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.

Improved antifungal activity of barley derived chitinase I gene that overexpress a 32 kDa recombinant chitinase in Escherichia coli host

Abstract Agricultural crops suffer many diseases, including fungal and bacterial infections, causing significant yield losses. The identification and characterisation of pathogenesis-related protein genes, such as chitinases, can lead to reduction in pathogen growth, thereby increasing tolerance against fungal pathogens. In the present study, the chitinase I gene was isolated from the genomic DNA of Barley (Hordeum vulgare L.) cultivar, Haider-93. The isolated DNA was used as template for the amplification of the ∼935 bp full-length chitinase I gene. Based on the sequence of the amplified gene fragment, class I barley chitinase shares 93% amino acid sequence homology with class II wheat chitinase. Interestingly, barley class I chitinase and class II chitinase do not share sequence homology. Furthermore, the amplified fragment was expressed in Escherichia coli Rosetta strain under the control of T7 promoter in pET 30a vector. Recombinant chitinase protein of 35 kDa exhibited highest expression at 0.5 mM concentration of IPTG. Expressed recombinant protein of 35 kDa was purified to homogeneity with affinity chromatography. Following purification, a Western blot assay for recombinant chitinase protein measuring 35 kDa was developed with His-tag specific antibodies. The purified recombinant chitinase protein was demonstrated to inhibit significantly the important phytopathogenic fungi Alternaria solani, Fusarium spp, Rhizoctonia solani and Verticillium dahliae compared to the control at concentrations of 80 µg and 200 µg.

Complications of open surgical Tracheostomies and their management - our experience

Objective: To justify the role of open surgical tracheotomy in patients admitted in surgical or medical intensive care units for ventilator support or secretion management

Study Design: A descriptive study

Place and Duration of Study: Department of otorhinolaryngology- Head and Neck Surgery, Dr Ruth K M Pfau Civil Hospital Karachi, Dow Medical College- Dow University of Health Sciences and Otolaryngology-Head and Neck Surgery Ziauddin University Karachi Jan 2014 to Jan 2018

Material and Methods: This study includes all elective and emergency tracheotomies performed in intensive care units (ICU). Patients with cervical spine injuries, bleeding diathesis and patients below 12 years of age were excluded from our study

Results: We encountered complications in 20 patients out of 534, on whom tracheotomies were carried out in intensive care setting. Hemorrhage during and after tracheotomy procedure occurred in eight patients, which was controlled by pressure, ligation or diathermy. Procedure related surgical emphysema occurred in two patients; it was limited to cervical region and subsided with conservative management. The inadvertent decannulation of tracheotomy tube occurred in two cases. Subglottic stenosis developed in four patients. Tracheo esophageal fistula was encountered in four cases

Conclusions: A low morbidity and mortality rate in our series justifies the role of open surgical tracheostomy in patients admitted in surgical or medical ICU for ventilator support or secretion management. It is also effective in a situation of unsecured airway

Lumbar interlaminar epidural injections in managing chronic low back pain with sciatica without using fluoroscopy

Objective: to find out the effectiveness of interlaminar parasagittal lumbar epidural injection without using flouroscopy in the management of low back pain with radiculopathy

Study design: descriptive case series

Place and Duration of study: Ziauddin University Hospital Karachi Clifton campus, from January 2013 to December 2014

Methodology: patients with lumbar back pain associated with unilateral sciatica for more than three months duration were included. Visual analogue scale [VAS] of 100 was used for pain severity assessment. Lumbosacral spine x-rays with skin surface marking were obtained before the procedure. Interlaminar parasagittal approach was used in lateral position with affected leg up. Follow up was done at 6 weeks, 3 months, and 6 months. During the course of 6 months, three injections were offered at any point of recurrence of pain with at least 2 to 3 weeks interval

Results: a total of 75 patients of both genders with the mean age of 45.03 +/- 14.35 year were included. Disc levels involved were L4/5 [53.33%], L5/S1 [38.66%], and L3/4 [8%]. Pre-procedural mean VAS score was 75.2 +/-15.99. In 65.33% patients sustained significant relief in pain noted at six months follow up. In 20% patients short term recovery observed with recurrence of pain in three months. No major complication was encountered during the procedure

Conclusion: interlaminar parasagittal epidural injection is simple, effective in relieving chronic low back pain associated with sciatica and does not need any special medical equipments and setup

Frequency of hepatocellular carcinoma in cirrhotic patients with hepatitis-C virus positive patients in Karachi-Pakistan.

