Chronic obstructive pulmonary disease, its new drug treatments and strategies: a review

COPD is a complicated disease. Current available treatments are just for symptomatic relief and they cannot reverse the damages to lungs tissues due to alveolar destruction in COPD. Research is being conducted to evaluate new treatments and strategies to find specific treatments to minimize the symptoms of COPD. A new mixture of herbal medicine i.e AKL1 has emerged and thought to cure COPD symptoms especially cough related quality of life of COPD patients. Although, the results have showed no significant difference as compared to placebo but researchers recommend further evaluation in a large population [COPD Patients] group. Another medicine Roflumilast, a phosphodiesterase 4 inhibitor, was also found to be effective to treat COPD under specific recommendations with further research needed. Finally another medicine Indacaterol, a novel, once-daily [o.d] inhaled long-acting beta2-agonist proved to be effective clinically to treat COPD related broncho-constriction and also increasing the COPD patient's compliance by reducing the number of doses as compared to other conventional inhaled bronchodilators such as Albuterol

Comparison of functional outcome in Mayo Elbow performance score in Olecranon Fractures after treatment with Tension band wiring and locking compression plate

Objective: To compare mean change in the Mayo Elbow Performance Score in olecranon fracture after treatment with tension band wiring and locking compression plate

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Orthopaedics, Benazir Bhutto Hospital Rawalpindi, from Aug 2015 to Aug 2016

Material and Methods: Sixty patients were included in the study. Patients were divided into two groups, A and B. For group A, Locking compression plate while in group B tension band wiring was used. Follow-up was carried out at the end of 1st week and then at the end of 6th week post-operatively. Functional outcome was assessed by mean change in Mayo Elbow Performance Score

Results: Mean age in the study was 43.62 +/- 12.187 years. There were 32 [53 percent] male patients and 28 [47 percent] female patients, while 34 [57 percent] patients had Mayo IIB fractures and 26 [43 percent] had mayo IIA fractures. Twenty five patients [42 percent] belonged to ASA class II while 35 [58 percent] belonged to ASA class I. Twenty Six patients [43 percent] presented within 24 hours of the injury while 34 [57 percent] presented within 48 hours. Mean change in the Mayo Elbow Performance Score in TBW group was 8.77 +/- 3.54 versus 10.63 +/- 3.479 for the LCP group [p=0.044]

Conclusion: Locking Compression plate is superior to Tension Band Wiring in patients with olecranon fracture in terms of Mayo Elbow Performance Score

Radiological mean age of fusion of medial end of the clavicle: a parameter of age

Objective: To determine the mean age of fusion of medial end of clavicle by radiography

Study Design: Cross-sectional study

Place and Duration of Study: Departments of Forensic Medicine, Dow Medical College and Ziauddin University, Karachi, from June 2010 to May 2011

Methodology: The subjects for this study were selected from various government colleges of Karachi. The subjects were analyzed for age and further confirmation was done by interviews where birth records and other physical parameters of age were also assessed. X-rays chest PA view was taken focusing on the medial end of clavicle; and were examined by a consultant radiologist and complete fusion of the medial end was noted. P-value less than 0.05 was considered significant

Results: The mean age of fusion of medial end of the clavicle was found to be 21 +/- 1.43 years. Significant difference was observed in male to female age of fusion 21.14 +/- 1.41 years versus 20.65 +/- 1.94 years [p > 0.05]. Similarly, statistically significant differences were observed between lower to middle income class and higher income class of all society. No difference was observed among various ethnic groups

Conclusion: Socio-economic factors, such as diet and nutrition, directly affect bone growth and hence bones' age. The results of fusion of the medial end of the clavicle are not affected by ethnicity; however, it is significantly affected by gender. More studies should be conducted in various parts of the country to make a natural standard in setting up uniform criteria for assessing age at or above 21 years

stitch in time, saves life; should B-Lynch suture be the first line surgical option for control of massive primary PPH due to refractory uterine atony? An experience at D.H.Q Hospital Faisalabad

