Transpedicular Decompression And Spinal Fixation In Thoracolumbar Burst Fractures

Objective: To evaluate the results of transpedicular decompression and single stage pedicle screw fixation in burst fractures of thoracolumbar spine. Materials & Methods: This study was carried out at PNS Shifa from Dec 2010 to Jan 2013. All consecutive traumatic burst fractures that underwent surgery were included in the study. Twenty three consecutive patients aged 17 to 57 (mean, 41) years who had burst fractures in the thoracolumbar (n=13) and lumbar (n=10) regions and were surgically treated were included in this study. There were 18 males and 5 females. Fractures were classified according to the AO classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status by the modified Frankel grading for traumatic paraplegia. All patients underwent posterior transpedicular decompression and same stage pedicle screw fixation. Outcome was assessed on Frankel grading scale. Results: The extent and level of neurological injury varied. It did not correlate with extent of canal compromise, age and sex of the patient. Neurological injury was greater with T11 and T12 injuries than Lumbar fractures. No worsening of neurological grade was observed after surgery; rather 20 of 23 patients (86.9%) improved to the next higher grade. Screw malposition to the extent warranting readjustment was noted in 2 cases. Hardware failure occurred in 1 case after 6 months, bed sores in 3 cases and deep vein thrombosis in 1 case. Conclusion: Single stage Transpedicular decompression and spinal fixation from a posterior approach gives good results in burst fractures of thoracolumbar spin

Micro-endoscopic Disectomy: Early Experience and Results

Objective: This prospective study was conducted to assess results and experience with microscopic endoscopic disectomy (MED).Study Design: This is a prospective study carried out at PNS Shifa, which is a tertiary care hospital, from July 2011 to June 2012.Methods: Thirty eight patients underwent surgery in which the MED system was used; all procedures were performed under general anesthesia. All patients were followed prospectively. MED system used in this study consisted of tubular retractors and an endoscope with xenon light source and HD image system by Karl Storz co. Germany. Outcomes were measured using Macnab criteria.Results: Thirty eight patients (27 males, 11females) underwent MED for prolapsed lumbar intervertebral disc. Mean operating time was 80 minutes. Follow up ranged from 3 to 12 months with a mean follow up 7.8 months. Thirty two patients had an excellent outcome while three had a good outcome. Three patients had a poor outcome. One patient with a big dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Three complications were noted and were all related to dural tears.Conclusions: Minimally invasive surgery using MED is clinically effective and reliable. Patient satisfaction is high and complications rates are comparable with those associated with traditional microdiscectomy procedures.Abbreviations: MED: Microendoscopic discectomy, HD: High Definition

Relationship among Hypovitaminosis D, Maternal Periodontal Disease, and Low Birth Weight

Objective: To determine if low birth weight is associated with hypovitaminosis D and periodontal disease among a sample of Pakistani women residing in district Jhelum, Punjab.STUDY Design: Cross-sectional study nested in a large community-based longitudinal study.PLACE AND DURATION OF STUDY: Tehsil Pind Dadan Khan, District Jhelum, Pakistan from August 2012 to October 2015.METHODOLOGY: Women during 12-16th week of pregnancy were selected. Dental examination was performed. Probing depth \u3e3 mm was labeled as periodontal disease, whereas serum level 2500 g) babies. Odds ratio was applied to measure the strength of association of low birth weight with maternal hypovitaminosis D and also for maternal periodontal disease.Results: There were 62 participants in the study. The mean age of mothers was 26.7 ±4.5 years. It was alarming to observe that 53 (85%) participants had vitamin D deficiency. However, periodontal disease was only seen in four participants (6%). Out of the 62 mothers, eighteen (29%) gave birth to low birth weight babies. None of the variables were found to be associated with the low birth weight.CONCLUSION: The present study did not find any significant association of low birth weight with hypovitaminosis D or maternal periodontal disease in the studied sample

Neuronal regeneration in denervated muscle following sensory and muscular neurotization

