Syed Muhammad Awais

Amputations of limbs during the 2005 earthquake in Pakistan: a firsthand experience of the author

PurposeOn 8 October 2005 a massive earthquake hit the northern mountainous areas of Pakistan and Kashmir causing 73,338 deaths and leaving over 125,000 severely injured. In a region which was less prepared for such an enormous disaster, mobilising rescue, relief and rehabilitation posed great challenges. The lead author (SMA) established two level 1 orthopaedic trauma and rehabilitation units in existing public hospitals through private philanthropy in the earthquake struck cities of Muzaffarabad in Kashmir and Mansehra in Khyber Pakhtun Khuwa (KPK) Province. The purpose was to combat the major catastrophe and later study the pattern of injuries especially amputations so as to improve the future strategies in similar scenarios.MethodsThis is a retrospective descriptive study of patients suffering from injuries of the limbs due to the earthquake who were managed in these centres with special emphasis on the patients with amputated limbs. The patients were received, worked up, investigated and prepared for definitive surgical procedures, in this case amputations. All patients were provided assistance for the fitting of a prosthesis and rehabilitation by referring them to specialised centres.ResultsOf 128,304 patients, 19,700 were managed in the centres established by the lead author over a period of seven months. Of these, 112 patients underwent amputations of upper and lower limbs.ConclusionsIn a massive calamity over a wide geographic area away from big university hospitals, such as the 2005 Pakistan earthquake, the level 1 operating theatre facilities must be established within the area to meet the needs of the patients nearest to their homes and families, and run forever so that patients can have excellent follow-up and can use the same facilities regularly. For example, in this study we managed 112 amputees and placed them in a rehabilitation programme, and transferred these centres to the hospital authorities after five years.

Is MRI Essential Prior to Arthroscopic Management of Internal Derangement of the Knee

Distraction osteogenesis popularized by Ilizarov has been the only solution in most of bone defect nonunions but this has never been worked in old fracture neck of femur with resorbed neck. We applied this principle in a young child with old fracture neck of femur with resorbed neck. We applied across hip external fixator and gradual distraction was started. Resorbed neck was completely formed in 06 months and patient regained his normal leg length and mobility and escaped major surgery.

Definition of a Peer-Reviewed Journal

A comprehensive policy on publication ethics has been published by the World Association of Medical Edi-tors (WAME), which addresses all the major areas of ethics which all contemporary science journals should consider. The Annals of King Edward Medical Uni-versity will publish different parts of WAME’s public-cation policy for its readers, authors and reviewers . Definition of a Peer-Reviewed Journal A peer – reviewed biomedical journal is one that regu-larly obtains advice on individual manuscripts from reviewers who are not part of the journal’s editorial staff. Peer review is intended to improve the accuracy, clarity, and completeness of published manuscripts and to help editors decide which manuscripts to pub-lish. Peer review does not guarantee manuscript qua-lity and does not reliably detect scientific misconduct. Peer reviewers should be experts in the manu-script’s content area, research methods, or both; a criti-que of writing style alone is not sufficient. Peer revie-wers should be selected based on their expertise and ability to provide high quality, constructive, and fair reviews. For research manuscripts, editors may, in addition, seek the opinion of a statistical reviewer. Peer reviewers advise editors on how a manuscript might be improved and on its priority for publication in that journal. Editors decide whether and under whi-ch conditions manuscripts are accepted for publication, assisted by reviewers’ advice. Peer reviewers are sometimes paid for their efforts but usually provide their opinions free of charge, as a service to their profession. Editors should require all peer reviewers to disclose any conflicts of interest, financial or otherwise, related to a particular manu-script and should take this information into account when deciding how to use their review. Generally speaking, people with a direct financial interest in the results of the manuscripts should not be reviewers. To be considered peer reviewed, a journal should have obtained external reviews for the majority of manuscripts it publishes, including all original rese-arch and review articles. Some editors request peer re-view for other kinds of articles, such as opinion pieces (commentaries / editorials) and correspondence. To have been peer reviewed, a manuscript should have been reviewed by at least one external reviewer; it is typical to have two reviewers and sometimes more opinions are sought. Editors of peer-reviewed journals need not send all submitted manuscripts out for review. Manuscripts that seem unlikely to be published in that journal may be returned to authors without external review, to allow authors to submit the manuscript to another jou-rnal without delay and to make efficient use of revie-wers’ and editors’ time. Editors should state their journal’s peer review policies, including which kinds of article are peer re-viewed and by how many reviewers, in the instructions for authors. Editors should also periodically publish statistics describing their journal’s review process, such as number of manuscripts submitted, acceptance rate, and average times from manuscript submission to rejection letter to authors and, for accepted manusc-ripts, time to publication. Acknowledgments The “Definition of a Peer – Reviewed Journal”, is reproduced from “Policy Statements” published by the World Association of Medical Editors (WAME). (www.wame.org)

