First metatarsal bone reconstruction using Masquelet’s technique after bone loss in open III B injury

Background: Masquelet technique involves two stages for reconstruction of bony defects. During stage one decontamination and debridement is performed. The bone defect is filled by a spacer made of bone cement. After a gap of around 6 weeks, a bio-membrane is established around the cement spacer. During stage two, the cement spacer is removed and cancellous autologous bone graft is used to fill the space that was previously occupied by the cement spacer. However, there is a huge scarcity of literature on reconstruction of bone defects in foot metatarsals, especially open injuries that require soft tissue coverage also. Methods: This prospective study involved 25 patients with a minimum follow-up of 12 months. Masquelet’s technique was used to reconstruct large bony defects in metatarsals of foot in a staged manner. The primary outcome variable was union and consolidation of the bone. The secondary outcome variables included complications and functional outcome using Maryland foot score. Results: One of the patients needed a below knee amputation for extensive bone and soft tissue infection. Pin site infection was the commonest indication observed and deep infection was observed on table at the time of second stage in two patients. Both the patients needed a re-do of stage one and a new cement spacer was placed which was removed at six weeks. Hallux varus deformity was observed in two patients at the final follow-up. Excluding the patient that needed amputation, all the patients had consolidation and union at the final follow-up and the mean Maryland foot score was 79.45±8.8. Good to excellent functional outcome was observed among 91.66% patients. Conclusions: Masquelet’s induced membrane technique is a potentially fruitful method to deal with bone defects created by open fractures of metatarsals of feet. However, due to limited sample size and lack of control group, we recommend large scale randomized control trials be conducted on the subject.

Outcome of volar Barton fractures of distal radius managed with open reduction and internal fixation with volar locking plate

Background: Volar Barton fractures of distal radius almost always require a surgical fixation. Near anatomical reduction and a stout fixation is imperative for good outcome. The present study aimed at studying the outcome of open reduction and internal fixation with volar locking plate for volar Barton fractures. Methods: The present study included 25 patients with volar Barton fractures of distal radius presenting to the orthopaedic department who were managed with volar locking plate. The minimum follow-up period was 12 months. Wrist movements were recorded and outcome was studied using modified mayo wrist score at final follow-up. Results: The mean modified mayo wrist score at final follow-up was 88.47±15.3. Excellent to good outcome was observed in 80% of the patients. None of the patients had a poor outcome. Clinically significant movements were observed at wrist at final follow-up. Superficial wound infection was the most common complication and deep infection was seen in two patients and both of them needed early implant removal at three months. Hypertrophic scar at surgical incision site was observed in two patients but did not bother the patients. Two patients needed a stellate ganglion block and physiotherapy for complex regional pain syndrome (CRPS) and both responded well. Conclusions: Open reduction and internal fixation (ORIF) with volar locking plate provides stout fixation in volar Barton fractures and allows early physiotherapy and rehabilitation of wrist. The results are predictably good in most patients with minimal complications rates.

Observations on Sagittal Alignment of Lumbo-Sacral Spine in Asymptomatic Adults in Kashmir

Introduction: Sacropelvic parameters in various spine and hipdisorders have been published in various studies. We aimed tostudy the normal sacropelvic parameters and curvatures of thespine and their correlation in asymptomatic Indian adults inrelation to variations in sex and age.Material and Methods: 200 Volunteers were taken fromgeneral population with age ranging from 18-50. Patientwas made to stand and left lateral radiograph exposing C7 toS1 and both the hips with a long 30x90 cm cassette placedat 230 cm from the X-ray tube was performed by a singleradiographer to avoid bias.Results: The average LL, SS, PI, PT, and SVA values wereaverage 55.61±10.68, 38.38±8.33,47.94±10.24,10.16±6.23 and 17.27±9.72 respectively. No statistically significantdifference was observed in statistical values with regardsto sex. Our study showed that PI has significant positivecorrelations with SS, LL and PT, and also affects LL. SS hassignificant positive correlation with LL.Conclusion: The current results could contribute to not onlythe understanding of normal sagittal spinal alignment, but alsoserve as a basis for realignment strategies in young Kashmiriadults.

