Outcomes of open reduction and internal fixation in displaced intra-articular scapular fractures : a case series.

Scapular fractures are rare injuries and usually occur due to high energy trauma. Displaced Intra articular fractures usually require operative treatment and yields better outcomes as compared to conservative management. To assess the functional and radiological outcomes of displaced intra-articular scapular fractures managed with open reduction and internal fixation. 12 patients were retrospectively reviewed and included in the study. Post-operative functional outcomes were assessed using mean quick DASH (Disability of arm, hand and shoulder) score while radiological outcomes were analyzed as percentage of implant cut-through, mal-union, non-union or infection.  The mean follow up was 14 months. Mean age was 40 years. The mean quick DASH score was 7.19 +/- 4.86. All of the patients had successful clinical and radiological healing and pain-free movements. Open reduction and internal fixation in displaced intra-articular scapular-fractures yields excellent and promising outcomes.

Tuberculosis control in Pakistan: reviewing a decade of success and challenges.

Pakistan has shown drastic expansion of tuberculosis (TB) care during the past 10 years, increasing case notifications from 11 050 in 2000 to 248 115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, all requiring continued and coordinated technical and donor support.

Toe-tourniquet syndrome: A rare potentially devastating entity.

Toe-tourniquet syndrome is a rare and commonly misdiagnosed condition caused by a hair or a fiber wrapped around digits (fingers and toes). A four months baby girl who was crying and presented with redness and swelling at her 2nd and 3rd toes of right foot. Child had red and swollen 2nd and 3rd toes of right foot with hair end protruding through wounds. Constricting hairs were cut and removed. Toetourniquet syndrome is a rare entity which is caused by hair wrapped around a toe or a digit. Diagnosis is mostly clinical. In order to prevent this condition to happen, education of parents and clinicians is a cornerstone.

Assessment of strontium and calcium levels in Pakistani diet.

To cope with nuclear emergency effectively due to ingestion of fission fragment (90)Sr, adequacy of nutritionally and radiologically important elements strontium and calcium was studied in typical Pakistani diet and baseline analytical data were generated. Concentrations of strontium and calcium were measured by using inductively coupled plasma-atomic emission spectroscopy (ICP-AES) and atomic absorption spectrometry (AAS) techniques. Daily dietary intake of strontium and calcium varied from 0.9 to 5.7 mg and 217 to 713 mg with the geometric mean value x geometric standard deviation of 2.6 x 1.7 and 487.1 x 1.4 mg d(-1), respectively. The average Sr concentration in the Pakistani diet was 1.4 times higher while Ca concentration was 0.4 times lower than the recommended values of the International Commission on Radiological Protection (ICRP). The calculated Sr/Ca ratio 5.3E-03 was also higher than the ICRP value. The study depicts that the strontium concentration in the Pakistani diet is adequate, while the calcium concentration is inadequate according to international standards and needs improvement.

Bladder carcinoma following cyclophosphamide therapy. A case report.

Cyclophosphamide was introduced in 1958 in an effort to minimize the side effects of nitrogen mustard. Cyclophosphamide (Cytoxan, Endoxan) is not an alkylating agent which has been used for the treatment of a variety of non-malignant as well as malignant diseases. It has also recently been the focus of considerable interest as an immunosuppressive agent, perhaps the most potent immunosuppressive drug that has been synthesized. Reports of urologic complications from this drug are haemorrhagic cystitis, vesical fibrosis and urothelial carcinoma.

Translating childhood tuberculosis case management research into operational policies.

The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

Diagnosis and outcome of childhood tuberculosis: implementing public health policy in three districts of Pakistan.

SETTING: All nine public sector hospitals in three districts of Pakistan. OBJECTIVE: To estimate case notifications of children with tuberculosis (TB) and their outcomes. DESIGN: A retrospective cohort following all children aged <15 years placed on TB treatment under the National TB Control Programme (NTP) in public hospitals. The study period was 2 years before and 2 years after the implementation of new NTP policy guidelines for childhood TB. Data were collected from hospital TB registers, patient treatment cards and quarterly reports. RESULTS: With the introduction of the new NTP policy, case notification of childhood TB increased from 189 (2004-2005) to 731 for the 2 years 2006-2007. The annual notification rate of childhood TB cases increased from 1.4 (2004-2005) to 5.2 per 100 000 population (2006-2007). Of the total 920 childhood TB cases registered, 610 were pulmonary, 202 extra-pulmonary and the remaining 108 unclassified. The three-fold increase in case notification was accompanied by a lack of follow-up, resulting in an increase in unknown treatment outcomes from 21.7% to 73.3%. CONCLUSION: Managing children with TB in routine NTP practice is possible, but without adequate operational guidelines, expanding services and follow-up, it can lead to suboptimal results.

Graphic tobacco health warnings: which genre to choose?

BACKGROUND: Tobacco prevention studies show that graphic health warnings are more effective than text warnings, but there are no data on the effectiveness of different types of graphic health warnings in a Pakistani population. Even marginal differences in the effectiveness of genres can be of potential significance for public health. OBJECTIVE: To study the effectiveness of different types of graphic tobacco warnings in a Pakistani population. STUDY DESIGN: We presented ten anti-smoking warnings to randomly selected volunteers (n = 170) and recorded their opinion on the effectiveness of each warning. The warnings were based on a range of images aimed at the diverse population interviewed. A grading scale based on appeal, application, educational potential and motivation towards cessation was used to produce a composite grade of perceived effectiveness of the warning. RESULTS: Our results indicate that graphic warnings reach a greater proportion of the population than text warnings. Those appealing to logic, and those inculcating a sense of fear by showing a deleterious outcome of smoking, were judged likely to be most effective in motivating smokers to quit and preventing experimental smokers from forming a habit.

Tuberculosis control in Pakistan: reviewing a decade of success and challenges

Pakistan has shown drastic expansion oftuberculosis [TBTcareduring the past 10 years, increasing case notifications from 11 050 in 2000 to 248115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, ail requiring continued and coordinated technical and donor support