How do patients with chronic spinal injury in Pakistan manage their bowels? A cross-sectional survey of 50 patients.

STUDY DESIGN: A cross-sectional survey. OBJECTIVES: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan. SETTINGS: Outpatient Department, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. METHODS: A total of 50 adult patients (18-65 years) with SCI of duration >12 months were sampled by convenience sampling. Medical record was reviewed, detailed neurological examination was performed and face-to-face semistructured interviews were conducted. Data were collected and analysed using SPSS v10. Frequencies and descriptive statistics were calculated for the various variables. RESULTS: Most of the patients (29) were males. The mean age was 33±11 years. Majority of the patients (76%) had thoracic-level injury. In all, 43 patients gave a history of occasional or regular faecal incontinence. In addition, 17 patients reported the regular use of laxatives whereas 22 used bulk-forming agents on a regular basis. Majority of the patients (56%) had at least one bowel evacuation daily. In addition, 31 patients required 16-30 min to complete the bowel evacuation. Approximately half (54%) required assistance in bowel evacuation. CONCLUSION: A large number of patients with chronic SCI in Pakistan had faecal incontinence. A majority of patients used methods such as suppositories, laxatives and bulk-forming agents to control the frequency and duration of the bowel programme. Adherence to standard bowel care programme and practices are influenced by sociocultural factors and lack of education on the part of the patients.

The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005.

STUDY DESIGN: Prospective observational study. OBJECTIVES: To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake survivors with spinal cord injury (SCI). SETTINGS: Rawalpindi, Pakistan, in the months after the October 2005 earthquake. METHODS: Earthquake survivors (n=187) with acute SCI were enrolled after verbal informed consent. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. They were followed for 10 weeks for clinical signs and symptoms suggestive of DVT. Case with clinical suspicion of a DVT underwent a duplex scan of both legs to confirm the diagnosis. The influence of age, gender, American Spinal Injury Association (ASIA) grade and lower limb fractures on occurrence of DVT was determined. RESULTS: There were 80 men and 107 women with a mean age of 28.3+/-12.4 years. Seventeen patients were clinically suspected to have a DVT and ultrasound was positive in nine (4.8%). There was no influence of age (P=0.4), gender (P=0.4), ASIA grade (P=0.1) or presence of a lower limb fracture (P=0.6) on the occurrence of a DVT. CONCLUSION: This study adds further evidence to support the belief that the incidence of DVT in Southeast Asian patients with an SCI is lower than the reported incidence in the West. It may not be necessary to apply the recommendations for DVT prophylaxis in Caucasians with SCI to other groups, including Southeast Asians.

Epidemiology of spinal cord injuries in the 2005 Pakistan earthquake.

STUDY DESIGN: Prospective observational study. OBJECTIVES: To identify the epidemiological features specific to spinal injuries as a result of an earthquake. SETTINGS: Rawalpindi, Pakistan in the months after the 8 October 2005 earthquake. METHODS: In the month after the earthquake, the one established rehabilitation center was augmented with two makeshift spinal cord centers. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. Neurological status and functional outcome was determined after 10 weeks. RESULTS: Of an estimated 650-750 spinal cord injuries, 187 were admitted to these centers, including 80 men and 107 women with a mean age of 28.3+/-12.4 years. Injuries occurred while standing in 57.8% of patients. Most (83.4%) who reached the spinal cord center were airlifted. A urinary catheter had been placed before admission in 91.5%. Most of the patients were paraplegic 89.3, with 50.8% incomplete injuries. Fracture or fracture dislocation was present in 70, and 75% underwent spinal fixation. Although pressure ulcers (28.9%) and urinary tract infections (39%) were common, deep venous thromboses (4.8%) and depression (5.8%) were seldom detected. At 10 weeks, 75% were continent or performing intermittent catheterization. There were no deaths and two births. CONCLUSION: After a disaster, evacuation of persons with a spinal cord injury to a specialized center results in low mortality. Response planning for disasters should include early aggressive medical rehabilitation.