Antimicrobial susceptibility patterns of clinical isolates of Pseudomonas aeruginosa isolated from patients of respiratory tract infections in a Tertiary Care Hospital, Peshawar

Objective: This study aims to determine the prevalence and susceptibility pattern of Pseudomonas aeruginosa and multidrug-resistant [MDR] isolates in patients suffering from respiratory tract infection

Methods: A cross sectional study was conducted from January to December 2014 in Northwest General Hospital and Research Centre, Peshawar. A total of 615 sputum samples were collected from both in and out-patients. Sputum samples were collected as per standard procedure and were inoculated on Blood, MacConkey and Chocolate agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute [CLSI] guidelines using Kirby- Bauer's disc diffusion method

Results: Out of 615 sputum samples, 354 [57.56%] were culture positive. Out of these a total of 71 [20.05%] strains of Pseudomonas were isolated, where 54.93% was from males and 45.07% were from females [Mean age was 44.29 +/- 22.72]. Highest sensitivity was seen to Amikacin [92.86%] followed by Meropenem [91.55%] while lowest sensitivity was seen to Cefoperazone + Sulbactam [16.9%]. There were 39.44% MDR strains, out of which 25% were Extensively Drug Resistant [XDR] and 10.71% were Pan Drug Resistant [PDR]. In vitro susceptibility of MDR isolates showed highest sensitivity to Amikacin [82.14%] followed by Carbapenems [78.57%]. All MDR isolates were resistant to Cefoperazone + Sulbactam. Resistance to Piperacillin + Tazobactam was 96.43%

Conclusion: Pseudomonas aeruginosa is one of the commonly isolated organisms and it is becoming more resistant to commonly used antibiotics. Carbapenems and aminoglycosides were the two classes of drugs that showed highest activity against Pseudomonas aeruginosa

Potential for Osseous Regeneration of Platelet Rich Fibrin: A Comparitive Study in Mandibular Third Molar Socket.

Aims: To evaluate the effi cacy of autologous platelet- rich fi brin in regeneration of bone and to assess clinical compatibility of the material in mandibular third molar extraction socket. Materials and Methods: This study was conducted in 20 patients visiting the out patient department of Oral & Maxillofacial Surgery, Subbaiah Institute of Dental Sciences. Patients requiring extraction of bilateral symmetrical mandibular third molars were taken for the study. Following extraction, platelet rich fi brin prepared from patients own blood was placed in one extraction socket. The patients were assessed for postoperatively pain, periodontal pocket depth and bone blending and trabecular formation. Radiological assessment of the extraction site was done for a period of 6 months to evaluate the change in bone density. Results: All the local signs and symptoms of infl ammation were mild to moderate and subsided in normal course of time. Pain was less in study site compared to control site. Soft tissue healing was better in study site. Evaluation for bone blending and trabecular bone formation showed earlier in study (prf)site compared to control(non prf) site in 10 patients. The evaluation of bone density by radiological assessment showed the grey level values calculated at 4months at the prf site were comparatively higher than the average baseline value of bone density at extraction site in control site. Conclusion: The study showed that autologous PRF is biocompatible and has signifi cant improved soft tissue healing,bone regeneration and increase in bone density in extraction sockets. However a more elaborate study with a larger number of clinical cases is very much essential to be more conclusive regarding its effi cacy.

Comparison of Analgesic Efficacy of Tramadol and Tapentadol in Impacted Mandibular Third Molar Surgery: A Randomized, Double Blind Clinical Study.