Objective: to see the effectiveness of B-Lynch brace suture as first line surgical option to control massive primary postpartum hemorrhage due to uterine atony refractory to medical treatment

Study Design: quasi experimental

Place and duration of study: this research work was done in D.H.Q Hospital Faisalabad from 2002-2004. During the study period 21 women underwent B-Lynch Brace suture to halt bleeding resulting from refractory uterine atony. Data was collected in prospective manner on a specialized proforma from attending house officers and postgraduate trainee registrars. The B-Lynch technique was used. Postoperatively the patients were kept in high dependency area within labor room for 24-48 hours. Follow up was done in O.P.D after discharge

Materials and Methods: the women who had severe/ persistent primary postpartum hemorrhage due to uterine atony were initially resuscitated and simultaneously managed with ecbolics as per unit protocol [i-e; 40 units oxytocin in 1000cc Normal Saline infusion, inj. methergen [withheld women with specific contraindications for methergen], inj. F2 alpha in each uterine cornu, and per rectal misoprostol. However those women who remained unresponsive to the medical treatment, underwent B-Lynch Brace suture as first line surgical option

Results: the success rate was 85.7% [n18] in terms of control of hemorrhage and hysterectomy was averted in 95% [n20] of women. Whereas in two women it needed to be integrated with stepwise uterine de-vascularization procedures

Conclusion: B-Lynch suture is effective as first line surgical option to arrest postpartum hemorrhage due to refractory atonic uterus

Preliminary study of biofilm formation properties and antibiotic susceptibility pattern of MRSA and MSSA isolates obtained in Yogyakarta, Indonesia

Aims: Nowadays, Staphylococcus aureus, especially methicillin resistant Staphylococcus aureus (MRSA), emerged as a major pathogenic agent of nosocomial infection and sepsis worldwide. Infections caused by these bacteria are often difficult to treat because of the development of antibiotic resistance. Biofilm formation is an important factor in the pathogenicity of staphylococcal infections and one of the reason of antibiotic treatment failure. In this study, the relationship between biofilm formation properties, the presence of mecA, icaA/D genes and antimicrobial resistance pattern were investigated in 10 methicillin sensitive Staphylococcus aureus (MSSA) and 10 MRSA clinical isolates. Methodology and results: Staphylococcal strains were identified by conventional microbiological methods, while determination of methicillin susceptibility was distinguished by the presence of mecA gene. To investigate biofilm production, congo red agar and microtiter plate test were performed. PCR was done to detect the presence of icaA/D genes, which responsible for biofilm production. Antibiotic sensitivity was carried out by agar diffusion method. The majority of MRSA isolates (90%) were not able to form biofilm, only one isolate (10%) showed capability of weak biofilm producer. Meanwhile, fully established biofilms were formed by all of MSSA isolates (100%). In addition, all MRSA and almost MSSA isolates (90%) harboured both icaA/D genes in their chromosomes. Antibiotic resistance profile of MRSA was more dominant than MSSA isolates. Conclusion, significance, and impact of study: Biofilm production of staphylococci showed difference regulation with regard to methicillin susceptibility. Antibiotic resistance profile was more dominant in MRSA, however biofilm production was found mostly in MSSA isolates.

Retained temporary epicardial pacing wiresþ:þ a rare cause of prosthetic valve endocarditis

Temporary epicardial pacing wires [TEPWs] are commonly used during cardiac surgery to meet unforeseen complications like heart blocks or asystole. These are generally considered to be safe. The incidence of major complications with their use is low, but could be life threatening. Complications can be divided into those encountered during placement, removal, or retention of temporary epicardial pacing wires. We report a rare case of prosthetic mitral valve endocarditis caused by TEPWs that migrated into the pulmonary artery, presenting 5 months following mitral and aortic valve replacement surgery that required percutaneous removal of these temporary pacing wires via a right femoral vein approach. This case highlights the fact that delayed complications can rarely occur due to retained TEPWs and may have serious consequences. This fact should be taken into account when the strategy on dealing with such wires following cardiac surgery is determined. Routine retention of temporary epicardial pacing wires is not recommended