Measles: demographic profile and associated morbidities of measles cases admitted in a teaching hospital

Objective: To determine the different demographic parameters, associated morbidity and mortality of measles cases admitted in a paediatric unit of a teaching hospital

Study Design: Descriptive cross sectional study

Place and Duration of Study: Pediatrics department Combined Military Hospital Kharian from October 2012- September 2013

Material and Methods: All patients admitted with diagnosis of measles according to World Health Organization [WHO] definition of clinical measles up to 12 years of age were included. Detailed history and clinical examination was done. Required information regarding study parameter was collected on a pre designed proforma. Different complications in relation to age, vaccination and nutritional status were assessed. Statistical data was analyzed by SPSS version 17

Results: Among total 68 patients, 48[70.58%] were male and 20 [29.41%] female. Mean age was 21.26 [ +/- 26.95] months. Thirty four [50%] patients were between 6-8 [completed] months of age, 3 [4.41%] less than 6 months whilst 5[7.35%] were aged between 5-12 years. Partially and unvaccinated patients were 19.11% and 88.88% respectively. Thirty [44.11%] cases were well nourished and 38 [55.88%] malnourished. Pneumonia [41.66%] was the commonest complication followed by diarrhea [37.5%], oral lesions [29.16%], otitis media [10.41%], eye changes, encephalitis, myocarditis and hepatitis [each 4.16%]. Mortality was 1.47%. Complications were more common in malnourished than well nourished patients [p-value <0.05] and in unvaccinated than vaccinated children [p-value <0.05]

Conclusion: Majority of patients was less than 9 months age. Pneumonia was the commonest complication and only cause of death. Complications were more common among unvaccinated and malnourished children

Effect of diabetes mellitus on orthodontic tooth movement in a rat model

The objective of this study was to observe bone response in terms ofosteoclast count and orthodontic tooth movement under optimal orthodontic force in diabetic and normoglycemic rat model. This experimental study was conducted at Animal House and Histopathology Department, Post Graduate Medical Institute, Lahore. Duration of study was June 2013 December 2013. 44 male wistar rats were included in the study and equally divided into two groups; group 1 [Normoglcemic or NG group] and Group 2 [Experimental Diabetic or EDB group]. Type-1 diabetes mellitus was induced by injecting streptozotocin [STZ] in EDB group. Citrate buffer solution was injected in NG group. Maxillary right first molar was moved mesially by applying 10 cN force using closed coil spring. All rats were euthanized on the 21st day after placement of the appliance. The orthodontic tooth movement was recorded by digital vernier caliper. Maxillae of the rats were dissected along with the molar teeth. Serial transverse sections of each maxilla in the interradicular bone at furcation area of first molar distobuccal root of control and appliance side were obtained for quantification of osteoclasts by histomorphometric study. Results showed that mean osteoclast count was significantly more in EDB group as compared to NG group, while no osteoclast was found on the non-appliance control side of both groups. Mean orthodontic tooth movement of rats in EDB group was significantly higher than NG group. It was concluded that Type-1 Diabetes Mellitus result in greater orthodontic tooth movement and increased osteoclasts as compared to normal subjects

Group B streptococcus neonatal meningitis-less common cause of neonatal meningitis in pakistan and disparity between csf culture and other parameters

Neonatal bacterial meningitis is a devastating illness with significant mortality and morbidity. Incidence and etiology of neonatal bacterial sepsis and meningitis varies among developed and developing countries. We are reporting a case of 6 days old neonate who presented with fever, refusal to take feed and then followed by an episode of seizure activity. Laboratory parameters for complete sepsis screening including cerebrospinal fluid [CSF] and metabolic screening were absolutely normal for his age, but CSF culture revealed growth of group B Streptococcus [Streptococcus agalactiae] Patient was treated successfully without any morbid sequel

Complications in laparoscopic cholecystectomy

Objective: to list and understand the types and the rate of complications associated with laparoscopic cholecystectomy done by a small group of surgeons over a decade at four military hospitals PNS Shifa Karachi, CMH Rawalpindi, MH Rawalpindi and PNS Hafeez Islamabad

Study Design: observational and descriptive study

Place and Period of study: CMH Rawalpindi from January 2003 to December 2012 [10 years]

