Patellar tendinopathy: pathomechanics and a modern approach to treatment

Patellar tendinopathy, a common condition in sport, can be recurrent and resistant to treatment, Risk factors include the level of training, biomechanics, and genetic factors. This review discusses several programs based on eccentric exercise and suggests principles for nonoperative treatment including improving shock absorption, load modification, and adaptation of the tendon to sporting stress. The level of pain that patients are asked to tolerate during tendon-exercise programs varies among programs, and it is unclear what level is optimal to stimulate tendon recovery. Rehabilitation presents several challenges: It can take a long time (3-12 months), exercise prescription in an athlete who is continuing to compete is not straightforward, and guidelines for treatment progression are poor, Nonoperative treatment can fail because of inappropriate exercise prescription and poor athlete compliance. If this occurs and surgical intervention is required, the athlete might still have an unpredictable outcome. Solutions to these problems require additional clinical research.<br /

Bacterial isolates in neutropenic febrile patients

One hundred consecutive patients with documented bacteremia and neutrophil count of 0.5 x 10(9)/L or below were retrospectively studied to determine the pattern of infection at the Aga Khan University Hospital in Karachi. These included patients with primary haematologic malignancies presenting with low counts, and those patients with cancer who developed neutropenia as a result of chemotherapy. The gram negative organism pseudomonas aeruginosa was the most common bacterial organism isolated constituting 31% of all positive blood cultures. Gram positive organisms were frequently isolated comprising 24% of all isolates of which 15% were Staph.aureus. Staph. epidermidis was not isolated in this series. Salmonella species were isolated in 9 patients. The other gram negative rods included non-lactose fermenting organisms frequently isolated in a nosocomial setting including Serratia and Acinetobacter. Four patients had positive fungal blood cultures. A single positive anaerobic culture was obtained. Sensitivities of the Pseudomonas aeruginosa reflected the high frequency of resistance seen in nosocomial isolates and those from the community. More than half (54.8%) of the isolates were resistant to carbenicillin and 9.6% resistant to gentamicin. Although 3.2% were resistant to cefotaxime, none were resistant to ofloxacin or ceftazidime reflecting the relatively recent arrival of the latter. In contrast, 23% of Staph. aureus were still sensitive to penicillin. Methicillin (cloxacillin) resistant Staph. aureus did not occur. However 26.6% of the Staph. aureus were resistant to erythromycin. Knowledge of the prevailing pattern of infection permits the development of investigative and therapeutic approaches of optimal efficacy

Viscous dissipation and radiation effects on MHD boundary layer flow of a nanofluid past a rotating stretching sheet

Viscous dissipation and radiative heat transfer in nanofluid with the influence of magnetic field over a rotating stretching surface has been investigated numerically. The steady laminar boundary layer flow is considered in this study. The governing boundary-layer equations are formulated and transformed into nonlinear ordinary coupled differential equations by using similarity variables. The governing equations are solved numerically using the Nactsheim-Swigert Shooting iteration technique together with the Runge-Kutta six order iteration schemes with the help of a computer programming language Compaq Visual Fortran 6.6a. The simulation results are presented graphically to illustrate influence of well-known parameters on the velocity, temperature and concentration distributions as well as skin-friction coefficient, Nusselt and Sherwood number at the sheet

Pathology of chronic achilles-tendon injuries in athletes

Overuse tendon conditions have traditionally been considered to result from an inflammatory process and were treated as such. Microscopic examination of abnormal Achilles-tendon tissues, however, reveals a non-inflammatory degenerative process. The histopathology found in surgical specimens in patients with chronic overuse Achilles tendinopathy and those with Achilles-tendon rupture are reviewed. Seminal studies suggest that so-called tendinitis is a rare condition that might occur occasionally in the Achilles tendon in association with a primary tendinosis. These data have clinical implications and require a review of the traditional classification of pathologies seen in tendon conditions, The authors recommend that nomenclature be based on histopathological findings rather than traditional hypothesis. <br /

Acute myocardial infarction: profile and management at a tertiary care hospital in Karachi