Background: Hepatocellular Carcinoma is the 5th most common neoplasm in the world and 4th most common cancer death. Most patients with HCC have an underlying chronic liver disease (often cirrhosis), resulting mainly from chronic infection by Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), excessive alcohol consumption, and often an association of these causes. HCC has recently gained more interest due to its increasing incidence in industrialized countries. Objective: To determine the frequency of hepatocellular carcinoma in hepatitis C reactive cirrhotic patients. Methods: Place and duration of study: Department of medicine, civil hospital Karachi. Duration: Six months from 16-12-2012 to 15-6-2013. Subjects and methods: Patients admitted in medical wards of civil hospital Karachi with liver cirrhosis due to hepatitis C virus were included in the study. Investigation relevant to hepatocellular carcinoma like alpha fetoprotein and ultrasound was performed. If the Alpha fetoprotein is greater, then 200 ng/ml in the setting of a mass in a cirrhotic liver the likelihood of hepatocellular carcinoma is greater then 90% and biopsy is not required. Results: Overall mean age was 41.1 ± 7.1 years with Male:Female = 4.2:1. Out of 141 cases; hepatocellular carcinoma was diagnosed in 8 (5.7%) of patients with HCV related cirrhosis with mean age 48.6 ± 6.4 years. Proportion of hepatocellular carcinoma was high 7 (6.1%) in male. 7 (6.4%) cases had child pugh-C, 1 (5%) case had child pugh-B and while no HCC was seen in child pugh-A. Conclusion: In this study hepatocellular carcinoma was 5.7% in cases with hepatitis-C induced cirrhosis. Older age (>54 years), male sex and child pugh-C were predominant factors leading to hepatocellular carcinoma.

Cranial neurosurgery without removing scalp hairs

Objective: to find out rate of wound infection, difficulties encountered and patient's satisfaction with scalp hair preservation during cranial surgeries

Study design: descriptive case series

Place and Duration of Study: Ziauddin University Hospital Karachi Clifton campus, from January 2013 to June 2014

Methodology: the hair cleaning and scrubbing procedure was done at the time of surgery with pyodine solution. Scalp shaving was not done. Routine surgical incision was made. Surgical wound was closed with a standard technique. Dressing was not applied. Exclusive traumatic lacerated extensive scalp wounds and cranioplasties cases were also included. Scalp hairs were shampooed postoperatively after 48 hours. The wounds were checked at outpatient follow-up on week 2, week 4 and then monthly for at least 3 months following discharge

Results: a total of 86 patients were operated without shaving scalp hairs. There were 55 females and 31 male patients. Average age was 45.5 year. The procedures included were craniotomies for traumatic intracranial hematomas, tumors, hypertensive intracerebral hematomas, burr hole procedures for chronic subdural hematomas and placement of ventriculoperitoneal shunts. Technical difficulties were posed by very short and coarse hairs. Infection rate was less than 0.86%. All of the patients were happy and satisfied with their appearance after surgery

Conclusions: Scalp hair preservation in cranial surgeries neither increased risk of postoperative wound infection nor made surgery difficult. The technique resulted in greater patients' satisfaction and good cosmetic outcome

Chronic liver disease [CLD]; frequency in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar hospital, Multan

To determine the frequency of chronic liver disease in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar Hospital, Multan. Descriptive case series. Six months from August 2009 to January 2010. Department of Internal Medicine, Nishtar Hospital Multan. A total of 88 patients with upper GI bleed were registered. Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GI Endoscopy was done to find out the source of bleeding. For identification of each patient, personal data was collected. All the data collected were entered and analyzed using SPSS-10. Mean age was 41.64 +/- 13.56 years with 49 [55.70%] male patients and 39 [44.30%] female patients. Majority of the patients 38[43.18%] were between 36-50 years of age. In our series frequency of chronic liver disease was 56.82%. Chronic liver disease is the most common cause of upper GI bleeding in our setting