Patients and Methods: case records of all patients [both genders and all age groups] undergoing laparoscopic cholecystectomy over a period of ten years were reviewed. Fifteen hundred patients with a clinical follow up record of at least six months were included in the study. Complications were grouped into three main categories, per operative, early post-operative and late post-operative. They were further sub-grouped into major and minor categories. A major complication was regarded as one causing significant morbidity or likely to be potentially fatal if not treated expeditiously. Data analysis included calculation of the number of patients, rate and percentage of different types of complications

Results: complications occurred in 495 [33%] cases. Major complications occurred in 199 [13.27%] cases. In the remaining 296 [19.73%], the complications were labeled as minor. Conversion to open surgery occurred in 147 [9.8%]. Post-cholecystectomy laparoscopic re-intervention within 48 hours was done in 3 [0.2%] cases. There was one mortality due to septicemia following bowel injury

Conclusion: the risk of complications is a possibility in any patient undergoing laparoscopic cholecystectomy despite remarkable advances in instrumentation and video systems. Most common complication is hemorrhage [1.3%] followed by CBD injuries [.13%]. Due attention to risk assessment, patient and family counseling, importance of valid consent and a flexible approach to conversion to open surgery is stressed

Treatment of mycosis fungoides with total skin electron beam therapy using modified stanford technique

A retrospective review of three patients with mycosis fungoides treated with total skin electron beam therapy, from the year 2007 to 2009, at the Oncology department, Ziauddin University Hospital

Neonatal idiopathic primary hypoparathyroidism: a rare cause of neonatal seizures

Etiology of neonatal seizures [NNS] is diverse and hypocalcemia is one of the treatable causes. Neonatal hypocalcemia [NHC] due to congenital hypoparathyroidism, either permanent or transient, is extremely rare. Its biochemical abnormalities include hypocalcemia, hyperphosphatemia and low levels of intact parathyroid hormone [PTH]. Isolated congenital hypoparathyroidism in which deficiency of PTH has no association with maternal, syndromic or endocrine defects is a very rare entity. We are reporting a case of a newborn who presented with seizures on the 5th day of life and later on investigations revealed hypocalcaemia due to isolated congenital hypoparathyroidism

Comparison of efficacy of oral and intramuscular iron supplementation for treatment of iron deficiency anemia in children

To compare the efficacy of oral iron preparation with intramuscular iron sorbitol in treatment of iron deficiency anemia in children. Randomized controlled trial. Paediatric department of Combined Military Hospital Kharian, Pakistan, from October 2011 to March 2013. In total 200 anemic chldren from 6 months to 5 years of age were included. Cut off value for Hb was < 8 gm/dl. Patients were divided into two groups, each of 100, randomly. Group A received oral sodium feredetate [iron edetate] and group B received intramuscular iron sorbitol. Rise in Hb > 10 gm/dl was kept as the desired value. Maximum duration of treatment planned was 12 weeks for group A and 2 weeks for group B. Laboratory parameters such as Hb%, mean corpuscular volume [MCV], retic count and serum ferritin level were used to detect the responses in both groups at one week, two weeks, four weeks and twelve weeks of treatment. Among 200 patients, male and female distribution was 45% and 55% respectively. Desired rise in Hb in group B was achieved much earlier i.e. at two weeks as compared to group A. Progressive rise in laboratory parameters was observed but this rise was more evident in group B as compared to group A. After one week treatment in group A, rise in retic count, Hb, ferritin and MCV was 0.759 +/- 0.318, 0.814 +/- 0.387, 0.47 +/- 0.154 and 4.28 +/- 2.468 respectively. But rise in these values in group B was 2.235 +/- 0.632, 2.335 +/- 0.135, 6.31 +/- 1.123 and 12.11 +/- 0.414 respectively. Same persistent different trend was observed at 2 and 4 weeks. After 12 weeks treatment in group A, rise in retic count, Hb, ferritin and MCV was 1.044 +/- 0.222, 5.204 +/- 0.134, 17.39 +/- 2.551 and 16.61 +/- 1.214 respectively but rise in these laboratory indices in group B was 0.551 +/- 0.261, 6.097 +/- 0.21, 42.49 +/- 2.768 and 20.68 +/- 2.233 respectively. The comparison of hematological indices after 12 weeks in A and B groups show sigruficant differences. All these parameters improved in both groups but improvement in group B was drastically more prominent when compared with group A [p-value < 0.05]. Intramuscular iron sorbitol therapy is an alternative and comparatively better treatment option as compared to oral iron therapy, sodium feredetate, in regards of treatment duration and earlier rise in the laboratory indices