Introduction: The chronological age of eruption of third molars is between 18 and 24 years with wide variation in the eruption time. The eruption failure being very common makes the extraction of impacted third molars one of the most frequent surgical procedures in the maxillofacial region. Materials and Methods: A study was conducted on one hundred patients who visited the Department of Oral and Maxillofacial Surgery, Subbiah institute of Dental Sciences for the removal of impacted mandibular third molars to compare the analgesic efficacy of tramadol and tapentadol in patients undergoing surgical extraction of impacted mandibular molars. Patients were divided into two equal groups, group A and group B. Patients were randomly assigned in either treatment groups with an assigned code. Both patient and investigator were not aware of the drug code. Group A patients received 50mg tramadol and group B patients received 50mg tapentadol orally immediately after surgery and 12 hours after surgery. Results: VAS score of group A was 6.22±0.65 and group B was 5.92±0.97 at the end of 2 hours. VAS score of group A was 6.18±1.08 and group B was 5.76±1.25 at the end of 8 hours. VAS score of group A was 6.36±0.96 and group B was 6.46±1.2 at the end of 12 hours. VAS score of group A was 6.2±1.2 and group B was 6.2±1.47 at the end of 24 hours. VAS scores, statistically were found to be in significant between two groups. All patients had moderate pain at the end of 2 hours, 92% of group A and 96% of group B patients had moderate pain at the end of 8 hours. Mild pain was noted in most patients around 24 hours according to the categorical pain scale. Conclusion: A study was conducted to compare the analgesic efficacy of tramadol and tapentadol on patients undergoing third molar surgeries. The results of the statistical analysis suggested that Tramadol and Tapentadol are effective in managing postoperative pain and neither of the drugs mentioned above were superior to other.

A novel 96-microwell-based high-throughput spectrophotometric assay for pharmaceutical quality control of crizotinib, a novel potent drug for the treatment of non-small cell lung cancer / Um ensaio espectrofotométrico de alto rendimento à base de novo de 96 micropoços para o controlo de qualidade farmacêutica crizotinibe, um novo potente fármaco para o tratamento de cancro do pulmão de células não-pequenas

This study describes the development and validation of a novel 96-microwell-based high throughput spectrophotometric assay for pharmaceutical quality control of crizotinib (CZT), a novel drug for the treatment of non-small cell lung cancer. We examined the reaction between CZT and 1,2-naphthoquinone-4-sulphonate, a chromogenic reagent. A red-colored product showing a maximum absorption peak (λ_max) at 490 nm was produced in an alkaline medium (pH 9). We examined stoichiometry of the reaction and postulated the reaction mechanism. To our knowledge, this is the first study to describe a color-developing reaction for the proposed assay. The reaction was performed in a 96-microwell plate, and the absorbance of the colored product was measured using an absorbance reader at 490 nm. Under optimized reaction conditions, Beer's law, which shows a correlation between absorbance and CZT concentration, was obeyed in the range of 4-50 µg/well with an appropriate correlation coefficient (0.999). The limits of detection and quantification were 1.73 and 5.23 µg/well, respectively. The assay showed high precision and accuracy. The proposed assay was applied successfully for the determination of CZT in capsules. Thus, the assay proposed in this study is practical and valuable for routine application in pharmaceutical quality control laboratories...

Este estudo descreve o desenvolvimento e a validação de um novo ensaio espectrofotométrico em larga escala em 96 micropoços para o controle farmacêutico de crizotinibe (CZT), novo fármaco para o tratamento de câncer de pulmão de células não pequenas. Examinamos a reação entre o CZT e o 4-sulfonato de 1,2-naftoquinona, um reagente cromogênico. Obteve-se, em meio alcalino (pH 9), produto vermelho, com absorção máxima (λ_max) em 490 nm. Examinamos a estequiometria da reação e propusemos mecanismo de reação. Este, segundo nosso conhecimento, é o primeiro estudo para descrever reação de desenvolvimento de cor para o ensaio proposto. A reação foi realizada em placas de 96 micropoços e mediu-se a absorbância do produto colorido utilizando-se leitor de absorbância a 490 nm. Sob condições otimizadas de reação, a lei de Beer, que mostra a correlação entre a absorbância e a concentração de CZT, foi obedecida na faixa de 4-50 µg/poço, com coeficiente de correlação apropriado (0,999). Os limites de detecção e de quantificação foram, respectivamente, 1,73 e 5,23 µg/poço. O ensaio mostrou alta precisão e exatidão. O ensaio proposto foi aplicado com sucesso para a determinação de CZT em cápsulas e é prático e válido para a aplicação de rotina em laboratórios de controle farmacêutico...

