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A study was conducted to determine the clinical efficiency of neem extract with Zinc Oxide (ZnO) nanoparticles on burn wound healing treatment in Rabbit model. Sixteen (16) male New Zealand white rabbits were assigned into four groups, each with four rabbits, and were kept together for 28 days. Group T0 as the control; T1 represented burn healing using neem extract; T2 represented burn healing using neem extract with ZnO nanoparticles; and T3 represented burn healing using a commercial drug (Bactrocin®). Data were accumulated on the healing rate, healing time, and WBC count. Healing rate was calculated at weekly interval and the healing time was observed regularly and calculated from day 7 at weekly interval and WBC count were investigated using an auto analyzer. The result showed that the healing rate (%) were T2 group= 93.75±1.25, T3 group=86.75±0.479, T1 group=84.25±1.75, and T0 group=70.75±2.25. Among this result the healing rate increased significantly in T2 (93.75±1.25) group, better by T3 (86.75±0.479), good by T1 (84.25±1.75) and worst by T0 (70.75±2.25) group. The application of neem extract with ZnO nanoparticles have also showed the quickest healing time (24.5±0.64 day) significantly (P

To see the efficacy of combined preparation of aloe vera gel and Zinc Oxide nanoparticles (ZnO NPs) on burn wound treatment has been studied in Rabbit model. Sixteen male New Zealand White male rabbits were divided into four different groups and data were collected on healing rate, healing time and WBC count in artificial hot iron burned rabbit model. Group T0, T1, T2 and T3 were as control, aloe vera gel, aloe vera gel with ZnO nanoparticles and Bactrocin® respectively. Area of the wound and healing time was determined at weekly interval. WBC was enumerated weekly interval using a hematology analyzer. The experimental results showed that rate was significantly increase in T2 (94.75±1.31) group, better by T3 treated group (92.50±1.32), good by T1 (85.50±2.21) and worst by T0 (70.50±2.72). The White Blood Count (WBC) count as greatly increased in the non-treated group in most of the cases (Day 0 and Day 28), but the best WBC count was found in (Bactrocin®) in the rest of the cases (9300±37.50, 8500±37.36 and 6600±24.25 cells/µl for 1st week, 2nd week and 3rd week respectively), while the good count was obtained from T2 (Aloe vera gel with ZnO nanoparticles) treatment. The overall result of the study showed that the use of aloe vera gel with ZnO nanoparticles has given faster wound healing with minimum days requirement, which proved that without antibiotics, wound healing was also possible by using of biosynthetic ZnO nanoparticles and can be recommended for burn wounds healing treatment in rabbits.

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Introduction: Intramedullary (IM) nailing is considered the method of choice for treatment of closed diaphyseal fractures of the tibia. However, there is controversy in the literature regarding the best way of managing open type III B fractures. The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for Gustilo and Anderson compound grade III B open tibial fractures. Materials and Methods: This was a retrospective case series of patients with Gustilo and Anderson compound grade III B open tibial fractures treated in our institution from Jan 2010 to May 2014. All the cases that were treated with unilateral tubular external fixators within 24 hours of injury were included. Serial debridement and early coverage if required, was done within seven days. Dynamisation and partial weight bearing was started at 8-10 weeks on observing early signs of fracture healing. Weight bearing with patellar tendon bearing cast was permitted at 12–16 weeks, on visualization of bridging callus and continued till radiological and clinical union. Results: There were 31 males (83.7%) & 6 females (16.2%) with Gustilo IIIB fractures with a mean age of 37.43± 8.92 years and a standard error of 0.55. The commonest mode of trauma was road traffic accidents followed by fall from height & direct trauma to the limb. All the patients were operated in emergency within 24 hours with debridement of wound and primary external fixation. The average time to union was 22.13 ±2.68, superficial pin track infection occurred in 11 cases & deep infection leading to loosening of Schanz screw was seen in two patients. Delayed union was seen in two patients whereas, non-union was seen in three patients requiring secondary procedures. Conclusion: The results show that unilateral external fixators can be used as primary and definitive treatment for compound type IIIB tibial shaft fractures with satisfactory outcomes. These are particularly hel

BACKGROUND: The purpose of this study was to evaluate the flexion-gap of the native knees in the normal population and to assess any gender-specific variations in the flexion gap of the knees. METHODS: A total of 50 normal asymptomatic volunteers with normal knee radiographs were selected for MRI of the knee. The left knee was scanned in an open MRI using a T1-weighted sequence. Imaging was performed in neutral, passive varus and valgus stress at 90° of knee flexion by placing custom-made blocks on a special board consecutively below the distal part of the leg. RESULTS: The study population consisted of 26 males and 24 females with a mean age of 25.77 years. Under varus stress, the mean lateral flexion gap increased to 9.28 ± 1.53 mm and under valgus stress, the mean medial flexion gap increased to 2.75 ± 1.22 mm from neutral. The increase in the flexion gap on the lateral side was 5.28 ± 1.79 mm, which was significantly higher compared to that on the medial side. In gender-specific analysis, the mean lateral flexion gap was 10.21 mm in females and 8.46 mm in males under varus stress. CONCLUSION: The findings of the study indicate that the lateral soft tissues are more lax compared to the medial soft tissue structures and this laxity is higher in females as compared to males. The study provides evidence of the existing physiological variations of these soft tissue structures resulting in a trapezoidal flexion gap in the native knees rather than the recommended rectangular gap.