Frequency of various causes of upper gastrointestinal bleed [UGIB] at a tertiary care hospital

To determine the frequency of various causes of upper gastrointestinal bleed [UGIB] at Tertiary Care Hospital. Descriptive cross-sectional study. This study was conducted at the Department of Internal Medicine, Nishtar Hospital Multan from August 2009 to January 2010. A total of 88 patients with upper GI bleed were registered. Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GI Endoscopy was done to find out the source and cause of bleeding. For identification of each patient, personal data was collected. All the data collected were entered and analyzed using SPSS-11. Mean age was 41.64 +/- 13.56 years with 49 [55.70%] male and 39 [44.30%] female patients. Majority of the patients 38[43.18%] were between 36-50 years of age. In our series the commonest cause of UGIB was oesophageal varices in 56.82% of cases followed by peptic ulcer disease in 38.63% of patients. Oesophageal varices followed by peptic ulcer disease are the commonest causes of UGIB in our setting

Presentation of complications of chronic liver disease at a tertiary care hospital

To see presentations of various complications of chronic liver disease at a tertiary care hospital. Retrospective study. This Study was conducted at Medical Unit 1, Nishtar Hospital, Multan for a period of 6 months from 01-01-2010 to 30-06-2010. Patients admitted at Medical Unit 1, Nishtar Hospital, Multan were included in the study. The medical record of these patients was checked. The data obtained were entered in SPSS-11 and analyzed. A total number of 50 patients were studied, 30 [60%] were male and 20 [40%] were female. Age of the patients ranged from 36-58 years. Mean age of the patients was 45.39 +/- 4.77 years. All the patients presented with fatigue, generalized weakness, oedema feet, anorexia and nausea. Twenty [40%] patients presented with jaundice. Abdominal distension was present in 42 [84%] patients. Twenty two [44%] patients were having altered consciousness. Twenty three [46%] patients presented with haemetemesis and 28 [56%] with melena. Low grade fever was present in 26 [52%] patients. Epistaxis was present in 2 [4%] patients. Previous history of jaundice was present in 40 [80%] patients and history of alcohol intake was present in 12 [24%] cases. On examination, all the patients were found emaciated with protuberant abdomen. Twenty [40%] were clinically jaundiced. Oedema feet was detected in 48 [96%] patients. Palmar erythema was present in 26 [52%]. Hepatic flaps were present in 24 [48%] patients. Shifting dullness and fluid thrill was present in 46 [92%] patients and engorged paraumblical veins were present in 36 [72%] patients. Splenomegaly was seen in 36 [72%] patients. Laboratory investigations revealed raised serum bilirubin in 26 [52%] patients and level of bilirubin was 3-6 mg/100 ml in most of the cases. ALT levels were raised in 33 [66%] patients above the twice of the upper limit of the normal value. Serum alkaline phosphatase was raised only in 1[2%] of patients. Platelet count was below 70000 in 32 [64%] patients. Anti HCV and HBsAg were detected in 38 [76%] and 12 [24%] patients respectively. Prothrombin time was prolonged 25 seconds [than control] in 36 [72%] patients. Serum albumin was less than 3 g/100 ml in all cases. Abdominal ultrasonography revealed coarse echotexture with nodular liver in 46 [92%] patients. Ascites was detected in 48 [96%] patients. Two patients [4%] had hepatic mass. Upper GI endoscopy revealed esophageal varices in 33 [66%] patients, fundal varices in 12 [24%] patients, gastric ulceration in 17 [34%] patients and duodenal ulceration in 11 [22%] patients. Patients of chronic liver disease present in tertiary care hospital at a very late stage of the disease and most common presentations are ascites, hepatic encephalopathy, upper GI bleeding and low grade fever. Awareness may be created to motivate the patients to report to tertiary care hospital at an early stage, so that development of these complications can be managed at the very initial stage

Prevalence of hepatitis-C antibodies amongst nursing staff working in a tertiary care hospital

