Traditional practices of the ethnoveterinary plants in the Kaghan Valley, Western Himalayas-Pakistan / Prácticas tradicionales etnoveterinarias de las plantas en el valle de Kaghan, Himalaya occidental Pakistán

Introduction: Indigenous people in a far-flung mountainous area without basic facilities, mainly rely on medicinal plants to cope with various veterinary health problems. Objective: The present study was carried out to explore the traditional knowledge of ethnoveterinary practices in Kaghan Valley, district Mansehra, Western Himalayas-Pakistan. Method: Ethnoveterinary data were collected between February to October 2014 from nine villages of the Kaghan Valley by involving 80 local people include traditional healers using a semi-structured interview. Results: A sum of 41 plant taxa of ethnoveterinary medicinal plants was documented for treating livestock ailments. Out of which, herbaceous plants were recorded with high percentage (27 species, 65.8 %). Most of the species were used to treat gastrointestinal diseases (12 taxa), followed by health improvement (7 taxa). The widely used part of plants for livestock aliments was the whole plant (9 species) followed by leaves (7 species), and preparation were paste (18 species) followed by powder with 10 species. The highest used values were recorded for Arisaema costatum (0.82), Primula denticulata (0.76), and high relative frequency citations for Berberis lyceum and Dryopteris ramosa with 0.37 each. Among the plant species Skimmia laureola, Thymus linearis and Phytolacca latbenia were among the taxa with cent fidelity level. Conclusion: The flora used in traditional remedies of the valley was found mostly endemic due to excessive utilization. Thus, further chemical investigation, better utilization and conservation of indigenous use of the reported species should be considered for future work.

Introducción: Los pueblos indígenas de zonas montañosas lejanas sin facilidades básicas dependen principalmente de las plantas medicinales para afrontar problemas de salud de tipo veterinario. Objetivo: Explorar el conocimiento tradicional en las prácticas etnoveterinarias en el valle de Kaghan, distrito de Mansehra, Himalaya occidental-Pakistán. Métodos: Se recopilaron datos etnoveterinarios mediante una entrevista semiestructurada entre febrero y octubre de 2014 en nueve aldeas del valle de Kaghan, con la participación de 80 habitantes locales, incluidos curanderos tradicionales. Resultados: Se documentó un total de 41 taxones de plantas medicinales etnoveterinarias para el tratamiento de enfermedades del ganado. Se registró un alto porcentaje de plantas herbáceas (27 especies, 65.8 %). La mayoría de las especies utilizadas han sido para tratar enfermedades gastrointestinales (12 taxones), y mejora de la salud (7 taxones). Para el tratamiento de enfermedades del ganado, lo más usual fue utilizar la planta entera (9 especies), seguida de las hojas (7 especies), con preparación en pasta (18 especies) y en polvo (10 especies). Las especies registradas con más uso fueron: Arisaema costatum (0.82), Primula denticulata (0.76) y Berberis lyceum y Dryopteris ramosa con la misma alta frecuencia relativa (0.37 cada una). Las especies Skimmia laureola, Thymus linearis y Phytolacca latbenia se reportaron entre los taxones con mayor nivel de fidelidad porcentual. Conclusión: La flora utilizada en los remedios tradicionales del valle de Kaghan fue mayoritariamente endémica. Se propone para trabajos futuros mayor investigación química, y mayor utilización y conservación en las especies de plantas reportadas por los indígenas.

Frequency of medical covers and diseases encountered in field by a field medical unit of Pakistan army

Objective: To determine the frequency of medical covers and diseases encountered in the field by a field medical unit of Pakistan Army

Study Design: Descriptive study

Place and Duration of Study: The Study was conducted in 61 Medical Battalion Multan, from Jan 2013 to Dec 2013

Patients and Methods: All the medical help demanded either in the form of nursing assistants [NA] or medical officers [MO] or advanced dressing station [ADS] or forward treatment centre [FTC], by a competent authority of HQ Log 2 Corps, during complete one year of 2013 [January 2013 to December 2013]

Results: A total of 90% of all medical covers were in-station and 95% of them required NA only. Ten percent of all medical covers were out-station and 98% of them required MO also. Eighty percent of the diseases faced in field were gastroenteritis, 15% upper respiratory tract infection [URTI], 5% were heat exhaustion, trauma, foot rot, arthropode/vector borne diseases

Conclusion: Prompt first aid and speedy evacuation is the essence of medical cover. Basic life support [BLS] trained nursing staff and speedy, reliable and fast ambulance is the core of medical evacuation. MO is only to be employed where distance from any other medical or surgical facility is more than 2 hours. Water source in field to be screened for coliform count under responsibility of concerned engineer detachment or packed water bottles to be provided from the supply detachments

Varicocele Surgery Improves Sperm Count in Infertile Oligospermic Patients and so Improves Fertility; A Study in a Tertiary Care Hospital

The objective of this study was to find out the role of varicocele surgery in oligospermic infertile patients. It was a prospective and descriptive study carried out in Surgical Unit-I, Abbasi Shaheed Hospital and Karachi Medical and Dental College (KMDC), Karachi from April 2004 to March 2014. In this study, all patients of infertility due to low sperm count having bilateral varicocele were included while those patients having azoospermia or patients with unilateral varicocele were excluded. All patients were clinically assessed for bilateral varicocele and confirmed by ultrasonography of scrotum and relevant investigations were done. Patients were prepared for varicocele surgery and ligation of pampiniform plexus done. Semenanalysis were done during follow up and results were analyzed on SPSS version 14. Total fifty seven patients (n=57) were included in which age range was 20 to 30 years in 33.3%, 31 to 40 years in 42.1%, 41 to 50 years in 19.3% and 51 years to onwards in 05.3% patients only. Chronic smoking was found in 68.4% patients while 31.6% were nonsmokers. Normal testes was found in 77.19% while 22.81% had smaller (atrophied) testes. Very low sperm count was in 15.79%, 50.88% had low sperm count and 33.33% had near normal sperm count. All patients were operated for bilateral varicocele and discharged. Follow-up semen analysis showed improvement and semen analysis became normal in 19.3% after six months, 21.05% after nine months and 36.84% after one year of surgery while 22.81% had no improvement even after one year of surgery. Thus, patients with bilateral varicocele having low sperm count showed improvement in sperm count after varicocele surgery and so infertile patients may become fertile after varicocele surgery.

