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

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

Sensory hypoinnervation in club foot

Abstract We have compared the density of nerve fibres in the synovium in club foot with that of specimens obtained from the synovium of the hip at operations for developmental dysplasia. The study focused on the sensory neuropeptides substance P; calcitonin gene-related peptide; protein gene product 9.5, a general marker for mature peripheral nerve fibres; and growth associated protein 43, a neuronal marker for new or regenerating nerve fibres. In order to establish whether there might be any inherent difference we analysed the density of calcitonin gene-related peptide-positive nerve fibres in the hip and ankle joints in young rats. Semi-quantitative analysis showed a significant reduction in the number of sensory and mature nerve fibres in the synovium in club foot compared with the control hips. Calcitonin gene-related peptide (CGRP) positive fibres were reduced by 28%, substance P-positive fibres by 36% and protein gene product 9.5-positive fibres by 52% in club foot. The growth associated protein 43-positive fibres also seemed to be less in six samples of club foot. No difference in the density of CGRP-positive nerve fibres was observed in the synovium between ankle and hip joints in rats. The lack of sensory input may be responsible for the fibrosis and soft-tissue contractures associated with idiopathic club foot

Outpatient percutaneous release of trigger finger: A cost effective and safe procedure

Introduction: Trigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome.Materials and Methods: This is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell\u27s criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months.Results: There was complete release of A1 pulleys in 52 out of 52 digits (100%) in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed.Conclusion: Percutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective

COMPARATIVE EFFICACY OF OXYCLOZANIDE, RAFOXANIDE AND BITHIONOL SULPHOXIDE AGAINST PARAMPHISTOMIASIS IN BUFFALOES

In this study comparative anthelmintic trials were conducted using Nilzan drench (Oxyclozanide 3.0% + Levamisole 1.5%), Fasifree (Rafoxanide 3.0%), Irchasol (Bithionol sulphoxide 10% + Levamisole 1.5%) and Nilvenn drench (Levamisole 1.5%) administered orally to compare their efficacy against paramphistomiasis in buffaloes. Seventy five naturally infected buffaloes were selected and divided into five equal groups i.e. A, B. C. D and E with 15 animals in each group. Each animal of group A was given Nilzan (1 ml/2 kg body weight), group B was given Fasifree (1 ml/4 kg) body weight), group C was given Irchasol (1 ml/ 2 kg body weight) group D was given Nilverm (1 ml/2 kg body weight), while group E was kept as untreated control. The efficacy of these anthelmintics was evaluated by counting eggs per grm (EPG) of faeces pre medication (on day zero) and then on day 7, 14 and 21 post medication. The mean efficacy of Nilzan, Fasifree and Irchasol was 97.29 98.5 and 85.56% respectively while Nilverm did not have any effect on Paramphistomiasis in buffaloes

The role of medical schools in UK students’ career intentions: findings from the AIMS study

Abstract Objectives To investigate differences in students’ career intentions between UK medical schools. Design Cross-sectional, mixed-methods online survey. Setting The primary study included all 44 UK medical schools, with this analysis comprising 42 medical schools. Participants Ten thousand four hundred eighty-six UK medical students. Main outcome measures Career intentions of medical students, focusing on differences between medical schools. Secondary outcomes included variation in medical students’ satisfaction with a prospective career in the NHS, by medical school. Results 2.89% of students intended to leave medicine altogether, with Cambridge Medical School having the highest proportion of such respondents. 32.35% of respondents planned to emigrate for practice, with Ulster medical students being the most likely. Of those intending to emigrate, the University of Central Lancashire saw the highest proportion stating no intentions to return. Cardiff Medical School had the greatest percentage of students intending to assume non-training clinical posts after completing FY2. 35.23% of participating medical students intended to leave the NHS within 2 years of graduating, with Brighton and Sussex holding the highest proportion of these respondents. Only 17.26% were satisfied with the prospect of working in the NHS, with considerable variation nationally; Barts and the London medical students had the highest rates of dissatisfaction. Conclusions This study reveals variability in students’ career sentiment across UK medical schools, emphasising the need for attention to factors influencing these trends. A concerning proportion of students intend to exit the NHS within 2 years of graduating, with substantial variation between institutions. Students’ intentions may be shaped by various factors, including curriculum focus and recruitment practices. It is imperative to re-evaluate these aspects within medical schools, whilst considering the wider national context, to improve student perceptions towards an NHS career. Future research should target underlying causes for these disparities to facilitate improvements to career satisfaction and retention. </jats:sec