decrease in the measured UPCR was found in comparison to the baseline(P=0.000). Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline. There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission. However, why these findings were not present in all patients who had no comorbidities is not clear.

RESUMO INTRODUÇÃO: Este estudo tem como objetivo determinar a incidência da síndrome nefrítica de novo (SN) em pacientes com COVID-19 e identificar os fatores associados. MÉTODOS: Todos os pacientes da enfermaria com pneumonia por COVID-19 foram investigados. Após a determinação dos critérios de inclusão e exclusão, a população do estudo foi identificada. Foram realizadas medições do teste da vareta da urina e da razão da creatinina das proteínas na urina (UPCR). RESULTADOS: Este estudo transversal descritivo foi realizado com 21 pacientes com COVID-19. A idade média dos pacientes foi de 42,2±8,8 anos e 71,4% dos pacientes eram do sexo masculino. A duração média do seguimento foi de 28,4±9,3 dias. O teste de RT-PCR na urina foi positivo em um paciente (4,8%). Houve melhorias observadas na hematúria em 71,4% e na proteinúria em 85,7% no final do acompanhamento. E uma diminuição significativa na UPCR medida em comparação à linha de base (p=0,000). Além disso, foram registradas melhorias nas contagens sanguíneas completas, nos parâmetros inflamatórios, nos testes de ferritina e de coagulação, comparados aos valores basais. Houve correlação positiva entre UPCR basal e ferritina, e correlação negativa entre os valores basais de UPCR e sódio. CONCLUSÃO: A síndrome nefrítica de novo induzida por COVID-19 pode ocorrer principalmente devido ao envolvimento túbulo-intersticial e frequentemente resulta em remissão espontânea. No entanto, a questão de por que esses achados não se apresentaram em todos os pacientes que não apresentavam condição comórbida não é clara.

The effects of favipiravir on hematological parameters of covid-19 patients

SUMMARY INTRODUCTION This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

RESUMO INTRODUÇÃO Este estudo tem como objetivo avaliar as alterações nos parâmetros hematológicos após o acompanhamento de pacientes que receberam tratamento com favipiravir devido à infecção por Covid-19. MÉTODOS Sessenta e dois casos em tratamento com favipiravir por pelo menos cinco dias devido à infecção por Covid-19 foram avaliados retrospectivamente. Parâmetros como idade, sexo, positividade do swab nasofaríngeo e doenças crônicas foram analisados. Os parâmetros hematológicos foram analisados antes e após o tratamento. RESULTADOS A idade média dos pacientes que receberam tratamento com favipiravir foi de 63,7±12,3 anos. A positividade do swab nasofaríngeo foi detectada em 67,7%. As condições comórbidas mais comuns detectadas nos pacientes foram hipertensão em 25 casos (40,3%) e diabetes em 16 casos (25,8%). Na análise estatística dos parâmetros hematológicos antes e após o tratamento com favipiravir, os níveis de leucócitos, PT-PTT-INR não foram afetados. Verificou-se que o RBC médio diminuiu de 4,33±0,58 M/uL para 4,16±0,54 M/uL (p=0,003); o nível médio de hemoglobina foi reduzido de 12,3 g/dl para 11,9 g/dl (p=0,041); o nível de hematócrito diminuiu de 38,1%±4,8 para 36,9%±4,2 (p=0,026); a contagem mediana de neutrófilos diminuiu de 4,57 K/uL para 3,85 K/uL (p=0,001); a contagem média de linfócitos aumentou de 1,22±0,53 K/uL para 1,84±1,19 K/uL (p=0,000); a contagem média de plaquetas aumentou de 244,1±85,1 K/uL para 281,9±103,3 K/uL (p=0,005). CONCLUSÃO Concluiu-se que o efeito patológico do tratamento com favipiravir no sistema hematológico foi a supressão na série eritrocitária e que não houve efeitos adversos em outros parâmetros hematológicos.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection

SUMMARY AIM The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.