Background and Purpose: Neurotization of denervated muscles has been shown to improve muscle bulk, but the neuronal regeneration response has not been compared previously in different surgical techniques of neurotization. Thus, using a rat model of experimental skeletal muscle denervation, we studied neuronal regeneration following sensory neurotization by two methods: sensory nerve to motor branch of muscle and direct sensory nerve implantation to muscle. Material and Methods: The lateral head of the gas-trocnemius muscle was denervated in 36 rats, of which the first 12 served as denervated controls. In the second group of 12, the sural nerve was anastomozed to the motor branch of the gastrocnemius muscle (sensory-to-motor nerve neurotization) and in the remaining 12 rats the sural nerve was split into 4 fascicles and embedded into 4 quadrants of the muscle (direct sensory nerve-to-muscle neurotization). Immunohistochemistry was used to examine nerve fibers in muscle containing the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP), and general neuronal marker protein gene product 9.5 (PGP 9.5). Results: Semiquantitative analysis showed that, compared to the control side, the number of nerve fibers on the experimental side was highest (p \u3c 0.01) for group III (direct sensory nerve-to-muscle neurotization) for all 3 markers. The difference was 71%, 298%, and 254% for PGP 9.5, CGRP, and SP, respectively. Interpretation: This method may be a good option for inducing neuronal regeneration in denervated muscles, and has therapeutic implications for prevention of atrophy of denervated muscles and as an adjunct for reconstruction of soft tissue defects

Septic arthritis of the hip in children: Aga Khan University Hospital experience in Pakistan

Objective: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children.Methods: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR). Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy.Results: Symptoms of pain, fever and restricted range of hip motion were common to all patients. The mean leukocyte count was 14,000 and the mean ESR was 63 mm. Cultures of blood and joint aspirate were positive in 9 and 28 patients respectively. Staphylococus Aureus was the commonest organism (14 patients) identified, and only one patient had Hemophilus influenzae. Seven patients had a mixed osteoarticular infection. Positive clinical response was noted in the mean time period of 8.6 days. In follow-up, four cases developed myositis ossificans and 2 cases showed signs of partial growth plate destruction.Conclusion: Our findings of the absence of H. influenzae and the presence of a number of gut organisms are different from the previous studies. Duration of symptoms was an important prognostic factor and correlated well with the final outcome. Early surgical decompression was found to be the treatment of choice. A combined osteoarticular infection should be kept in mind in cases which show a poor response after the initial joint debridement

Frequency of Gγ-globin promoter −158 (C>T) XmnI polymorphism in patients with homozygous/compound heterozygous beta thalassaemia

BackgroundResponse to hydroxyurea therapy in homozygous or compound heterozygous beta thalassaemia (BT) has been reported as more favourable in the presence of XmnI polymorphism. The prevalence of XmnI polymorphism may vary with BT phenotypes and genotypes, and differs geographically in distribution. Prevalence of XmnI polymorphism is not known in northern Pakistan.ObjectiveTo determine the frequency of Gγ-globin promoter −158 (C>T) XmnI polymorphism (XmnI polymorphism) in patients with homozygous or compound heterozygous beta thalassaemia.MaterialsPolymerase chain reaction (PCR) for common beta thalassaemia mutations and Gγ-globin promoter −158 (C>T) XmnI polymorphism was performed on 107 blood samples of transfusion dependent beta thalassaemia (BT) patients in Pakistan. One hundred samples of unrelated BT traits and 94 samples of healthy subjects as controls were also analysed for BT mutations and XmnI polymorphism.ResultsOut of 301 DNA samples, XmnI polymorphism was detected in 71(24%); in normal controls, XmnI polymorphism was detected in 34/94 (36%) subjects; while in homozygous/compound heterozygous BT, it was detected in 14/107(13%) patients (Fisher’s exact test, p=.0002). In heterozygous BT group, XmnI polymorphism was detected in 23/100 subjects (Fisher’s exact test, p=.03 with normal controls, and p=.049 with homozygous/compound heterozygous BT). The most common BT genotype was Frame Shift (Fr) 8–9/Fr 8–9, and none of the patients with this genotype had XmnI polymorphism. The second most common genotype was IVSI-5/IVSI-5; 4/26 (15%). Cases with this genotype had XmnI polymorphism.ConclusionXmnI polymorphism in homozygous/compound heterozygous BT group is 13%. The most common genotype associated with XmnI polymorphism was IVSI-5/IVSI-5

