ABSTRACT
To compare laparoscopic TEP Inguinal hernioplasty with and without dissection balloon. Observational study. Minimal Invasive Surgical Centre Jamshoro and General Surgical Department at Dow University Hospital, Ojha Campus Karachi. May 2011 and Dec 2012. Twenty [20] male patients with uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in two groups; group A Commercially available dissection balloon and group B. Telescopic dissection for creating TEP working space. We had 20 male patients for this study. The average age was 43.6 and ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia, 4 patients 40% had direct inguinal hernia in group A and 5 patients 50% had direct hernia in group B. Peritoneum was breached in 5 [50%] patients with telescopic dissection. One patient [10%] with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP while other group normal. The incidence of scrotal edema/seroma was greater in group B then group A. 40% patient in group B developed seroma while 0nly 1 [10%] patient with bilateral groin hernia in group A developed seroma. Pain was scored on VAS at 1 and 4 hours after surgery was higher in group B. The mean operation time was 55 min [45-100] in the group with the balloon and 73 min [50-120] in the group without the balloon [p = 0.004]. TEP laparoscopic inguinal hernia repair is probably the best option amongst the two techniques used in laparoscopic inguinal hernia repair and dissection with balloon is though costly but more helpful in dissection and safer
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To Study Therapeutic Effect of Carnitine on Atorvastatin-induced Mechanical Myotoxicity of Gastrocnemius Muscles of Rats. Observational study. This study was conducted at Department of Physiology, University of Karachi, from 21[st] January 2012 to 30[th] December 2013. Present study showed that effect of statin on mechanical properties of gastrocnemius muscle of rats and use of carnitine as prevention of statin induced myopathies. Animals were injected statin for 6 weeks in one group and carnitine to another group along with statin to study the possible therapeutic effect. After treatment period, animals were decapitated and gastrocnemius muscles were isolated. Twitch and tetanus of muscles were recorded in each group. Our results showed that treatment of statin reduced the body weight of animals and increased the resting length [106%] of isolated gastrocnemius muscles. We also observed that force of contraction of both twitch and tetanus in statin treated group were significantly reduced [P>0.0001]. This negative effect of statin on twitch and tetanus parameters of muscle was partially decreased by an additive treatment of carnitine. Thus, carnitine plays a vital role in improving muscle contractile ability caused by statins. Our study demonstrated the potential preventive measure of atorvastatin-induced myopathy using carnitine and its impacts on mechanical function of muscles
ABSTRACT
To evaluate the role of the rapid influenza diagnostic test [RIDT] and clinical decision in the diagnosis of H1N1. In November 2009, 290 suspected influenza patients were examined for H1N1 during an outbreak in Riyadh, Saudi Arabia. Nasopharyngeal swabs were analyzed using Directigen EZ Flu A+B kit. Monoclonal anti-human influenza A/B and reverse transcription- polymerase chain reaction [RT-PCR] were used. Positive and negative controls were used in each run of specimens. Validity indices were calculated for RIDT and clinical diagnostic criteria. The sensitivity and specificity of RIDT were 40.5% [95% confidence interval [CI]: 33.0-48.5], and 94.5% [95% CI: 88.6-97.6]. The sensitivity of clinical decision was 66.3% [95% CI: 58.4-73.4], and the specificity was 65.4% [95% CI: 56.3-73.4]. The sensitivity of clinical decision was higher in early presenters [79.2%; 95% CI: 57.3-92.1]. The RIDT sensitivity was higher in younger patients [48.4%; 95% CI: 35.7-61.3]. The positive predictive value [PPV] was 90.4% [95% CI: 80.7-95.7] for RIDT, and 71.1% [95% CI: 63.1-78.0] for clinical decision. The PPV for RIDT was greater for older [94.7%; 95% CI: 80.9-99.1] and late [90.7%; 95% CI: 76.9-97.0] presenters. The adjusted odds ratio for clinical decision was significant for cough, headache, and fatigue. The RIDT can be useful in epidemics and high prevalence areas, whereas clinical decision, and RT-PCR complement the diagnosis of H1N1 in any setting
ABSTRACT
There are no comprehensive, spatially referenced databases of public and private health facilities in any of the countries of the Eastern Mediterranean Region. This study in Pakistan was conducted to demonstrate the feasibility of creating a spatially referenced health facility database for a medium-sized city, in a low-cost, non-resource intensive manner and to visualize the spatial relationship between hospitals and clinics in the city of Islamabad. Cumulatively, 166 [77.6% of all clinics mapped] were in close proximity [within 1 km] to a hospital. Repeating such studies elsewhere would help us to better understand different spatial distribution patterns, the reasons for them and the implications for health-care planning
Subject(s)
