Dr Zeeshan Qamar Orthopedic Surgeon

27/10/2024

05/01/2024

Drilling a hole in the thick tibial crest may be associated with excessive heat generation and there is a risk the drill bit may slip medially or laterally damaging the soft tissues.

As the anteromedial tibial wall provides adequate thickness for the placement of pins, this trajectory is preferable. A trajectory angle (relative to the sagittal plane) of 20-60° for the proximal fragment and of 30-90° for the distal fragment is recommended.

25/07/2021

Ringer vs Normal saline

21/04/2021

Skull Fracture & Raccoon eyes 👉 may be used to describe large dark rings around the eyes. They can signify a few different conditions that cause internal bleeding near the eyes.
The condition is not caused by lack of sleep or cosmetics but is the result of a medical condition or injury. Diagnosis, treatment and recovery time depend on what has caused it.

What are raccoon eyes?

Medically known as periorbital ecchymosis, this condition describes bruising and discoloration around a person's eyes that resemble the dark circles around a raccoon's eyes.
The blood collecting in the soft tissues around the eyes causes bruises, which can vary in color from red to dark purple. The size of the bruises may also vary depending on the cause and type of injury.
Raccoon eyes are usually a sign of a serious condition that should be diagnosed and treated immediately.

What are the signs and symptoms of a skull fracture?
If a child has hit their head, signs of a fracture include:

* a lump or dent on the head
* bruising or swelling on the head
* headache
* confusion or disorientation
* dizziness
* nausea or vomiting
* loss of consciousness
* clear fluid or blood running from the nose or ears
* bruising around the eyes (raccoon eyes)

* It is vital that all head injuries should be checked out at hospital. Most children with a simple, straightforward fracture will make a full recovery. More serious skull fractures will require treatment and maybe surgery

10/06/2020

31/05/2020

Prof Mutti Ullah Mutti personal experience after being infected and recovered from corona infection
If you have symptoms of fever cough ,pains in the body sometimes only loss of smell and taste or headaches and diarrhoea and your test of corona is positive or even if negative as false negative is also very common as me and Rizwana both had three negative tests but corona finally confirmed on chest CT.so if symptoms consider it to be corona and start taking precautions and do the following along with duas and astaghfar.
The things you need for home management :

1. Thermometer

2. Pulse oximeter. You can get a small wireless one for Rs 3000

3. Disinfectant solution in spray bottles (1 part bleech or dettol + 10 parts water )

4. Gloves, masks, protective aprons

5. Separate utensils for food better disposable.

6. Hand santizers.

Now basic precautions and what a care giver needs to do:

1. If it is necessary to go to the room of an infected person then Use PPE when getting close to patient with N95 mask goggles or face shield and gloves and dispose off after leaving the room. Otherwise complete isolation ,don’t enter the room. Leave food outside in disposable plates and spoon. Or normal dishes if the patient can wash himself.

2. Frequent use of hand sanitizer before you enter and after you leave that room and apply disinfectant spray to all the handles and k***s of the door.

3.Separate washroom for positive patient and patient to use spray solution generously after every use. If number of infected are more then allocate one washroom to all positive people.

4.Room isolation of patient is of course mandatory.

5.For dirty clothes, wash all clothes with standard detergent and warm watter

Now the medical aspect.

1. Panadol 2 tab when fever or aches and pains.

2.Tab Azithromycin 500mg OD for 5days

3.Mucolyter sachet three times a day in a glass of water.

4. Since WHO has temporarily suspended the use of hydoxycholoroquin( HCQ)in the Solidarity Trial till safety is assessed as preliminary reports showing more harm than good I recommend not to take HCQ

Awake proning for 1 hour or as much as possible after every three hours (lying in prone position and taking deep breaths) proning is ulta laitna.

Now Lab parameters to be done every 72 hours.

1. CBC

2. Procalcitonin (for super added infections)

3. D dimers (for coagulopathy and one of most critical) if raised hospitalisation maybe required or anticoagulant is necessary

4. LDH, Ferritin and CRP (Inflammatory markers)

Now coming to herbal things and gharelo totkay:

1. Sana makki Ka kehwa (herb can be found easily from herbalist) kehwa with honey. Take weekly.

2. Olive oil drops, one in each nostril x BD

3. Kolwanji, few seeds twice daily

4. Neem k pattay ka powder, 1 pinch x BD (Great symptomatic relievee for throat irritation)

5. Khajoor

Vitamins:

1. Zincat syrup 1 tablespoon daily

2. CaC 1000 / osnate D or any calcium1 daily

3. B complex 1 daily (surbex or neurobion or any good preparation

4. Vit D (Sunny D cap once a week) or any preparation containing 500 units to be taken daily

Now food:
1. Daily caloric requirement should be achieved. High protein diet. If doesn’t eat anything because of anorexia then supplements like liquid Ensure etc

2. Add frest fruits and vegetables.

3. use milk shakes

4. A lot of fluids

5. Standard roti, chawal with salan at meal times

Now most important religious aspect:
1. Namaz and Allah sy dua

2. There are alot of duas for better health and for astaghfar which can be found easily online.

3. Sadka to maximum of your capacity.

4. Don't loose hope. emotional break down is quite common. Allah’s help is the only answer. Dua has its taseer and should be an integral part. Pray with full confidence. Allah is always there to help you.

In home management, you can manage a pateint only to a limit after which you may need hospitalisation.

So coming to alarm symptoms which require immediate hospitalisation:

1. Oxygen saturation reaching or less than 94%on rest.

2. Altered mentation

3. Any signs of dehydration

4. Tachypnea of greater than 25 breaths/min.

5. Visible respiratory distress on rest

Symptoms which you may think are worrisome but may just need sometime.