RESUMO OBJETIVO O objetivo deste estudo é analisar o significado prognóstico dos antígenos do grupo sanguíneo ABO e Rh, juntamente com vários parâmetros em pacientes acompanhados com o diagnóstico de COVID-19. MÉTODOS Foram avaliados 397 pacientes que foram acompanhados e tratados devido à infecção por COVID-19. Foram analisadas as idades, gêneros, doenças crônicas, antígenos do grupo sanguíneo ABO e Rh, taxas de internação em unidades de terapia intensiva (UTI) e taxas de mortalidade dos pacientes. A idade média de 397 pacientes com COVID foi de 47 ± 17 anos. Na análise do grupo sanguíneo dos pacientes, A Rh positivo (A +) foi o tipo sanguíneo mais frequentemente observado (176 dos pacientes, 44,3%), seguido pelo O Rh positivo (0 +) (109 dos pacientes, 27,5%) 38 dos pacientes eram Rh negativos (Rh -) (9,6%). 53 dos pacientes (13,4%) foram acompanhados em UTI e 29 faleceram (7,3%). Não houve mortalidade nem admissão na UTI para o grupo Rh. A comparação dos grupos Rh quanto à necessidade de admissão na UTI revelou uma taxa significativamente alta de admissão na UTI no grupo Rh + (p = 0,011), enquanto não foi encontrada relação significativa entre mortalidade e antígeno Rh (p = 0,069). CONCLUSÃO O tipo sanguíneo mais frequentemente observado foi o A + entre os pacientes com COVID-19. O grupo sanguíneo Rh + foi encontrado em todos os casos admitidos na UTI e com evolução mortal. O grupo sanguíneo Rh + foi encontrado em um número significativamente alto de pacientes internados na UTI, enquanto nenhuma relação significativa foi encontrada entre a mortalidade e o grupo sanguíneo Rh.

Atherosclerosis in geriatric patients known to be healthy

Background: The aim of the present study is to determine the presence of atherosclerosis in geriatric patients who are known to be healthy and examine sociodemographic and laboratory parameters affecting the presence of atherosclerosis.Method: 90 healthy volunteers including 66(73.3%) non-geriatric ones and 24(26.7%) geriatric ones were included in the study. It was analyzed whether there was a correlation between the two groups in terms of the parameters of gender, age average, alcohol consumption, smoking, carotid intima-media thickness (CA-IMT), and pulse wave velocity (PWV). Sociodemographic and laboratory parameters of the volunteers with and without atherosclerosis in the geriatric group were examined. Results: Among geriatric volunteers (Group 1), 13(54.2%) were male; whereas, among non-geriatric volunteers (Group 2), 41(62.1%) were male. CA-IMT was determined to be higher in Group 1 (averagely 0.80±0.12 mm) than Group 2 (averagely 0.62±0.14 mm) (p:<0.001). PWV was significantly higher in Group 1 (averagely 10.32±1.44 m/s) than Group 2 (6.26±1.09 m/s) (p:<0.001). After PWV or CA-IMT examination, atherosclerosis findings were determined in 12 healthy geriatric volunteers (50%) in Group 1.Conclusion: It should be remembered that even though atherosclerosis can be frequently observed in geriatric individuals who are known to be healthy, it may also go unnoticed. Determination of atherosclerosis with noninvasive methods will be helpful in preventing complications that might be caused by atherosclerosis.

Relationship of salusin-alpha and salusin-beta levels with atherosclerosis in patients undergoing haemodialysis