RESPONSIBLE RESEARCH PUBLICATION: INTERNATIONAL STANDARDS FOR AUTHORS

Summary Editors are accountable and should take responsibility for everything they publish. Editors should make fair and unbiased decisions independent from commercial consideration and ensure a fair and appropriate peer review process. Editors should adopt editorial policies that encourage maximum transparency and complete, honest reporting. Editors should guard the integrity of the published record by issuing corrections and retractions when needed and pursuing suspected or alleged research and publication misconduct. Editors should pursue reviewer and editorial misconduct. Editors should critically assess the ethical conduct of studies in humans and animals. Peer reviewers and authors should be told what is expected of them. Editors should have appropriate policies in place for handling editorial conflicts of interest. Reference Kleinert S and Wager E (2011), Responsible research publication: international standards for editors. A position statement developed at the 2nd World Conference on Research Integrity, Singapore, July 22-24, 2010. Chapter 51 in: Mayer T and Ste-neck N (e ds). Promoting Research Integrity in a Global Environment. Imperial College Press / World Scientific Publishing, Singapore (pp 317-28). (ISBN 978-981-4340-97-7).

STUDY DESIGN AND ETHICS IN SCIENTIFIC PAPERS

Good research should be well justified, well planned, and appropriately designed, so that it can properly address the research question. Statistical issues, including power calculations, should be considered early in the study design, to avoid futile studies that produce subject risk without enrollment sufficient to answer the research question. Outcomes should be specified at the start of the study. Research should be conducted to high standards of quality control and data analysis. Data and records must be retained and produced for review upon request. Fabrication, falsification, concealment, deceptive reporting, or misrepresentation of data constitute scientific misconduct. Documented review and approval from a formally constituted review board (Institutional Review Board or Ethics committee) should be required for all studies involving people, medical records, and human tissues. For those investigators who do not have access to formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed. If the study is judged exempt from review, a statement from the committee should be required. Informed consent by participants should always be sought. If not possible, an institutional review board must decide if this is ethically acceptable. Journals should have explicit policies as to whether these review board approvals must be documented by the authors, or simply attested to in their cover letter, and how they should be described in the manuscript itself. Animal experiments should require full compliance with local & national, ethical & regulatory principles, and local licensing arrangements. Journal recommendations for preferred presentation and analysis of data should be described in the Information for Contributors or Authors. Wherever possible, recommendations should be based on evidence about methods of data presentation that are readable and most likely to be interpreted correctly by readers. Editors should keep themselves informed of this research and adapt their recommendations as it evolves.