Evaluation of healing at urethral anastomotic site by pericatheter retrograde urethrogram in patients with urethral stricture

Stricture urethra has been always a surgical challenge. Different opinions regarding time require healing at anastomotic site after urethroplasty, so various strategies are there regarding time for post-operative catheter removal. In this study, healing was assessed by pericatheter retrograde urethrogram [PUG] before the catheter removal. Prospective study was conducted from January 2006 to December 2009. Twenty eight cases of short-segment urethral stricture [<2 cm] who underwent urethroplasty were included and divided into two groups depending upon etiology; post-traumatic group [road traffic accident/straddle type injury] and iatrogenic stricture group [due to prolong catheterization/after cystoscopy/Faulty Foleys balloon placement]. Post-operative PUG was done on 14[th] post-operative day in all patients for healing assessment. Extravasation of dye on PUG was taken as anastomotic leak. If the patient had not showed extravasation, the catheter was removed. Otherwise it was kept further for next one week and again PUG was done for healing assessment. Extravasation of dye was noted in 4 patients [33%] of iatrogenic group and 14 patients [87.5%] of the post-traumatic group on 14[th] post-operative day PUG. [P

Degree of thrombocytopeniaand malaria parasite species

Background: Malaria is a common health issue of our country and has shown variable prevalence in different regions of the world. It has a vast array of clinical presentation including, high grade fever with rigors and chills, headache, dizziness, acute renal failure, hepatopathy, joint pains and congenital malaria. It has various abnormalities on laboratory indices like thrombocytopenia, anemia, and leucopenia

Objective: This study was conducted to find out the degree of thrombocytopenia and types of the parasites among malaria patients from upper Punjab

Patients and Methods: This descriptive case series was conducted in CMH, Kharian, from 1[st] September, 2011 to 30[th] September, 2012. All the suspected malaria patients were included on the basis of history, physical examination and diagnosed on laboratory parameters [thick and thin films]

The data was entered and analyzed in SPSS version 16

Results: Out of the 273 enrolled cases in our study, 190 [69.6%] had malaria. 145 [76.3%] were infected by Plasmodium vivax and 45 [23.7%] had falciparum malaria. Out of these 190 patients 151 [79.5%] had thrombocytopenia, and among these patients having thrombocytopenia, 118 [78.1%] were infected by vivax species and 33 [21.8%] were infected by Falciparum species

Conclusion: It is concluded from our study that majority of the patients in this region of country, are suffering from Vivax and Falciparum malaria and present with varying degree of thrombocytopenia

Antibacterial effect of mango [mangifera indica Linn.] leaf extract against antibiotic sensitive and multi-drug resistant Salmonella typhi

Alternative herbal medicine has been used to treat various infections from centuries. Natural plants contain phytoconstituents having similar chemical properties as of synthetic antibiotics. Typhoid fever is a serious infection and failure of its treatment emerged multi-drug resistant [MDR] bugs of Salmonella typhi. Due to multiple and repeated issues with antibiotics efficacy, it became essential to evaluate biological properties of plants from different geographical origins. Mango leaves have been reported for various medicinal effects like antioxidant, antimicrobial, antihelminthic, antidiabetic and antiallergic etc. Objective of present study was to investigate anti-typhoid properties of acetone mango leaf extract [AMLE] against antibiotic sensitive and MDR S. typhi isolates. A total of 50 isolates of S. typhi including MDR [n=30] and antibiotic sensitive [n=20] were investigated. Staphylococcus aureus [ATCC 25923] and Salmonella typhimurium [ATCC14028] were used as quality control strains. AMLE was prepared and its antibacterial activity was evaluated by agar well diffusion screening method and minimum inhibitory concentration [MIC], by agar dilution technique. Zone of inhibition [mm] of AMLE against MDR and antibiotic sensitive isolates was 18 +/- 1.5mm [Mean +/- S.D]. Zone of S. aureus [ATCC 25923] and S. typhimurium [ATCC14028] was 20 +/- 1.5mm [Mean +/- S.D]. MIC of AMLE was reported in range from 10-50 mg/ml. The present study described the inhibitory effects of mango leaves against S. typhi

Embolectomy for acute limb ischemia: experience in 84 cases in a tertiary care hospital