INTRODUCTION@#In patients undergoing haemodialysis, cardiovascular mortality and morbidity, characterised by accelerated atherosclerosis and increased inflammation, are elevated. Salusins are newly defined molecules in the atherosclerotic processes, and while salusin-alpha (Sal-α) acts as an antiatherogenic factor, salusin-beta (Sal-β) has a proatherogenic role. Their roles are as yet undefined in patients undergoing haemodialysis.@*METHODS@#In this cross-sectional study, salusin levels, carotid intima-media thickness (CIMT) from the common carotid artery and pulse wave velocity (PWV) were measured for 180 patients undergoing haemodialysis and 90 healthy controls.@*RESULTS@#Mean Sal-α and Sal-β levels in patients undergoing haemodialysis (Sal-α: 726.4 ± 578.7 pg/mL; Sal-β: 1,080.4 ± 757.1 pg/mL) and healthy controls (Sal-α: 325.8 ± 303.7 pg/mL; Sal-β: 268.1 ± 409.0 pg/mL) were determined. Negative correlation was observed between Sal-α levels and CIMT (patients undergoing haemodialysis: r = -0.330, p < 0.0001; healthy controls: r = -0.223, p = 0.035) and PWV (patients undergoing haemodialysis: r = -0.210, p = 0.005; healthy controls: r = -0.378, p < 0.0001) in both groups. In patients undergoing haemodialysis, positive correlation was observed between Sal-β/Sal-α ratio and CIMT (r = 0.190, p = 0.012) and PWV (r = 0.155, p = 0.041). On subgroup analysis, Sal-α levels were found to be low in patients with diabetes mellitus.@*CONCLUSION@#Patients undergoing haemodialysis have higher Sal-β and Sal-α levels, and their higher Sal-β/Sal-α ratio, in comparison with healthy controls, might have cardiovascular risk implications.

association of vitamin D status and vitamin d replacement therapy with glycemic control, serum uric acid levels, and microalbuminuria in patients with type 2 diabetes and chronic kidney disease

Objective: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid [SUA] levels, and microalbuminuria [MAU] in patients with type 2 diabetes [T2DM] and chronic kidney disease [CKD]

Subjects and Methods: A total of 1,463 patients with T2DM and CKD [aged 14-88 years], 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25[OH]D, level, SUA, hemoglobin [Hb]A1[c], creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio [UACR] were obtained from the medical records. The Mann-Whitney U test, the chi[2] test, the Mantel-Haenszel test, and linear regression models were used for data analysis

Results: Vitamin D deficiency and insufficiency were evident in 770 [52.0%] and 357 [24.0%] patients, respectively. Median HbA1[c] levels [7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01] were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR [beta -0.01; 95% CI -0.01 to -0.001; p = 0.017] and HbA1[c] [beta -1.1; 95% CI -1.6 to -0.6; p < 0.001], but with low levels of SUA [beta 1.3; 95% CI 0.5-2.2; p = 0.002]. Vitamin D replacement was associated with a significantly low level of HbA1[c] [7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]

Conclusion: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1[c], and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management

Role of MRI in functional prognosis of metastatic cord compromise

Objective: primary objective of our study was to establish the strength of association of MRI findings at presentation with clinical outcome of patient i.e. Motor deficit and Sphincter control. Secondary objectives included Incidence of tumors affecting spinal cord and Correlation of motor weakness and sphincter control with patient presentation

Methods: this retrospective study was conducted in Department of Radiology,Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, between Jan 2013 and June 2013. The study included series of 64 patients, including 38 men and 26 women, ranging between 35 and 70 years [mean, 48.5+/-13 years], presenting with symptoms and signals of spinal stenosis

Results: results for tumors involving less than 25%, N: 24 [37%] were included in this group. All showed stable appearance or improvement on follow up. Data was not significant [when expecting stability/improvement in 75-100% of patients].When further divided into 2 groups. Improvement was seen in [6] p> 0 and stability in [18] p< 0.05 significant. Results for tumors involving less than 25-50%, N: 26 [40.6%]. 45% showed improvement, when expecting stability/ improvement in 50-75% of patients. Data was statistically insignificant data with p > 0.05.Moreover, the results for tumors involving less than 50-75%, N: 4 [6.2%]. 50% showed improvement/stability post treatment. 50% showed progression. In patients tumors involving less than 75-100%, N: 10 [15%]. 20% showed improvement. Statistically significant data with p< 0.05.Cord signal was compromised in 28 [34.3%]. 22 had muscular weakness. Improvement was seen in 45%. 12 had sphincter dysfunction. 50% showed improvement in clinical symptoms

Conclusion: MRI has a potential to predict the functional outcome in patients with metastatic cord compromise

Comparison of hydrocolloid with conventional gauze dressing in prevention of wound infection after clean surgical procedures

