Comparison of Absorbable with non Absorbable sutures in closure of Laparotomy incisions

Objective: To compare the absorbable with non absorbable sutures in wound dehiscence after closure of Laparotomy incisions. Methodology: This randomized control trial was conducted in the department of general surgery, Bahawal Victoria Hospital, Bahawalpur in seven months duration from June 2016 to January 2017. Data was entered in statistical software SPSS version 23 and analyzed for desired variable analysis. Mean and SD was calculated for numerical data like age and Body Mass Index,  and frequency percentages were calculated categorical data like gender, Anemia etc. Chi square test was applied for effect modification or association of outcome variables with effect modifiers. P value < 0.05 was considered as significant. Results: In this study, a total number of 100% (n=130) patients were included, divided into two equal groups, 65 in each i.e. group Prolene and group Vicryl. In our study, wound dehiscence occurred in 6.2% (n=4) cases in whom Prolene was used whereas 21.5% (n=14) had wound dehiscence with the use of Vicryl suture. Vicryl was followed by significantly higher incidence of wound dehiscence than closure by Prolene (χ2= 6.448 DF = 1, P value=0.011). Conclusion: Observation of our study concluded that non absorbable Prolene has better outcome and less wound dehiscence and other complication as compared to absorbable Vicryl suture. Keywords: Absorbable suture, non absorbable suture, wound dehiscence, laparotomy

Comparison of Functional Outcomes in Terms Of Post-Operative Mobility for Unipolar Versus Bipolar Un-Cemented Hemiarthroplasty in Elderly Patients with Displaced Intracapsular Femoral Neck Fractures

Objective: To compare of functional outcomes in terms of post-operative mobility for unipolar versus bipolar un-cemented hemiarthroplasty in elderly patients with displaced intracapsular femoral neck fractures. Methodology: Our study design is Randomized Control Trialconducted inDepartment of Orthopedics Bahawal Victoria Hospital, Bahawalpur. April 2015 to October 2016.Sample size is (calculated by taking n6 =138, confidence interval 95, power of study 80, P1= 33%, P2=13%) 69 in each group. Sampling technique used was non probability consecutive sampling. All patients who meet the inclusion criteria presenting to orthopedic unit of Nishtar Hospital Multan with fracture neck of femur were selected for study. Patients were divided into two groups randomly by lottery method and enrolled for unipolar or bipolar hemiarthroplasty. Chi-square test was used to compare outcome variable in both groups. A p-value < 0.05 was considered statistically significant. Effect modifiers like age and sex was controlled by stratification. Chi square test was applied to see significant difference. Results: Overall, there were 100% (n=138) patients in this study, both genders. The mean age of the patients was 66.35±4.29 years. (Range: 60 to 80years) Mean age and SD of group A (no walking aid) was 54.52 ± 3.10 and in group B (walking aid) 54.99 ± 3.19. Time up go score was noted as successful 33.3% (n=46) and 66.7% (n=92) as unsuccessful. Walking aid was noted in 65.2% (n=90) patients. Functional outcome was noted as good in 26.8% (n=37) patients and noted as bad in 73.2% (n=101) patients. Out of 100% (n=38) patients, good outcome was 26.3% (n=10) unipolar and 73.7% (n=28) bipolar. Out of 100% (n=100) Bad outcome was 59% unipolar and bipolar 41%. Conclusion: Functional outcome in term of mobility is better in case of bipolar prosthesis as compared to unipolar. Thus in our conclusion bipolar prosthesis is preferred procedure as compared to unipolar hemiarthroplasty in treating patients with displaced intracapsular femoral neck fracture. Keywords:Bipolar Hemiarthroplasty, Unipolar Hemiarthroplasty, Displaced intracapsular femoral neck fractures

Renal Cell Carcinoma of pelvic kidney with atypical nodal metastasis: A diagnostic challenge

Ectopic pelvic kidney is a known congenital anomaly; however, the presence of renal cell carcinoma (RCC) in an ectopic kidney is rare with the evidence available in the form of a few case reports only. In this case report, we present a case of metastatic RCC in the pelvic kidney which became a diagnostic challenge because of atypical contrast-enhanced computed tomographic (CT) characteristics and unusual pattern of lymph node involvement including cervical lymph node in the absence of visceral metastasis. Because of its unusual location and uncertain vascular anatomy, ectopic kidney poses a surgical challenge. Owing to the rarity of this condition, optimal surgical approach, metastatic potential, routes of metastasis, and effectiveness of systemic agents in pelvic RCC compared to RCC in a normally located kidney, are largely unknown. Key Words: Renal cell carcinoma, Pelvic kidney, Lymph node metastasis

Analysis of Human Gait Cycle with Body Equilibrium based on leg Orientation

Gait analysis identifies the posture during movement in order to provide the correct actions for a normal gait. A person\u27s gait may differ from others and can be recognized by specific patterns. Healthy individuals exhibit normal gait patterns, while lower limb amputees exhibit abnormal gait patterns. To better understand the pitfalls of gait, it is imperative to develop systems capable of capturing the gait patterns of healthy individuals. The main objective of this research was to introduce a new concept in gait analysis by computing the static and dynamic equilibrium in a real-world environment. A relationship was also presented among the parameters stated as static \& dynamic equilibrium, speed, and body states. A sensing unit was installed on the designed metal-based leg mounting assembly on the lateral side of the leg. An algorithm was proposed based on two variables: the position of the leg in space and the angle of the knee joint measured by an IMU sensor and a rotary encoder. It was acceptable to satisfy the static conditions when the body was in a fixed position and orientation, whether lying down or standing. While walking and running, the orientation is determined by the position and knee angle variables, which fulfill the dynamic condition. High speed reveals a rapid change in orientation, while slow speed reveals a slow change in orientation. The proposed encoder-based feedback system successfully determined the flexion at 47$^\circ$, extension at 153$^\circ$, and all seven gait cycle phases were recognized within this range of motion. Body equilibrium facilitates individuals when they are at risk of falling or slipping