Common carotid artery intima-media thickness in patients with ischaemic and haemorrhagic stroke

An increase in the intima-media thickness of the common carotid after [CCA-IMT] is generally considered as an early marker of atherosclerosis and has been associated with a higher risk of stroke and myocardial infarction. Cross-sectional Study. This study was conducted in Department of Medicine at Karachi Medical and Dental College and Abbasi Shaheed Hospital from June 2011 to December 2011. We determined cross-sectionally the diagnostic ability of CCA-IMT to distinguish between brain infarction and intracerebral haemorrhage. Total 150 patients aged >40 years of both sexes with hemorrhagic and ischaemic stroke were included, while patients with history of endartectomy, head injury, space occupying lesion and on anticoagulation were excluded. All information was recorded on proforma. Thickness of common carotid artery of >/= 0.5 mm was considered significant. Analysis was performed through SPSS-10.0. Frequencies and percentages were computed to present categorical variables including stroke type and wall thickness of common carotid artery in terms of [ 0.5 mm]. Chi-square test was applied to see association of increased CCA-IMT with stroke type. Statistical significance was taken at p < 0.05. Among 150 patients of stroke, 13 [8.7%] patients of left and 8 [5.3%] patients of right had increased CCA-IMT. The CCA-IMT was significantly higher in patients with ischemic stroke patients [p=0.001]. The present results demonstrate the possible predictive power of non-invasive measure meant of CCA-IMT with respect to brain infarction versus intracerebral hemorrhage and deserve further investigation. Despite high prevalence of hypertension in patients with haemorrhagic stroke, increased CCA-IMT which is considered as an early marker of atherosclerosis is strongly related to ischaemic stroke than haemorrhagic stroke

Fahrs disease: a young girl presenting with fits

Fahr's disease refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. We describe a 28 year's old unmarried girl who presented with fits, anxiety, and panic attacks. She had bilateral symmetrical intracranial calcification. She was proved to have hypoparathyroidism and pleural tuberculosis

Infected benign cystic terotoma of the mediastinum

A young man aged 22 years presented with shortness of breath, left sided chest pain, mild dry cough, peripheral cyanosis, fever and generalized weakness for three years. He was diagnosed as having a large infected cystic mediastinal mass with tricuspid regurgitation and severe pulmonary hypertension. On thoracotomy, one litre of pus was aspirated and tumour was excised and sent for histopathology. Biopsy report revealed benign cystic teratoma. This case is reported to highlight the management of a huge infected benign cystic teratoma which is rarely found

Management practices of childhood diarrhea

To elicit management practices of childhood diarrhea in this region. A cross-sectional survey. This study was carried out in CDDU-CHC [Control of Diarrheal Disease Unit Children Hospital Complex] Multan, over a period of nine months [March-Nov 2005]. Five hundred and twenty patients [age group 2 months-5 years] presenting with diarrhea and dehydration at CDDU-CHC Multan, were randomly selected. Management practices; use of medicines and intravenous fluids, preparation and use of ORS and other home made rehydration solutions, feeding practices during diarrheal attack were determined. Interviewing each mother, a pre-designed questionnaire was filled. Most of the families belonged to a poor socio-economic class; only 18.3% mothers could read and write. Mean duration of diarrheal attack was 4.1 days. Most of the mothers [95%] used allopathic medicine but only 49% from qualified doctors. Mothers [78%] knew about ORT [Oral Rehydration Therapy], but preparation and use of ORS and home available solutions was not appropriate in most of the cases. A large number of mothers withheld semisolid foods during diarrheal attack. ORT and adequate feeding during and after diarrhea are keys to the successful management of diarrhea. With regard to the management practices, there is a great need to improve awareness among mothers and caretakers about continuation of breast-feeding and/or semisolids during diarrheal attack, hand washing practices, preparation and use of ORS and avoiding antidiarrheal drugs