Effect of teriparatide on bone regenerate after distraction osteogenesis

Abstract OBJECTIVE: To determine the effect of teriparatide on new bone formation in a rat model of distraction osteogenesis. METHODS: The experimental study was conducted at the Aga Khan University Hospital, Karachi, in November-December 2010, and comprised male Sprague-Dawley rats weighing 250gm each who were allocated to two treatment groups, teriparatide and saline, both given subcutaneously for 7 weeks. Femoral distraction was done for 3 weeks at the rate of 0.4mm/day, followed by a further 4 weeks for consolidation. New bone formation was assessed using X-ray scoring system, bone densitometry and histology. RESULTS: The 12 rats in the study were divided into two groups of 6(50%) each. All rats in the teriparatide group showed new bone formation whereas bone formation was present only in 2(33.3%) rats in the saline group. Bone densitometry showed that area (size) of the new bone formed adjacent to the margins of the osteotomy site as well as the total bone mineral content of the new bone was significantly higher (p\u3c0.05) in the teriparatide group. Histological analysis showed larger but statistically insignificant (p\u3e0.05) area of woven and trabecular new bone in the teriparatide group. CONCLUSIONS: The results suggested a promising role of parathyroid analogue therapy in distraction osteogenesis for promoting bone formation and consolidation. This may have strong clinical implications in cases of limb lengthening and bone transport

Numerical optimization of (FTO/ZnO/CdS/CH₃NH₃SnI₃/GaAs/Au) perovskite solar cell using solar capacitance simulator with efficiency above 23% predicted

The presented study deals with the investigations of the methyl ammonium tin halide (CH3NH3SnI3) based perovskite solar cells for optimized device performance using solar capacitance simulations software. Several necessary parameters such as metal work functions, thickness of structural layers, charge carrier’s mobility and defect density have been explored to evaluate the device performance. Calculations reveal that for the best efficiency of device the maximum thickness of the perovskite (CH3NH3SnI3) absorber layer must be 4.2 μm. The thickness values of 0.01 μm for ZnO electron transport layer (ETL), 0.871 μm for GaAs hole transport layer and 0.001 μm for CdS buffer layer have been found which proved to be optimum for maximum power conversion efficiency (PCE) of 23.80% for the device. The variation of open circuit voltage (Voc), Short circuit current (Jsc), Fill Factor (FF %), quantum efficiency (QE) against thickness of all layers and interface defect densities in FTO/ZnO/CdS/CH3NH3SnI3/GaAs/Au composition have been critically explored and their crucial role for the device performance has been reported. Heterojunctions between ZnO-ETL and CdS buffer layers have shown improved device performance and PCE. Current investigations may prove to be useful for designing and fabrication of climate friendly, non-toxic and highly efficient solar cells

Iatrogenic trauma following percutaneous and minimally invasive surgical interventions

Technological progress has changed the landscape of surgical practice. Minimally invasive surgery (MIS) and percutaneous interventions (PC) are constantly replacing open procedures. This reduces hospital stay and allows quicker recovery. The application of MIS should follow the good medical practice dictum by Hippocrates i.e. First do no harm . To remain abreast with new procedures, the medical personnel are required to update and enhance their knowledge and skill. To ensure safety, the innovations are rigorously tested and tried. The learning curve of MIS is shortened by simulator training and proctorship. Credentialing processes are in place to enhance safe delivery of care. Despite of all these measures MIS and PCI are associated with adverse effects. The purpose of this article is to overview the iatrogenic trauma associated with MIS and PCI in major surgical subspecialties