Recent Advances in Medical Education

Competency-based training is a shift from the old paradigm of showing that training programs are capable of teaching to showing that trainees can actually do what is expected of them. Not just the ability to do, but to do it well. In ophthalmology this has necessitated development of new valid and reliable competency assessment tools.1 Importantly, these tools provide a more objective assessment of competence and serve as teaching tools as well. Most countries do not use assessment tools to determine resident competence in surgical procedures and those that do still rely on minimum numbers of cases as a measure of competence. This system must be replaced by valid and reliable measures of competence rather than simply by subjective impression and the number of cases performed. Many of these assessment tools are available in multiple languages on the International Council of Ophthalmology’s website (www.icoph.org). To facilitate competency attainment, the United States has recently instituted the “Milestones Project” designed to closely follow a resident as they achieve competency milestones throughout their training.2 Objective assessments are used when possible to gauge progress and prompt remediation in a more timely fashion. In addition, internationally validated competency – based curricula have been produced to guide ophthalmic education.3 these curricula are meant to be adapted for local use based on the needs of the population.

History of Developments of Computers, Internet and World Wide Web

The Computing Hardware evolved from the machines that performed separate manual action to perform (1) writing, (2) record keeping and (3) arithmetic operations, to punched card machines, and then to stored – program computers. The development of electronic digital computers started in the late 1930s. The first full scale electronic digital computers built during and shortly after world war II were quite good at arithmetic computation. The first commercial computer machine (Ferranti Mark 1) was delivered in February 1951, and at least nine others were sold between 1951 and 1957. Since then the main frame computers have been miniaturized to the desktop, laptops, tablets and hand held machines. Now, the desktop computers are more than a million times as fast and a billion times as cost effective as the first commercially available electronic computers built in the early 1950s. The Internet was developed in the early 1960s to enable computers to share information on research and development in scientific and military fields. In late 1962 the theory of packet switching was developed, which formed the basis of Internet connections. Two computers were connected with each another California in 1965 over dial-up telephone lines. It showed the feasibility of wide area networking. The Internet, then known as ARPANET, in 1969 connected four major computers at universities in USA, and by January 1971 a large number of universities, commercial and military research organizations were connected with each other on network. The internet connectivity became wireless through on land signal transmission and then through satellite. Internet is a very efficient tool of sending and receiving digital data/information from one computer to another, from one part of world to another within seconds. The World Wide Web (www) or simply “Web” is a global information system, which has provided access to any digital information, anywhere in the world, at any time to any individual. The Web was developed at The European Organization for Nuclear Research known as CERN, established in 1954 with aim to operate the world’s largest particle physics laboratory based in the northwest suburbs of Geneva, with 20 European member states. The turning point of www was introduction of Web Browser in 1992. In 1993 CERN made use of web browser protocol free of cost which resulted in “Dot – com” boom and bust. The www is functioning as “warehouse of information”, e.g. digital libraries etc, which can be reached via internet from anywhere, by any one at any time.

Electronic Search for Scientific Literature and Participating in Online Journalism

Moving towards a paper free world with faster communication services accessible to everyone around the globe, the use of electronic resources for scientific literature and online journalism is developing very rapidly. Rather than conventional libraries and printed journals, today we have huge online libraries and journals accessible at the click of a finger. Many of these resources are freely accessible to everyone while the others are available after paying the subscription fees.

Occupational Hand Injuries Presenting at Accident and Emergency Department / Mayo Hospital Lahore. A Review of Six Months

Distraction osteogenesis popularized by Ilizarov has been the only solution in most of bone defect nonunions but this has never been worked in old fracture neck of femur with resorbed neck. We applied this principle in a young child with old fracture neck of femur with resorbed neck. We applied across hip external fixator and gradual distraction was started. Resorbed neck was completely formed in 06 months and patient regained his normal leg length and mobility and escaped major surgery.

The Academic Freedom of Teachers and Institutions

Distraction osteogenesis popularized by Ilizarov has been the only solution in most of bone defect nonunions but this has never been worked in old fracture neck of femur with resorbed neck. We applied this principle in a young child with old fracture neck of femur with resorbed neck. We applied across hip external fixator and gradual distraction was started. Resorbed neck was completely formed in 06 months and patient regained his normal leg length and mobility and escaped major surgery.