To highlight the presentation, outcome and the role of embolectomy in the management of acute limb ischemia. A descriptive study. Department of Vascular Surgery, CMH Rawalpindi from Oct 2008 to Dec 2010. All patients with acute limb ischemia presenting at CMH Rawalpindi during study period and managed by embolectomy were included. Embolectomy was performed through transfemoral or transbrachial approach, depending upon the limb involved under local anesthesia with Fogarty catheter. Eight four patients of acute limb ischemia were managed by embolectomy during study period. Lower limb was affected more frequently 51 [60.7%] than upper limb 33 [39.3%]. Male to female ratio was 1.4: 1. Forty eight [57.1%] patients reported 12 hours after the onset of symptoms. Embolism was the most common cause present in 53 [63%] and most frequent site of obstruction was femoral bifurcation 23 [45%]. Presence of paralysis and skin changes were bad prognostic signs. Eight patients [9.5%] had fasciotomy at the time of embolectomy. Nine major amputations were carried out in 8 patients [10.7%]. Eleven patients [13.0%] died within 30 days. Limb salvage rate was 83.3%. In the scenario of multiple new therapeutic techniques, embolectomy is still a simple, safe and effective surgical option for treatment of acute limb ischemia

Haemophilia B: clinical manifestations and complications

Haemophilia B is X-linked recessive inherited disorder of factor IX deficiency. It is classified as severe, moderate and mild depending upon plasma levels of factor IX. The development of inhibitors is seen during treatment of haemophilia B against F-IX. This study was aimed to determine the frequency of different complications in haemophilia B patients. Total 45 patients of Haemophilia B already enrolled in the Haemophilia society of Pakistan Lahore chapter were included in this study. Clinical history and physical examinations were recorded on a pre designed proforma. Laboratory testing for establishment of diagnosis of haemophilia B and inhibitors of FIX was done. Out of 45 patients, 10 [22.2%] had severe disease while 28 [62.2%] had moderate and 07 [15.6%] had mild disease. Twenty nine [64.4%] of patients with severe and moderate disease were diagnosed below 5 years of age while none with mild disease was diagnosed under 5 years of age. Arthropathy was the most frequently developing complication in patients 10 [100%] of severe Hemophilia B. Post circumcision bleeding was found to be the most common first episode of bleeding in patients of haemophilia B 29 [64.4%]. Inhibitor against F-IX developed in only one patient of severe disease 1 [10%]. Arthropathy is the commonest complication and circumcision is the first bleeding site in most of the haemophiliacs

Risk factors associated with childhood asthma among children aged 1-12 years in Rawalpindi

To explore various risk factors associated with childhood asthma in Rawalpindi garrison and city among children 1-12 years old. Case Control study. Pediatric departments of Military Hospital [MH] and Combined Military Hospital [CMH] Rawalpindi from 1st Aug to 30th Nov 2009. A total of 128 children with diagnosis of asthma presenting in outpatient and indoor pediatric departments of MH and CMH Rawalpindi between ages of 1-12 years were included. Age, gender and socioeconomically matched 112 children without diagnosis of asthma were included as controls. A predesigned questionnaire containing various factors associated with childhood asthma was filled by the researcher by detailed interview with either of parents. Data was analyzed by SPSS version 15 and chi-square test was applied to determine significance. p value <0.005 was considered significant. Out of 15 risk factors studied 8 were found significantly associated with childhood asthma. Significant factors were education of any of the parents more than matric, history of fever at least three times in last year, use of antibiotics, history of hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma [p value<0.005]. Non significant factors were mode of delivery, exclusive breast feeding for more than 3 months, partial breastfeeding for more than 6 months, history of eczema, atopy, history of viral respiratory infections in infancy and less than three number of rooms at home. Male preponderance was noted amongst cases. Education of parents, fever, antibiotics, hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma proved to be significant factors which are similar to those reported in other studies. However, difference was found in other factors. Recognition of these factors can help to optimize management of asthma in children in this area