To compare hydrocolloid with conventional gauze dressing in prevention of infections after clean surgical procedures. Randomized controlled trial. Department of Surgery, CMH Rawalpindi from 22 Jan 2010 to 22 Aug 2010. A total of 400 patients undergoing clean surgical procedures were randomly allocated in two equal groups, A and B by lottery method. In group A, simple gauze dressing was applied after clean surgical procedures while in group B hydrocolloid dressing was used. On 7[th] post operative day, patients were observed for presence of infection. Mean age of sample was 42.08 +/- 11.112 years. In group A out of 200 Patients, 14[7.0%] while in group B 10[5%] developed infection postoperatively [p=0.709]. There is no difference in the rate of infection when using a gauze dressing or a hydrocolloid dressing after clean surgical procedure

Surgical treatment of upper cervical spine injuries [C1-C2]: experience in 26 patients

To describe the spectrum of operations in unstable upper cervical spinal injuries in [atlanto-axial] region at our unit. A cross-sectional study. Spine Unit, Department of Orthopedics, Combined Military Hospital [CMH], Rawalpindi from Jan 2001 to Dec 2008. Frequency of different kind of operations in 26 patients operated for upper cervical spinal injuries was reviewed. A performa was made for each patient and records were kept in a custom built Microsoft access database. Average age of patients studied was 27 years with male pre dominance. Total 12[46%] patients had Atlanto-axial instability, 8[31%] had Hangman's fracture and 6[23%] patients had odontoid peg fracture. While 11[42%] patients had no neurological deficit according to American spinal injury association impairment scale [AIS-E] and 15[58%] had partial neurological deficit. The patients were divided into three groups. Group A had odontoid peg fracture, Group B had atlanto-axial instability and Group C had Hangman's fracture. The spine was approached posteriorly in 19[73%] cases and anteriorly in 7[27%]. Pedicle screw fixation was done in 6[23%] patients, odontoid peg screw fixation in 6[23%], Gallie's fusion in 5[19%], occipito-cervical fusion in 4[15%], posterior transarticular fixation in 3[12%], anterior transarticular fixation and decompression in others, 9[60%] patients improved neurologically postoperatively and there was no deterioration of neurological status. Nonunion in two [8%] cases and implant failure in one [4%] were complications. Upper cervical injuries [C1-C2] are rare and their management is complex, necessitating lot of experience for their management. Early diagnosis and appropriate treatment is essential for good outcome. Each injury has to be managed at its own merit and a single operation may not be appropriate in all situations. General guidelines can be drawn from our study for the management of these cases on modern lines

Diversity of presentations in decompensated chronic liver disease due to HCV

Background: An estimated 170 million people worldwide suffer from HCV infection. Chronic hepatitis C virus [HCV] infection is often a clinically silent infection presenting many years after with complications related to decompensation, so

Objective: To emphasize the role of early detection and intervention in preventing complications of HCV related chronic liver disease

Materials And Methods: Newly diagnosed decompensated chronic liver disease [CLD] due to HCV infection presenting to respective hospitals during 2010

Study design: observational multicentre study

Results: Out of 340 new cases of decompensated chronic liver disease due to hepatitis C virus. 190 [56%] were females and 150 [54%] were male. In terms of presentation, patients were having overlapping symptoms and signs like ascites, jaundice, upper GI bleed and encephalopathy. 220 [64.7%] had clinical ascites, 70 [20.5%] had spontaneous bacterial peritonitis, 130[38.2%] had altered conscious level and150 [44.1%] had upper GI bleed. It was inferred from history that 170[50%] patients with Hepatitis C were detected while being investigated for complaints other than liver disease. Other presentations included jaundice in 10[2.9%] 50 [14.7%] with previous upper GI bleed, 80 [23.5%] with CLD, 10 [2.9%] with epigastric discomfort and 20 [5.8%] had altered conscious level. 235 [69.1%] with Child's Score B and 105[30.4%] with Child's Score C