Focal fibrocartilaginous dysplasia (FFCD) is a rare developmental disorder frequently leading to angular deformities in young children. It most commonly affects the proximal tibia followed by distal femur. There are totally 22 reported cases of FFCD of femur. We report a case of FFCD of distal femur as a cause of varus deformity that was managed nonoperatively. The deformity resolved spontaneously over a period of 8 years. This is the second reported case of spontaneous resolution of angular deformity secondary to FFCD of distal femur. We strongly recommend to observe the behavior of deformity over a period of 24 months before any surgical intervention is planned.

Introduction: The present management line of osteoarthritis of knee is mostly symptomatic, therefore the need to investigate treatment modality which addresses the disease process in itself. This study was undertaken with an aim to evaluate the efficacy of platelet rich plasma in primary osteoarthritis of knee. Materials and Methods: This prospective study was done on 67 knees in 60 patients of early primary osteoarthritis of the knee. Three injections of platelet rich plasma were given at four weeks interval and the outcome was evaluated using WOMAC and VAS score at pre injection, 3 weeks, 12 weeks and 24 weeks. Ahlback’s grading was done at pre-injection and at 6 months. Results: Most of the cases in our series were in the age group of 51-60 years with female predominance (66.7%), 46 cases had grade 2 disease and the remaining had grade 1 involvement. Improvement in WOMAC score parameters started at 3 weeks with progressive improvement at subsequent follow-ups. WOMAC score parameters (pain, stiffness, physical function and total score) at pre injection were 14.31, 5.01, 36.52 and 55.75 and at 6 months follow up were 6.54, 2.03, 19.07 and 27.66 respectively. Similar improvement was seen in VAS score with pre injection score of 6.45 and final score of 3.76. The average WOMAC score was less for grade 1 as compared to grade 2 (45.52 and 60.41). Improvement was seen in 89.55% of cases though the level varied from good to mild improvement. There was no complication related to the treatment in our series. Conclusion: The initial results conclude that PRP is an effective treatment modality in early grades of primary Osteoarthritis of knee. However, further high evidence studies are required to look for the long-term effects and to confirm the findings of this study. Keywords: Platelet rich plasma, osteoarthritis, intra articular injection, PRP in knee.

Purpose: Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India. Methods: A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed. Results: Of total 357 patients, 271 (76%) were below the age of 12 years; 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9:1. Out of total patients, 242 (67.8%) presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball (15.7%) and finger nail trauma (13.2%). Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury (47.8%), followed by streets (17.9%) and playground (14.9%). Conclusion: Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children. Key words: Ocular trauma; Open globe injuries; Closed globe injuries; Birmingham eye trauma terminology system; Adnexal injuries; Pediatric ocular trauma

Background: Enlarged lymph glands almost always represent a local or systemicdisease that may be benign or malignant. We see many patients including the referred onesin our OPD clinic and subsequently do the excision of quite a big proportion of the enlargedglands especially the cervical glands. Study Design: Descriptive study. Setting: Retrospectby reviewing the operative and histopathology department of King Edward Medical University.Period: April 2016 to April 2017. Methods: We will analyse the record of 121 patients who hadperipheral lymph gland enlargement and presented to us. Results: Ours results show that themean age of our patients was 25.03±18.06 years. We found that 40% of our patients had adefinitive diagnosis from the histopathology of excised lymph nodes while 35.5% of the patientshad reactive hyperplasia and 25% of the patients had inconclusive results and we were unableto help them. Conclusion: Our results conclude that the lymph nodes are a very good source ofgetting the diagnosis especially the cervical lymph nodes with a diagnostic yield of 76.4% andwe may need to have a more robust criteria for excising the peripheral lymph glands in order toimprove the diagnostic yield from 40%.