Congenital lobar emphysema: cause of respiratory distress in neonate and infant

The aim of the study is to share a series of cases presented with respiratory distress in neonatal period or infancy due to uncommon case of congenital lobar emphysema. Different modes of presentation and diagnostic work up is discussed. Congenital lobar emphysema results from hyperinflation of a segment of lung from incomplete obstruction of major airway. This result in respiratory distress due to compression of other lobe of same lung and contra lateral lung. A series of neonates and infants under 2 years of age presented with respiratory distress due to congenital lobar emphysema at Liaquat National Hospital,Karachi. These children presented with progressive respiratory distress and underwent thoracotomy and lobectomy. In most of the cases, diagnosis was obvious on plain chest X-ray, but to confirm, CT scan and/or perfusion radioisotope scan is performed. Thoracotomy and lobectomy gave excellent results

Extrahepatic biliary obstruction; postoperative morbidity and mortality

The objectives of this study are to evaluate the surgical management, both definitive and palliative, in selected patients with biliary obstruction and to find out the postoperative morbidity and mortality in these patients. A descriptive study. Duration of the study is two years conducted from June 2002 to May 2004. The study was carried out at the surgical unit 4 of the Combined Military Hospital and surgical department of the Military Hospital. Thirty eight cases of biliary obstruction were included. A convenient sampling technique was followed. Data analyzed by using SPSS version 10.0 for windows on computer. Descriptive statistics like frequency, percentage, average etc were computed for data presentation. Any inferential test was not found to be applicable for this descriptive type case series. We selected 38 patients with features of extrahepatic biliary obstruction. Out of these [n38] 15 patients [39.5%] suffered from benign diseases while those having malignant diseases were 23 [60.5%]. 19 [50%] patients died within two years of follow up while 19 [50%] were the survivors. Mortality was maximum for the malignant cases. In benign cases only one patient died. Maximum deaths 6 [31.6%] occurred in the period of up to one month of operation. 20 patients had one or another complication of operation and hence the morbidity came out to be 52%. According to our results the mortality and morbidity related to extrahepatic biliary obstruction in our patients was higher compared to other studies which can only be reduced by early detection and treatment

Preventing measures adopted against hepatitis by dental practitioners in Lahore

Objective: To study the preventive measures adopted against hepatitis by dental practitioners

Setting: This descriptive study was conducted in Lahore involving 73 private dental practitioners

Results: Majority of dental practitioners, 87.7% were vaccinated against hepatitis B virus. 95.9% washed hands with soap before and after doing any dental procedure. 87.7% and 95.4% used new set of sterilized instruments and disposable needles for each patient respectively. 94.5% and 78.1% used disposable cartridges and gloves respectively. 86.3% utilized disposable suction tips. 75.3% dental surgeons used an auto-clave. Non of the dental practitioners had attended any short course or any workshop regarding hepatitis and only 35.6% had studied guidelines about hepatitis prevention. 60.3% dental practitioners were not using sterilized hand piece for each patient. 16.4% did not utilize sterilized burs and 90.4% did not sterilize the tip of light cure unit. 94.5% did not use needle cutters, and 98.6% were disposing their infectious waste in routine garbage

Conclusion: Emphasis should be placed on consistent adherence to recommended infection-control strategies. Each dental facility should develop a written protocol for instrument reprocessing, operatory cleanup and management of injuries. There should be training of all dental health care workers in proper infection control practices

Platelets dysfunction in patients of end stage renal disease

Patients with end - stage renal disease [ESRD] develop increased bleeding tendency, which is characterized by defective interaction of platelets with damaged sub endothelium due to impaired platelet functions. This study was earned out to demonstrate the aggregation defects in uraemic patients by using different platelet agonists. A total of 57 subjects were included in the study. These were divided into two groups; 37 patients of ESRD on maintenance haemodialysis and 20 healthy adults as control. Complete blood count [CBC], urea and creatinine were carried out on all the samples. Aggregation studies were performed using chronology 490 - 2D Platelet Aggregometer. Adenosine diphosphate [ADP], collagen, ristocetin and arachidonic acid were used as agonists to perform aggregation studies and correlation of these parameters with Haemoglobin [Hb], Haematocrit [Hct], urea and creatinine were determined. All the subjects included in this study were evaluated for platelet aggregation in vitro. Percentages of maximal aggregation of platelets with ADP, collagen, ristocetin and arachidonic acid were significantly low in uraemic patients as compared to the control group. Aggregation with ristocetin was particularly reduced in uraemic patients [Mean 57.54 +/- 23.85%] in comparison with controls [Mean 84 +/- 6.01%]. Inverse correlation of urea was found with ADP response [p value 0.028] and creatinine with arachidonic acid [p value 0.036] which was statistically significant. No correlation was found between haemoglobin, haematocrit and percentage of maximal aggregation after stimulation with collagen, ADP, ristocetin and arachidonic acid. Aggregation responses were reduced with almost all the agonists, especially ristocetin as compared to control samples. This shows that defective platelet - vessel wall interactions play an important role in uraemic bleeding tendency