To determine the prevalence of HCV infection amongst nursing staff working in a tertiary care hospital. Simple descriptive study of prevalence. Nursing staff of Nishtar Hospital Multan. 152 senior nursing staff working in all wards of Nishtar Hospital Multan. Diagnosis of HCV infection was made by detection of antibodies to HCV in serum [ACON Hepatitis C Virus Rapid Test Strip, Serum]. Those nurses whose test was positive by the above technique, underwent second generation Elisa testing for Hepatitis C to confirm the diagnosis [Cobas Core Anti-HCV EIA]. Study was conducted upon 152 nursing staffs working in different wards of Nishtar Hospital Multan, which is a tertiary care hospital. These 152 staff nurses were checked for anti-HCV and only 3 cases were positive [1.97%] and 149 negative [98.03%]. Study shows that the prevalence of HCV infection among nursing staff is 1.097%, which is low as compared to other studies but higher in comparison to the general population of Multan [0.27%]. It is recommended that both private and public health care systems to increase the awareness. The health care workers should strictly follow appropriate preventive measures

Risk factors of coronary heart disease at tertiary care hospital

Coronary heart disease [CHD] is the single most common cause of death in the developed world. The incidence rate, risk factors prevalence and mortality vary widely among the countries. To identify risk factors associated with clinical evidence of CHD. This retrospective study was carried out in Cardiology ward, Nishtar Hospital, Multan during the period from January 2004 to January 2005. A total number of 100 patients were included in the study, attending OPD and emergency. Out of these, 60 were male and 40 were females. Age range was 40-80 years. Out of 100 patients 45 [45%] were smoker and 55 [55%] were non-smoker. Diabetes mellitus was also a contributed risk factor for CHD, 75 [75%] patients were diabetic as shown in. hypertension was found in 65 [65%] of cases. Higher age, being male, heredity, family history of CHD, hyperlipidemia, and hypertension were associated with CHD

Prevalence of hepatitis B and C virus in health care worker [paramedical staff] of tertiary care hospital

Viral hepatitis is a major public health problem throughout the world. Viruses, which can lead viral hepatitis, are hepatitis A virus [HAV], Hepatitis B virus [HBV], Hepatitis C virus [HCV], hepatitis D virus [delta antigen], Hepatitis E virus [HEV] and hepatitis G virus [HGV]. To see the frequency of hepatitis B and C in paramedical staff [Nurses, Dispensers and laboratory workers] of tertiary care hospital. This Descriptive study was conducted among paramedical staff during the period from April 2003 to July 2005. A total of 200 cases from paramedical staff was included in the study. After taking permission or consent a proforma was filled for each volunteer about any history of previous surgery, blood transfusion, accidental needle prick. Blood samples were collected from these staff. A total number of subjects who were studied from April 2003 to July 2005. Out of which 150 were nurses, 25 were dispensers and 25 were laboratory workers. HBV positive cases in 50 males and 150 females. Anti HCV was detected in 50 males and 150 females. A campaign to discourage unnecessary injection therapy and intravenous drips must be started and public should be given awareness of their danger. Moreover public should also be instructed to avoid tattooing, ear and nose piercing and circumcision by formal barbers

Incidence of ischemic heart disease in patients with type-II dependent diabetes mellitus

Hyperlipidemia appears to be a risk factor for atherogenesis. Diabetic patients have increased platelet adhesiveness and response to aggregating agents. These changes are also likely to favour atherogenesis. Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and ad higher incidence of myocardial infarction than the general population. To find out the incidence of IHD in patients with NIDDM and too evaluate the pattern of clinical presentation of IHD in diabetic patients like with typical/atypical symptoms, evidence of silent ischemia and myocardial infarction. This study was carried out in Nishtar Hospital, Multan from June 2004 to July 2005. A total of 100 patients were included in the study. Study design is non-probable purposes. The 100 patients selected for study were between 30-80 years old. Majority of them belonged to 30-45 years of age. Mean age was 48.7 +/- 11.2 years. History of disease duration was also noted and 100 patients included had disease from 1 month to 30 years. Out of 100 patients, 70 [70%] were male and 30 [30%] were female. Among these 17 had evidence of IHD. Typical symptoms of IHD were found in 6 patients. Majority of them had more than one symptom and in one patient, dyspnea was the only symptom. Moreover 5 patients [29.5%] of those who had IHD had dyspnea apart from other atypical symptoms. The incidence of IHD is higher in diabetic patients as compared to non-diabetics