A Commentary on Telerehabilitation Services in Pakistan: Current Trends and Future Possibilities

A 2014 World Health Organization (WHO) study reported that almost 27 million people with disability live in Pakistan with fewer than one allied rehabilitation professional per 10,000 people. The current study sought to determine the attitudes toward telerehabilitation via a survey administered to 329 Pakistani rehabilitation professionals. Study results indicate that rehabilitation professionals in Pakistan are knowledgeable about telerehabilitation and Information and Communication Technology (ICT), and are receptive to employing telerehabilitation programs and applications. Therefore, we can infer that the future of telerehabilitation can be bright in Pakistan but requires the attention of policy makers and non-government organizations to launch an appropriate program nationwide. The authors suggest that a range of telerehabilitation services (e.g., consultation, assessment, and therapy) could alleviate the shortage of rehabilitation personnel in Pakistan

In vitro Studies on Anti-diabetic and Anti-ulcer Potentials of Jatropha gossypifolia (Euphorbiaceae)

Purpose: To evaluate α-glucosidase and α-chymotrypsin enzyme inhibitory activity of Jatropha gossypifolia as a probable remedy for the management of diabetes and ulcer.Methods: Different extracts and fractions of the root, leaf and stem bark of the plant were screened for their α-glucosidase and α-chymotrypsin inhibitory activity using standard in vitro inhibition assays. Acarbose and chymostatin were used as positive control, respectively.Results: n-Butanol and ethyl acetate fraction showed maximum enzyme inhibition for α-glucosidase with 67.93 ± 0.66 and 67.67 ± 0.71 % and half maximal concentration (IC50) of 218.47 ± 0.23 and 213.45 ± 0.12 μg/ml, respectively. Dichloromethane and ethyl acetate leaf fractions exhibited maximum α-chymotrypsin inhibition activity of 85.08 ± 0.38 and 83.87 ± 0.70 %, and IC50 of 133.1 ± 0.68 and 134.5 ± 0.12 μg/ml, respectively, Acarbose exhibited enzyme inhibition activity of 92.14 ± 0.38 % with IC50 of 38.24 ± 0.1 μg/ml, while chymostatin exhibited 93.67 ± 0.38 % enzyme inhibition and IC50 of 8.24 ± 0.11 μg/ml.Conclusion: The presence of bioactive secondary metabolities with enzyme-inhibiting activity lends some support for the traditional use of this plant in the management of diabetes and ulcer. However, further investigation of the plant including identification of its active components is required.Keywords: α-Chymotrypsin, α-Glucosidase, Inhibition, Jatropha gossypifolia, Anti-diabetic, Anti-ulce

Design and implementation of Adaptive Neuro-Fuzzy Inference system for the control of an uncertain Ball on Beam Apparatus

Controlling an uncertain mechatronic system is challenging and crucial for its automation. In this regard, several control-strategies are developed to handle such systems. However, these control-strategies are complex to design, and require in-depth knowledge of the system and its dynamics. In this study, we are testing the performance of a rather simple control-strategy (Adaptive Neuro-Fuzzy Inference System) using an uncertain Ball and Beam System. The custom-designed apparatus utilizes image processing technique to acquire the position of the ball on the beam. Then, desired position is achieved by controlling the beam angle using Adaptive Neuro-Fuzzy and PID control. We are showing that adaptive neuro-fuzzy control can effectively handle the system uncertainties, which traditional controllers (i.e., PID) cannot handle

Total parotidectomy under local anesthesia: A novel technique

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. The facial nerve can be easily identified with on command movements by the patient rendering the use of nerve stimulator or injection of the dye superfluous. This technique makes total parotidectomy an outpatient procedure and facilitates an early discharge

Do clinical manifestations of Systemic Lupus Erythematosus in Pakistan correlate with rest of Asia?

Objective: Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data.Methods: Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia.Results: Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races.CONCLUSION: This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations

Genetic Investigation of Consanguineous Pakistani Families Segregating Rare Spinocerebellar Disorders

Spinocerebellar disorders are a vast group of rare neurogenetic conditions, generally characterized by overlapping clinical symptoms including progressive cerebellar ataxia, spastic paraparesis, cognitive deficiencies, skeletal/muscular and ocular abnormalities. The objective of the present study is to identify the underlying genetic causes of the rare spinocerebellar disorders in the Pakistani population. Herein, nine consanguineous families presenting different spinocerebellar phenotypes have been investigated using whole exome sequencing. Sanger sequencing was performed for segregation analysis in all the available individuals of each family. The molecular analysis of these families identified six novel pathogenic/likely pathogenic variants; ZFYVE26: c.1093del, SACS: c.1201C>T, BICD2: c.2156A>T, ALS2: c.2171-3T>G, ALS2: c.3145T>A, and B4GALNT1: c.334_335dup, and three already reported pathogenic variants; FA2H: c.159_176del, APTX: c.689T>G, and SETX: c.5308_5311del. The clinical features of all patients in each family are concurrent with the already reported cases. Hence, the current study expands the mutation spectrum of rare spinocerebellar disorders and implies the usefulness of next-generation sequencing in combination with clinical investigation for better diagnosis of these overlapping phenotypes