Localization of accessory pathways according to AP Fitzpatrick ECG criteria in patents with Wolff-Parkinson-White Syndrome in our population

The objective of this prospective study was to localize the accessory pathways [AP] in patients with Wolff Parkinson White syndrome [WPW] using algorithm laid down by AP Fitzpatrick, in our population. 500 consecutive patients with the most pre-excited 12 lead ECG in sinus rhythm visiting emergency department were analyzed. Delta wave frontal plane vector, polarity in VI, height in leads I, II and III and sum of delta waves polarities in II, III and aVF. R wave size in leads I, II, III, VI; R/S ratio in leads I, aVL, V1; S wave size in V1 and QRS axis and duration; QRS horizontal plane transition zone were the main EGG variables used to localize the accessory pathway. The most discriminative characteristics were combined to form the following steps. Step 1, location of the transition lead [R and S waves are equiphasic] in the chest leads and R>S wave by > or < 1mV, this divides the pathways into right and left sided. Step 2, sum of delta waves polarities in leads II, III and aVF, this divides the pathways into Septal or lateral locations. Among 500 patients, 409[81.8%] patients had WPW syndrome while 91[18.2%] patients had WPW pattern, Mean age of study population was 34.23 +/- 12.5 years. There were 327[65.4%] males and 173[34.6%] females with a male to female ratio of 3:1. Three hundred [60%] patients had right sided accessory pathways while 190[38%] had left sided AP. Among right sided AP Right posteroseptal pathway was the most common location 87[28.8%] comprising [17.7%] of total population. Left antero-lateral pathway was the most common location not only among left sided pathways 95[50%] but also in total study population [19.4%]. The AP Fitzpatrick ECG criteria for localization of the accessory pathways on surface ECG is an excellent non invasive method for determination of the site of accessory pathway with very high sensitivity, specificity and predictive accuracy. It is an excellent tool before planning invasive electrophysiological study in WPW syndrome

Peripheral vascular injuries; epidemiology and management

Peripheral vascular injuries constitute 4-6% major trauma. Although uncommon the complication of hemorrhage and Ischemia can be limb threatening and life threatening. Rapid diagnosis and appropriate treatment is therefore essential. Delay allows irreversible Ischemic injury to take place and encourages propagation of intravascular thrombosis, which results in eventual loss of function or even limb itself. [I] To collect data about different aspect of epidemiology and management of Peripheral vascular injuries. [II] To study the relationship between latent period for revascularization and outcome of surgery. Non interventional observational study. CMH Kohat. From 01 Jan 2004 to 31 Dec 2006. Total of 46 cases of all age and sex groups was included in the study. Only those patients were included who had vascular injury to extremities whether direct [penetrating, blunt] or indirect [associated with fracture and dislocations] injuries. Relevant history was obtained from the patients themselves and from their relatives or witnesses. Relevant physical examination was performed. Necessary investigations were done. Patients were treated according to standard protocol. The peripheral vascular injuries were more common in 21-40 years of age group [69%] and among male [82%].Vascular trauma caused by the firearm injuries [60.86%] was the most common cause, other being road traffic accidents [26.08%] and blunt trauma [13.04%]. The most common clinical presentation was shock and paresthesia [50%]. Most of the patient reached hospital within 6-12 hours [47%], and belongs to rural areas [69%]. Frequency of involvement of vessels was femoral artery [41%] and brachial artery [23%]. Types of vascular injuries were, laceration to the vessel wall [56%] and loss of vessel wall segment [17%]. End-to-end anastomosis was most common [78%] .others being interposition reverse vein graft [13%] and direct suturing of vessel wall [8.7%] Amputation rate was highest in cases where revascularization occurred after more than 12 hour [71%]. Common complications after repair were residual edema [17%] and infection [6%]. Overall mortality rate was 4% and morbidity rate was 28%. All cases of peripheral vascular injuries should be surgically explored. Revascularization should be achieved within 12 hours. Patients presenting late or with crush injuries may need amputation