Objective: Adhesive capsulitis or frozen shoulder is a painful condition affecting up to 5% of the general population. We conducted this study with the aim of evaluating the results of physiotherapy plus intra-articular methylprednisolone injection versus physiotherapy alone in idiopathic frozen shoulder. Methods: This prospective clinical study was conducted in a tertiary care center between August 2016 and August 2018. Patients who were diagnosed with idiopathic frozen shoulder were included in the study, and each patient was randomly allocated to one of two groups: physiotherapy alone (group A) and physiotherapy plus intra-articular steroid injection (group B). Results: A total of 52 cases diagnosed with idiopathic frozen shoulder were included and treated with the two modalities. There was a significant improvement in group B compared to group A at 6 weeks and 3 months in the range of flexion, abduction, and external rotation. The Shoulder Pain and Disability Index showed improvement in both pain and disability score in group B ­compared to group A, and improvement was significant at 6 weeks and 3 months. Conclusion: The results demonstrate the advantages of physiotherapy plus intra-articular steroid injection in idiopathic frozen shoulder. The predictability of results with physiotherapy plus intra-articular steroid injection in selected patients is excellent, and it is a better modality of treatment compared to physiotherapy alone.

Purpose: Distal tibia fractures comprise about 7%–10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing. Methods: This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome. Results: There were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23–65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16–22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (

Background: Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. Methods: The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient’s pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. Results: All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. Conclusions: The use of dual plating for fixation of the lower tibia and fibula fractures is often associated with soft tissue complications, exposed implant, and increased risk of infection. We conclude that in fractures of the distal tibia and fibula it is better to use a rush nail for the fibula with a concurrent MIPPO for the tibia for the reasons cited above. Moreover, with the use of rush nail the cost of implant is also reduced, which is a very important factor in developing countries.

Case A 45-year old man presented with a right open tibial fracture with a prominent, fixed deformity because of a retained right tibial intramedullary nail from a previous tibial fracture. After multiple futile intraoperative attempts to extract the bent nail, it was finally sectioned using an industrial drill bit that permitted its removal and revision tibial nailing. Conclusions A tibial fracture resulting in a retained, bent nail presents unique challenges for nail extraction and subsequent exchange nailing. Failed implant removal can be limited by the equipment available in the operating theater. In this setting, the judicious use of inexpensive industrial materials and instruments may be effective in select cases.

Mobile Schwannoma is a very rare entity and is reported sparsely in literature, with most of them occurring in lumbar spine region. We present a case of seventy-year-old male patient who had pain in lower back radiating to ipsilateral thigh. A diagnosis of migratory tumour was made based on findings of plain and contrast MRI preoperatively. We did a two level laminectomy and tumour excision. In this report, we intend to discuss various likely causes of tumour migration and various diagnostic methods to tackle this surgical dilemma, we have also attempted to review the sparse literature available till date on migratory lumber schwannoma.

Adequate training of Lady Health Visitors is foundational for the prosperity of community health worker scheme in Pakistan.Objective: To determine the deficiencies in the training Lady Health Visitors by assessing their knowledge and psychomotor skills.Study Design: Cross – sectional study.Study Duration and Place: The study was conducted in 6 – month duration in Community Medicine Department, KEMU, Lahore.Subjects and Methodology: A cross – sectional stu-dy was carried out at Model Maternal and Child Care Centre, Montgomery Road, Lahore. A total of 100 Lady Health Visitors were selected on the basis of laid down inclusion criteria. Data was collected through a pretested questionnaire and analyzed by SPSS version.Results: LHVs had an adept comprehension of vaccinations of 9 diseases covered by EPI (99%). They had adequate knowledge of antenatal vaccines (64%), perinatal vaccines (87%) and postnatal (77%) vaccines, indicating good recall. But they had less grasp on the method of filling vaccination cards (30%) and counselling about side effects of vaccines (17%) showing low psychomotor skills. However, recall and psychomotor skills showed significant correlation (p < 0.05).Conclusion: Our study concluded that there is a significant correlation between recall and psychomotor skills of our Lady Health Visitors. By analyzing the strengths, weaknesses, opportunities and threats of the training of Lady Health Visitors, our study showed that they had better recall but lower psychomotor skills. Hence modifications are required in their training to improve psychomotor skills.

Background: Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. Methods: The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient’s pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. Results: All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. Conclusions: The use of dual plating for fixation of the lower tibia and fibula fractures is often associated with soft tissue complications, exposed implant, and increased risk of infection. We conclude that in fractures of the distal tibia and fibula it is better to use a rush nail for the fibula with a concurrent MIPPO for the tibia for the reasons cited above. Moreover, with the use of rush nail the cost of implant is also reduced, which is a very important factor in developing countries.

A total of 480 day-old Fayoumi chicks were randomly selected and divided into four groups of 120 chicks each. The chicks in each group were further sub divided into 3 replicates giving 40 chicks to each replicate. The treatments included feed supplementation with TM-200, Tylan Premix and Reotin F upto 5th week of age during winter (Phase I) and summer (Phase 11). The average body weight gain during Phase 1 (November-December) was significantly (P< 0.05) increased in all supplemented groups whereas highest weight gain was obtained consequent to supplementation with Tylan Premix. The average feed consumption and mol1ality was significantly higher (P