Objective: Acute Myocardial Infarction (AMI) is a rising epidemic in developing countries. While studies in the West have established the characteristics and management of AMI patients, comprehensive data reflecting these issues in the Pakistani subjects is scarce. This study examined the profile and management of AMI in patients hospitalized at a tertiary care hospital in Karachi, Pakistan.Methods: Three hundred forty four patients admitted in 1998 with the diagnosis of AMI met our inclusion criteria. Data on presentation, investigations, monitoring and therapy was obtained. Chi-square and t tests were used to analyze the data.Results: Out of 344 patients with AMI, 71% were males; 58% had a Q wave MI. Majority of the patients who presented within 2 hours of symptom onset (36%), had chest pain. Patients with dyspnea and no chest pain were more likely to present after 12 hours of the onset of symptoms. In-house mortality was found to be 10.8%. Low HDL and diabetes was associated with in-hospital complications. Twenty nine percent of patients were given thrombolytic therapy with a mean door-to-needle time of 1 hour 36 minutes; 33% of patients who were eligible of Streptokinase did not receive it. Cardiac catheterization was performed in 28% patients. Echocardiography and Exercise Tolerance Test, both under utilized, were performed in 67% and 16% of patients, respectively. Two hundred sixteen (70%) patients discharged from hospital were contacted via telephone and the 1-year mortality rate among them was 28%.CONCLUSION: The profile and management of AMI was in coherence with earlier, Western studies. Chest pain units need to be established in the Emergency Room. Patients should be risk stratified prior to discharge. Public awareness regarding primary and secondary prevention and symptoms of AMI needs to be increased

Case-control study of suicide in Karachi, Pakistan

Background: In recent years suicide has become a major public health problem in Pakistan. Aims: To identify major risk factors associated with suicides in Karachi, Pakistan. Method: A matched case-control psychological autopsy study. interviews were conducted for 100 consecutive suicides, which were matched for age, gender and area of residence with 100 living controls. Results: Both univariate analysis and conditional logistic regression model results indicate that predictors of suicides in Pakistan are psychiatric disorders (especially depression), marital status (being married), unemployment, and negative and stressful life events. only a few individuals were receiving treatment at the time of suicide. None of the victims had been in contact with a health professional in the month before suicide. Conclusions: Suicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated, The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan

A roadmap to develop dementia research capacity and capability in Pakistan: a model for low- and middle-income countries

Objective To produce a strategic roadmap for supporting the development of dementia research in Pakistan. Background While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low- and middle-income countries (LMIC) like Pakistan. Methods We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change-based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a “research question” priority survey, and consultations with Key Opinion Leaders. Results We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real-world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life. Conclusion This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures

Adoption of JMM practices – A key to performance improvement of a local automotive industry

It is imperative for a manufacturing company all over the world to constantly look for ways to increase productivity and at the same time to lower cost to secure a competitive position. It is recognized that practices associated with Japanese Manufacturing Management (JMM) can yield a superior competitive advantage in terms of productivity, quality and provide overall successful business performance. This paper discusses the transfer of the best practices of the JMM locally and analyses the impact of adoption and adaptation of the management system as an in-depth case study conducted in a Malaysian automotive company. This study is to identify what are the changes in terms of the philosophy and practices undertaken by the company and ascertain the impact of the JMM on its manufacturing and financial performances. The elements of business performance from the viewpoint of manufacturing are based on safety, Parts Per Million (PPM), in-line Defect per Unit (DPU), First Time Quality (FTQ), cycle time, productivity, efficiency and stock level. The results show a positive impact to the automotive plant manufacturing performance. For example, safety index has reduced to 0 major accident occurrences. The PPM and In-line DPU have improved by 98% and 91% respectively whereas the FTQ has improved by 167%. Cycle time has reduced from 20 to 6 minutes and productivity increased up to 43% whilst the efficiency reached at 99.9%. The stock level was reduced from half month to 3 days after the adoption of the JMM. The revenue has increased up to 92%, the percentage of expenses has reduced from 11.04% to 3.06% giving an improvement of 72% whilst the net profit has increased from 5.33% to 8.15%. The Return of Asset (RoA) and Return of Equity (RoE) also showed slight improvement despite the effects from the restructuring exercise, Tsunami calamity and fluctuation in Japanese exchange rate