Mediterranean Region , Database , Demography , CommunicationABSTRACT
Road rage and road traffic accidents increase the burden of morbidity and mortality in a population. A cross-sectional survey with convenience sampling was conducted among commercial vehicle drivers in Lahore, Pakistan [N= 901] to record their behaviours/experiences regarding road rage and road traffic accidents. Respondents were asked about incidents of shouting/cursing/rude gestures or threats to physically hurt the person/vehicle, by others or themselves, in the previous 24 hours or 3 months, and their involvement in road traffic accidents in the previous 12 months. Auto-rickshaw drivers were significantly more likely to report various road rage experiences/ behaviours and involvement in accidents compared with bus and wagon drivers. A total of 112 respondents [12.4%] reported being involved in a road traffic accident in the previous 12 months but traffic police did not record the accident in 52.7% of cases. The results of this study underline the need to improve road safety in Pakistan
Subject(s)
Humans , Male , Automobiles , Rage , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
To evaluate the feasibility and safety of laparoscopy in the management of hydatid cysts. All consecutive patients diagnosed with liver hydatid disease were offered laparoscopic management. We performed select conservative procedures using standard laparoscopic instruments after sterilization of the cysts with 20% hypertonic saline. Deroofing, evacuation and partial cystectomy were performed. Omentoplasty was performed, and a drain was placed in the cyst cavity. A total of 63 patients [M:F=48:15] with 75 cysts were managed successfully by laparoscopy. The mean age +/- SD of the patients was 38.59 +/- 11.46 years old. The mean operative time +/- SD was 88.24 +/- 23.52 minutes [range: 52-145 minutes]. The mean size of the cysts was 9.2 cm [range: 5.8-16.5cm]. The mean hospital stay +/- SD was 3.49 +/- 1.16 days [range: 1-7 days]. There was no disease or procedure related mortality. Recurrence of a cyst was observed in 3 [4.76%] cases. Open surgery had to be performed on four patients. There were no major complications; minor biliary leaks were observed in 7 cases and cavity infections in 5 cases. The mean follow-up +/- SD in 51 patients was recorded as 28.9 +/- 31 months. Laparoscopic treatment of hydatid cysts of the liver is safe and effective, with low morbidity and a low recurrence rate in uncomplicated cysts. Despite some of its limitations, the procedure is a good alternative to open surgery in select cases.
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Some studies show a decline of FEV [1] only one month after withdrawal of inhaled corticosteroids [ICS], while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease [COPD] population, and that its exclusion may result in no spirometric deterioration. We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD [Grade II-IV]. They were divided into two phenotypic groups. 1. Irreversible asthma [A and B] [n = 13]: A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane [>/= 6.6 microm]. B. Airflow limitation [AFL] likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD [A and B] [n = 19]: A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV [1] [350 ml] vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV [1] + 1.33% [SD +/- 5.71] and FVC + 1.24% [SD +/- 5.32]; a change of <12% in all patients. We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group
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To evaluate the visual outcome and complications after modified capsular tension ring [CTR] and intraocular lens implantation [IOL] in eyes with subluxated lenses. This is a prospective case series managed at Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan. Thirty three eyes with subluxated lenses having zonular weakness less than 180 degrees were implanted modified CTR and IOL implant after lens matter aspiration. Main outcome measures were postoperative best-corrected visual acuity [BCVA], IOL centration, and complications. The age of 24 patients ranged from 2.5 to 38 years, mean 13.34 +/- 9.8 years. The follow up period was 20.87 +/- 2.40 months. The mean pre operative logMAR BCVA was 0.98 +/- 0.52 SD and the mean post operative logMAR BCVA was 0.38 +/- 0.32 SD [p value 0.000]. Intractable secondary glaucoma was seen in 01[03%] eye. One eye [03%] needed surgical anterior capsulotomy for anterior capsular phimosis. At the last follow-up visit, the modified CTR provided excellent centration and positioning in all cases. Modified CTR and primary IOL implantation in the capsular bag gives good visual outcome with no serious complications. However, it requires a highly experienced surgeon and sufficient patience for a relatively time-consuming procedure