Conclusion: Majority of patients become aware only when complications set in. Early detection and interventions should be stressed because the available treatment options for the complications are beyond the reach of majority of patients and don't have a permanent solution

Metabolic syndrome frequency in patients presenting with acute myocardial infarction

To determine the frequency of metabolic syndrome in patients presenting with acute myocardial infarction [MI]. Cross -sectional, observational, multi center study. Allied Hospital Faisalabad from 01-01-2009 to 30-06-2010. Any patient fulfilling the criteria of acute myocardial infarction were admitted and enrolled in the study during the study period. Demographic details, history and clinical examination of the patients were recorded on prescribed performa after securing an informed consent. Blood Pressure was recorded in lying posture from right arm and waist circumference measured at umbilical level in lying position. Blood sample was collected in fasting state for estimation of plasma glucose, serum HDL-cholesterol and serum triglycerides levels. Out of 690 patients, 420[60.86%] were male and 270[39.14%] were females with average age 55.90 +/- 10.19. 40% males and 44% females had metabolic syndrome and incidence increased with age. Waist circumference was increased in 46.85% participants followed by increased fasting blood sugar [42%] levels. Frequency of metabolic syndrome was high among the patients with acute myocardial infarction. It supports the potential for preventive efforts in persons with high risk for acute myocardial infarction

Epidemiology of non-disaster spinal injuries at a spine unit

To describe the demography, types of injuries and their management in all non-disaster spinal injury patients admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. Case series. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, from April 2001 to December 2008. Data of all new non-disaster spinal injury patient admissions, kept in a custom-built database at Spine Unit, was analyzed. Demography, type of injuries and their management was described in percentages. Five hundred and twenty one non-disaster patients were selected out of a total 671 new admissions with spinal injuries. Mean age was 39.1 years and 77% were males. Mechanisms of injury included; fall in 62% and road traffic accidents in 32%. Fracture dislocations and burst fractures were equally distributed [36% each]. Most of the injuries [43.6%] were at T11-L1 level. Forty three percent patients had complete spinal cord injury [SCI], 33% had incomplete SCI and 24% did not have any SCI. Eight patients had concomitant spinal injury at a different level. Twelve percent patients had associated other major injuries. Seventy percent patients were treated surgically. Average follow-up was for 4 years. Non-disaster spinal injury was frequent in young males usually due to fall or road traffic accident. It involved fracture dislocation or burst fracture at T11-L1, level in most cases requiring surgical treatment

Outcome of instrumented spinal fusion for chronic low back pain: review of 100 patients

Objective of this study was to evaluate the outcome of instrumented spinal fusion in selected patients with Chronic Low Back Pain [CLBP] in our setup. Quasi-experimental study. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan. Jan 2002 to Dec 2007. Consecutive first one hundred patients were selected from spine unit database that underwent instrumented spinal fusion for chronic low back pain lasting more than one year, due to degenerative disease of spine. Average age was 42 years. There were 62 males and 38 females. Diagnosis included; spinal stenosis [26%], failed disc surgery [22%], spondylolisthesis [19%], degenerative disc disease [17%], and instability [16%]. Operations performed; Pedicle Screw Fixation [PSF] with Postero-lateral Fusion [PLF] in 3% patients. Trans Laminar Facet Screw [TLFS] with PLF in 24% patients. Anterior Lumbar Inter-body Fusion [ALIF] in 9% patients. Posterior Lumbar Inter-body Fusion [PLIF] in 40% patients and Trans-foraminal Lumbar Inter-body Fusion [TLIF] in 24% patients. Average follow up was for 30 months. 86% patients had full spinal fusion. 71% patients were fully satisfied with treatment, 28% were partially satisfied. Post-operatively, on average, visual analogue scale [VAS] showed 48 points significant improvement and Oswestry Disability Index [ODI] showed 53 points significant improvement. Instrumented Spinal Fusion is effective in our set up for relieving symptoms and improving functional outcome in selected patients with debilitating Chronic Low Back Pain due to degenerative disease of spine. Single fusion technique is not ideal for all types of patients and surgeon has to be versatile and trained in using different fusion techniques as the situation demands