1. A lot of Aches and pains

2. Fever spikes (up to a point where these are managable by panadol)

3. may have few episodes of loose stools but usually self limiting

4. Some shortness of breath on exertion, walking, going to washroom (looking for oxygen saturation is critical again).

5. Developement of any rash

6. Anorexia

One last thing, this infection is extremely contagious.

I again would like to stress on seeking medical guidance before you commence to home management.

Jazakallah khair
Professor Mutti Ullah Khan

24/03/2020

Dear worthy Colleagues,
As per our experiences, observations and assessment in Wuhan, we want to share some key information with you to better understand COVID-19 pandemic and best practices the Chinese government followed which also been officially recognized by WHO. Due to these efforts, there is no new COVID-19 case in Wuhan and Hubei province.

We are sharing this Information to senstize our policy makers, administration, health officials and General public of Pakistan.

1. Key findings are the following:

ii. COVID-19 is a zoonotic virus and bats appear to be reservoir of the disease. However, the intermediate host(s) has not yet been identified.
iii. The virus has features typical of the Coronavirus family and belongs to the Betacoronavirus 2B lineage.
iv. It is neither SARS nor influenza. It is a new virus with its own characteristics. COVID-19 transmission on children appears to be limited compared with influenza.
v. COVID-19 is transmitted via droplets and fomites during close, unprotected contact between an infector and infectee.
vi. From late January to mid of February 2020, fever clinic patients fell from a peak of 500 per day to 50 per day in hospitals of Wuhan.
vii. The median age of the affected patients is 51 years with the majority of the cases aged between 30 and 69. 51.1% are male and 77% are from Hubei.
viii. Airborne spread has not been reported for COVID-19 and it is not believed to be major driver of transmission, based on available evidence.
ix. The fecal-oral route does not appear to be a driver of COVID-19 transmission.
x. In China, human-to-human transmission is occurring in families. Most clusters (78-85%) have occurred in families.
xi. As COVID-19 is a newly identified pathogen, there is no known pre-existing immunity in humans.
xii. Data on individuals aged 18 years old and under suggests that there is relatively low attack rate in this age group (2.4% of all reported cases). Infected children have largely been identified through contact tracing in households of adults.

2. Key signs and symptoms include:

a. Fever (87.9%)
b. Dry cough (67.7%)
c. Fatigue (38.1%)
d. Sputum production (33.4%)
e. Shortness of breath (18.6%)
f. Sore throat (13.9%)
g. Headache (13.6%)
h. Myalgia or Arthralgia (14.8%)
i. Chills (11.4%)
j. Nausea or vomiting (5%)
k. Nasal congestions (4.8%)
l. Diarrhea (3.7%)
m. Hemoptysis (0.9%)
n. Conjunctival congestion (0.8%)

2.1 Individual at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer.
2.2 The disease in children appears to be relatively rare and mild with approximately 2.4% of the total reported cases amongst individuals aged under 19 years.
2.3 Mortality rate increases with age with the highest mortality rate among people over 80 years of age with 13.2% for those with cardiovascular disease, 9.2% with diabetes, 8.4% with hypertension, 8% with chronic respiratory disease and 7.6% for cancer.

3.Key elements of the Chinese Response to COVID-19 include the following:

i. Early stage focused on preventing the exportation of cases from Wuhan and other cities of Hubei Province and also importation of cases by other provinces (to control the source of infection, block transmission and prevent further spread).
ii. The second focused on reducing the intensity of the epidemic and slowdown in the increase in cases.
iii. The third stage focused on reducing clustering of cases thoroughly controlling the epidemic and striking a balance between epidemic prevention and control, sustainable economic and social development, unified command, standard guidance and scientific evidence-based policy implementation.
iv. New technologies such as big data and artificial intelligence were applied to strengthen contact-tracing and management of priority population.

4.Assessment:

i. China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history. The national approach promoted universal temperature monitoring, masking and hand washing.

ii. Achieving China exceptional coverage and adherence to the containment measures has only been possible due to the deep commitment of the Chinese people to collective action in the face of this common threat.

iii. China’s bold approach to contain the rapid spread of this virus has changed the course of a rapidly escalating and deadly epidemic. The decline in the number of COVID-19 cases across China is real.

iv. With regard to it efforts for returning normalcy to all aspects of life, China is appropriately adopting a science-based phased approach with the clear recognition and readiness of the need to immediately react to any new COVID-19 cases or clusters as key elements of the containment strategy.

5. The fundamental elements of the Chinese policy to contain COVID-19 include the following:

i. Proactive surveillance to immediately detect cases.
ii. Very rapid diagnosis and immediate case isolation.
iii. Rigorous tracking an quarantine of close contacts.
iv. An exceptionally high degree of population understanding and acceptance of these measures (most important).
Major Recommendations

6- Major recommendations to contain COVID-19 include the following:

i. Maintain an appropriate level of emergency management protocols depending upon risk-analysis.
ii. Carefully monitor the phased lifting of the current restriction on movement and public gathering.
iii. Further strengthening the readiness of the emergency management.
iv. Prioritise active, exhaustive case finding and immediate testing and isolation, painstaking contact-tracing and rigorous quarantine of close contacts.
v. Fully educate the general public on the seriousness of COVID-19 and their role in preventing its spread.
vi. True solidarity and collaboration is essential among nations to tackle the common threat.
vii. Rapidly share information as required under the international health regulations.
viii. Recognise the rapidly changing risk profile of COVID-19 affected countries and continually monitor outbreak trends and control capacity to reassess any additional health measures that significantly interfere with international travel and trade.