No abstract

Supra condylar fractures in children are a serious injury with a significant morbidity. Setting: CMH Multan. Patients presentvery late, often after being mishandled by traditional bone-setters, with lifelong consequences. All children up to the age of 12 years withsupra condylar humeral fractures presenting to our hospital were included in the study. Careful history and examination was carried outand necessary x-rays were taken. Time since injury, all treatments administered, complications and any other data was recorded. Period:From 1999 to 2004. 304 cases were included in the study. Only 12% patients presented within 24 hours. 87.5% children presented from72 hours to 3 weeks post injury. The reasons recorded were lack of access to proper medical help, illiteracy, poverty and manipulation bytraditional bone setters. Based on Gartland's Classification1 61% patients had un-displaced and 39% had displaced fractures. 61% wereType I fractures, 19% Type II and 20% Type III fractures. Due to late presentation these patients had more complications including myositisossificans, neurological complications and contractures due to tight bandages by traditional health bone setters. Patients with displacedsupracondylar fractures, who present early, usually require manipulation and fixation by percutaneous pinning 2,3,4. In our study,because of very late presentation they could not be treated by closed reduction and 18 %cases with type III fractures were treated by OpenReduction and Internal Fixation. Since they presented very late and had complications like Radial nerve palsy, Median nerve palsy, Ulnar5 nerve palsy , ischemia, Brachial artery compression, Compartment syndrome, Volkmann's ischemic contracture the treatment protocolhad to be changed. Post operative complications in a few patients included Pin tract infection and Elbow stiffness. In most cases full rangeof movement could not be achieved, however functional movement was satisfactory. These resulted in less patient satisfaction andlifelong consequences. To conclude our study shows that due to very late presentation of supracondylar fractures of the humerus inchildren different management protocols have to be made, tailored to individual needs of the patient.

ABSTRACT... Introduction: Arthroscopy has a significant efficacy amongst patients, but is dependent on the anasthesia used. This is particularly important, as research on knee arthroscopy has established importance on anasthesia, particularly the type and number used. Study Research Objective: This study conducted over a period of 2 years, included all patients undergoing knee arthroscopy, irrespective of age, gender and underlying conditions (whether traumatic, degenerative, infective or inflammatory). In this study the Impact of postoperative pain management on patient recovery was evaluated. There is evidence that the knee joint has morphine receptors, thus nalbuphin was used. Study Design: Randomized Case Control Study. Setting: Department of KRL Hospital. Period: Jan 2014 to Dec 2015. Methodology: Randomization was done through the random number generator function provided by Open EPI Ver. 3.01. The random numbers generated were compared with serial numbers assigned to patients through consent forms and then assigned to the three groups accordingly (Control, Lignocaine, Lignocaine + Nalbucin). Out of 117 patients 6 patients were given general anesthesia and 111 were given spinal anesthesia. Arthroscopy was done under tourniquet control. To measure pain thresholds, a visual analogue scale from 1 to 9 was used and then made into three groups: mild (1-3), moderate (4-6) and severe (7-9). Patient Mobilization was measured 4, 6, 8, 10, 12, 14, and 16 hours post operation. Analysis was done using OpenEPI Ver. 3.01 and Microsoft Excel 2013 separately for both Lignocaine and Lignocaine + Nalbuphin. A systematic literature review was done to compare the results found in this study with those found in this study. For this purpose, the following string was used in Google Scholar and Pubmed: "Arthroscopy" AND "TB" AND "Synovial Biopsy" and "Postoperative Pain Management" AND "Arthroscopy" AND "Knee Joint". Results: Interventions of Lignocaine and Lignocaine + Nalbucin were more effective than control. Lignocaine + Nalbucin combined showed higher chances of mobility when compared to Lignocaine and control. Systematic Literature Review also provided similar results. Conclusion: If this procedure is performed with the correct expertise and the patient given intra articular lignocaine and Nalbuphin, the patients show early and good recovery and therefore they can be discharged the same day thus reducing the cost on the patient as well as the hospital.

Introduction: Arthroscopy has a significant efficacy amongst patients, butis dependent on the anasthesia used. This is particularly important, as research on kneearthroscopy has established importance on anasthesia, particularly the type and number used.Study Research Objective: This study conducted over a period of 2 years, included all patientsundergoing knee arthroscopy, irrespective of age, gender and underlying conditions (whethertraumatic, degenerative, infective or inflammatory). In this study the Impact of postoperativepain management on patient recovery was evaluated. There is evidence that the knee joint hasmorphine receptors, thus nalbuphin was used. Study Design: Randomized Case Control Study.Setting: Department of KRL Hospital. Period: Jan 2014 to Dec 2015. Methodology: Randomizationwas done through the random number generator function provided by Open EPI Ver. 3.01.The random numbers generated were compared with serial numbers assigned to patientsthrough consent forms and then assigned to the three groups accordingly (Control, Lignocaine,Lignocaine + Nalbucin). Out of 117 patients 6 patients were given general anesthesia and 111were given spinal anesthesia. Arthroscopy was done under tourniquet control. To measure painthresholds, a visual analogue scale from 1 to 9 was used and then made into three groups:mild (1-3), moderate (4-6) and severe (7-9). Patient Mobilization was measured 4, 6, 8, 10, 12,14, and 16 hours post operation. Analysis was done using OpenEPI Ver. 3.01 and MicrosoftExcel 2013 separately for both Lignocaine and Lignocaine + Nalbuphin. A systematic literaturereview was done to compare the results found in this study with those found in this study. Forthis purpose, the following string was used in Google Scholar and Pubmed: “Arthroscopy”AND “TB” AND “Synovial Biopsy” and “Postoperative Pain Management” AND “Arthroscopy”AND “Knee Joint”. Results: Interventions of Lignocaine and Lignocaine + Nalbucin were moreeffective than control. Lignocaine + Nalbucin combined showed higher chances of mobilitywhen compared to Lignocaine and control. Systematic Literature Review also provided similarresults. Conclusion: If this procedure is performed with the correct expertise and the patientgiven intra articular lignocaine and Nalbuphin, the patients show early and good recovery andtherefore they can be discharged the same day thus reducing the cost on the patient as wellas the hospital.

The spectrum of rheumatic disease is wide and includes conditions with diverse pathology, although most have in common a heritable risk with a complex genetic basis. Over the past decade intense efforts have been done to understand the contribution of genotype to the expression of disease in terms of both basic pathogenesis and clinical characteristics. The dramatic improvement in technology and methodology has accelerated the pace of gene discovery in complex disorders in an exponential fashion. This review focuses on rheumatoid arthritis and describes some of the recently described genes that underlie this condition and the extent to which they overlap.