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To estimate the insulin resistance and its correlation to gender and inflammatory cytokines IL6 and TNFalpha in obese Pakistani patients. In one fifty obese patients of both sex, weight, height and Waist circumference was noted and BMI was calculated. Fasting blood was drawn to check for blood sugar and insulin levels. IL6 and TNFalpha were checked via ELISA. Insulin resistance was calculated by HOMA IR. Mean BMI in males was 29.566 +/- 4.4322 kg/m2and 33.96 +/- 5.5609 kg/m2 in females. Sixty one [40.7%] had normal insulin resistance [1.704 +/- 0.647] and 89 [59.3%] had increased insulin resistance [9.678 +/- 10.143]. Mean TNFalpha and Mean IL6 were not statistically different in both the groups [p value 0.891 and 0.386 respectively]. Mean HOMA IR was 5.649 +/- 6.03 in males and 6.8005 +/- 9.76 in females. Mean IL6 was 46.166 +/- 117.67pg/ml and mean TNF was 22.492 +/- 89.99pg/ ml. IL6 and TNF was more in males as compared to females [p-value 0.001]. TNFalpha and IL6 significantly correlated to each other [p value 0.001]. Insulin resistance was increased in sixty percent of obese subjects but showed no difference in mean inflammatory cytokine levels from those with normal HOMA IR. TNF and IL6 levels were more in males. These markers significantly correlated to each other but not to obesity parameters
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To determine the lung function among Saudi type 1 diabetes mellitus [T1DM] children and adolescents. This study was conducted in the Department of Pediatrics, Division of Pediatric Pulmonology and University Diabetes Centre, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from December 2008 to July 2010. A group of 52 [26 male and 26 female] volunteer T1DM children were recruited with an age range from 8-14 years [mean 12.05 +/- 1.42 years], mean duration of disease of 5.25 +/- 0.47 years, and mean glycosylated hemoglobin of 11.27 +/- 0.31%. Spirometry was performed on an Electronic Spirometer [Compact Vitalograph, Stockwell, London, UK]. Pulmonary function in children with diabetes showed significant lower mean values of actual lung function parameters forced vital capacity [FVC], peak expiratory flow [PEF], and maximum mid expiratory flow rate [MMEF] compared to their predicted values. However, there was no significant reduction in the actual forced expiratory volume in the first second [FEV1], and FEV1/FVC% compared to their predicted values. The actual lung function data among Saudi T1DM children and adolescents showed significantly lower values of FVC, PEF, and MMEF compared to the predicted lung function data
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A new test [Dr. KSU H1N1 RT-PCR kit] was recently developed to provide a less expensive alternative to reAl time reverse transcriptase-polymerase chain reaction [RT-PCR]. We report the findings of a validation study designed to assess the diagnostic accuracy, including sensitivity and specificity, of the new kit, as compared to reAl time RT-PCR. Cross-sectional validation study conducted from 18-22 November 2009 at a primary care clinic for H1N1 at a tertiary care teaching hospital in Riyadh. Nasopharyngeal swab samples and data on socio-demographic characteristics and symptoms were collected from 186 patients. Swab samples were sent to the laboratory for testing with both reAl time RT-PCR and the new Dr. KSU H1N1 RT-PCR kit. We measured the sensitivity and specificity of the new test across the entire sample size and investigated how these values were affected by patient socio-demographic characteristics and symptoms. The outcomes of the two tests were highly correlated [kappa=0.85; P<.0001]. The sensitivity and specificity of the new test were 99.11% and 83.78%, respectively. The sensitivity of the new test was affected only minimally [96%-100%] by patient characteristics and number of symptoms. On the other hand, the specificity of the new test varied depending on how soon patients were tested after onset of symptoms [100% specificity when swabs were taken on the first day of the symptoms, decreasing to 75% when swabs were taken on or after the third day]. The specificity of the new test also increased with increasing body temperature. The new test seems to provide a cost-effective alternative to reAl time RT-PCR for diagnosing H1N1 influenza. However, further testing may be needed to verify the efficacy of the test in different settings and communities
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Tobacco use is increasing among young people, especially in Gulf nations such as Saudi Arabia. The objectives of this study were to estimate the prevalence and behavioural patterns of tobacco use among undergraduate students at King Saud University, Riyadh, Saudi Arabia during the academic year 2008/09 and investigate factors that influenced their tobacco use. A cross-sectional study was done of a representative sample [n = 6793] of the undergraduate student population using a modified version of the global youth tobacco survey questionnaire. The prevalence of smoking was 14.5% among students, 22.2% and 2.2% among fathers and mothers and 43.1% and 14.8% for male and female siblings; 15.0% reported all or most of theirfriends smoked. The most important independent predictors of smoking were: friends' smoking [some: OR - 6.7 and all: OR - 54.9], sister's smoking [OR - 2.2], mother's smoking [OR = 2.1], single status [OR -1.7] and age [OR -1.18]
Subject(s)
