Objective: To compare the hemodynamic response to orotracheal intubation via direct laryngoscope versus fiberoptic bronchoscope in patients undergoing general anesthesia.Study Design: Comparative Study.Place and Duration of Study: Anesthesia Department of Military Hospital, Rawalpindi from 1st March to 30th May 2014.Materials and Methods: A total of 110 patients for elective surgeries with general anesthesia, were included and randomized into two groups. The patient in group F (n=55) were intubated by direct laryngoscopy (DLS) and group L (n=55) cases intubated by fiberoptic bronchoscopy (FOB). The hemodynamic response heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline, at induction, at laryngoscopy, at the time of intubation and 3 minutes after intubation.Results: The age of the patients ranged between 19-45 years. Average age of participants was 33.76 and 31.56 and average weight of patients was 71.22±1.493 and 73.18±1.390 Kg in group F and L respectively. At induction, hemodynamic values dropped to 20% of the baseline values. At the time of intubation (laryngoscopy or fiberoptic bronchoscopy) and 3 min after intubation, hemodynamic values increased significantly (p<0.05) in both groups.Conclusion: Our study demonstrated that both groups (Fiberoptic bronchoscopy verses direct laryngoscopy) showed same hemodynamic responses during orotracheal intubations.

Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical & Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material & Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II & III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.