Humans , Male , Female , Risk Factors , Students , Universities , Cross-Sectional Studies , Surveys and Questionnaires , PrevalenceABSTRACT
Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students [316 males and 520 females] completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it Students who opposed legalization [74.4%] cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia
Subject(s)
Humans , Male , Female , Students , Surveys and Questionnaires , Universities , CultureABSTRACT
A cross-sectional survey with convenience sampling was conducted among rickshaw drivers in Rawalpindi, Pakistan to study their road rage behaviour and experiences. Cumulatively 318 male drivers participated in this study. The most common forms of road rage reported were: having been shouted at; and having experienced rude gestures from other drivers [78.9% each]. Least common forms of road rage reported were: threats of physical hurt or having actually been physically hurt [
Subject(s)
Humans , Male , Behavior , Time , Safety , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Black seed [Nigella sativa], belongs to Rannunculaceae family. It has various functions, including immuno-modulatory, anti-oxidant, anti-inflammatory and anti-neoplastic effects. Anticancer properties of NS compounds are related to their cytotoxic and apoptotic effects. In this study, cytotoxic and apoptotic effects of ethanol: extract of NS was investigated on human kidney cancer cell line [ACHN] and normal cell line [L929]. NS ethanolic extract at 0, 10, 50, 100, 250, 500, 750, 1000, 1250, 1500, 1750 and 2000 micro g/ml concentrations were prepared and studied in culture mediums of ACHN and L929 cells. After 24, 48 and 72h, morphologic changes and MTT assay were performed in both cell lines. Indeed, early and late apoptosis were studied by phosphatidyl serine kit employing flow cytometry technique. After 24h, NS extract at 750 micro g/ml and higher concentrations caused morphological changes and also reduced percentage of alive cells significantly [P<0.05] in ACHN cells compared with L929 cells that showed similar changes at 1250 micro g/ml and higher concentrations. After 48 and 72h, these effects were more prominent. MTT assay results, showed that NS concentration of 750 micro g/ml and higher doses reduce percentage of alive ACHN cells [P<0.05]. L929 cells showed similar changes at 1250 micro g/ml and higher concentrations [P<0.05]. Maximum apoptosis in ACHN cells was happened at 1000 and 1250 micro g/ml [92%] compared with L929 cells that showed maximum apoptosis at 1500 micro g/ml [89%]. Indeed, both cell lines showed a significant increase in apoptosis compared with their control groups [P<0.001]. NS ethanolic extract can may be useful as a cytotoxic and chemotherapeutic agent in kidney cancer treatment
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The purpose of the study was to explore and recognize the variety of reasons that underlie the female students' decision of entering the field of medicine. Cross sectional. Five medical colleges in Karachi, namely Sindh Medical College, Dow Medical College, Aga Khan University, Ziauddin Medical University and Baqai Medical University. 1[st] March 2008 to 31[st] July 2008. 900. All the female medical students of these medical colleges who consented to participate were included, and those who did not consent were excluded. Out of 900 female medical students who participated in the study, 336 [37.3%] were from pre-clinical years, that is from 1[st] and 2[nd] year of M.B, B.S; and 564 [62.7%] from clinical years, which includes students from 3[rd] to 5[th] year. There are a variety of reasons for the choice of medicine as a profession by the females, with the majority being attracted to it by the respect directed to a doctor, while others desired to serve humanity. Some other reasons were parental pressure, chances of better suitors and greater financial prospects. Respect for medical profession was the first choice for majority of study participants. This needs to be publicized to change the mind set of our traditional and conservative society
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Humans , Female , Students, Medical , Education, Medical , Cross-Sectional StudiesABSTRACT
Smokeless tobacco [ST], wtclefy used in Pakistan, poses a high risk for oral cancer. Our hospital-based data illustrate that oropharyngeal cancer [9.9%] is the second leading malignancy after breast cancer [16.1%], and is significantly higher than in other Member States of the World Health Organization's Eastern Mediterranean Region. Urdu-speaking communities had a proportionately higher rate of oropharyngeal cancer [20.4%], followed by Balochis [19.9%], Sindhis [16.8%], Punjabis [11.7%] and Pashtuns [9.6%]. Association of oropharyngeal cancer with ST use was four times higher relative to no history of tobacco use after adjusting for age, ethnicity and gender. Our findings also show a predominance of this cancer among males relative to females and one-third of the reported cases occurred among individuals under 40 years. These findings have significant social impact, indicating the need for urgent intervention against the use of ST