Risk factors for surgical site infection in clean surgeries in Abbasi Shaheed Hospital

To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III

Desmoid tumour of lower abdomen

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report a case of a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour

Bilobed gallbaldder

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration

Proportion of bile micro-organisms and their culture and sensitivity to various antibiotics in patients with gallstones

To provide scientific basis for selecting a prophylactic antibiotic in the cases of elective cholecystectomy, according to our local conditions. Descriptive Study. General Surgery department of Abbasi Shaheed Hospital Karachi from 1st Jan, 2004 to 31st Dec 2004. Fifty patients with chronic cholecystitis ranged between 20 to 65 years were admitted through outpatient department. These patients also included high risk patients with diabetes mellitus, ischaemic heart diseases, hypertension and immunocompromised patients. Patients with acute cholecystitis, empyema, obstructive jaundice, common bile duct stone, carcinoma of gallbladder or biliary tree, cirrhosis and patients having septic foci elsewhere were excluded. Patients were selected according to convenient sampling. During cholecystectomy bile was sent for culture and sensitivity. For analysis of data SPSS-10 was used. In this study positive bile culture was found in 44 percent of cases and most prevelant organisms were E.coli and Klebsiella. With regard to antibiotic sensitivity. Amikacin, quinolone, imipiname and piperacillin has shown almost 90% sensitivity. Prophylactive antibiotic should be used in all cases of elective cholecystectomy

Complications of colostomy in Abbasi Shaheed hospital

To describe the different complications of colostomy that developed after its construction either in emergency or elective surgery in Abbasi Shaheed Hospital Karachi. Descriptive study from January 2006 to Dec. 2007 during which fifty patients who were above 12 years of age were admitted in Surgical Unit-I, of Abbasi Shaheed Hospital, Karachi, through emergency and out patient department. Information of patients including history, clinical examination, investigations, and indication of surgery, operative procedure and operative findings were collected. Gut preparation was done in elective cases only. Detail about stoma, its type, complications and treatment were observed carefully. Emergency colostomies were performed in emergency theatre while elective cases were done in main theatre. Patients were followed up from the construction of colostomy to the fourth post operative week to analyze the complications associated with stoma formation. Reversal of colostomy was done after 8th to 12th post operative period. Among them 40 patients 80% were males and 20% were females. Students, labors and old age were mostly affected class. Most of them were victims of terrorism. Intestinal trauma due to gun shots and stab were the leading cause while the intestinal pathology like tuberculosis, carcinoma, volvulus, intestinal obstruction were found to be the less common causes of stoma formation. 40 patients [80%] were operated in emergency theatre while 10 patients [20%] under went elective faecal diversion. Majority of Colostomies were temporary loop colostomies, formed only for diversion and decompression of distal segment. Out of fifty patients, none of the patients had any major post operative complications like necrosis, prolapsed, parastomal hernia and fistula formations. Only twelve patients [24%] developed complications. Abdominal wall infection in two patients [4%] and skin excoriation in 3 patients [6%] around the stoma were found the commonest local complications. Retraction in 2 patients [4%], stenosis in two patients [4%] with stoma obstruction in 1 [2%] and detachment in 1 [2%] were found. All these cases required refashioning of Colostomy. Stoma bleeding and pain was also observed and treated in 2 patients [4%]. The psychological trauma of having colostomy with a bag on the belly was a considerable problem which patient had during the period, which was reduced and post operative counseling and training was given. Stoma surgery has a wide range of clinical implication. It is relatively a save procedure either to reduce leakage of distal colonic repair or to provide sufficient time for the healing of intraperitonial trauma. The complications occurred in only 24% patients among which skin excoriation and skin infection occured in a few patients. Having an artificial anus was a mental torture for patients

Results of ultrasound findings in cases of pure cystic scrotal swellings in patients of all ages in ash

To describe the results of ultrasound findings in pure cystic scrotal swellings in patients of all ages in ASH. It was a descriptive case series carriedout from Jan 2003 to Dec 2005 in SOPD and Surgical unit-1, Abbasi Shaheed Hospital and KMDC, Karachi. A total of 100 patients were taken who had pure scrotal swellings which were cystic in nature clinical examinations. These patients were treated in this hospital during this period. All patients [n=100] attending SOPD of Abbasi Shaheed Hospital with presenting complain of pure scrotal swellings were clinically examined with especial attention to get above the swelling, fluctuation and transillumination test and their size of the swelling also noted by an inch tape. An inform consent was taken and ultrasound of scrotum was done in ultrasound department to confirm the cystic swelling of scrotum and also to measure the size of the swelling. These patients were then divided into three groups according to the size of the scrotal swelling in which Group A [n=22] patients had size <5cm in diameter, Group B [n=51] had size 05-10cm in diameter and Group C [n=27] had size >10cm in diameter. All patients were admitted for surgery [exploration of the scrotal swelling]. On exploration of the scrotum [n=100], about 39% [n=39] of patients had < 50 ml of fluid, 32% [n=32] of patients had 50-100 ml of fluid while 29% [n=29] of patients had >100 ml of fluid in the sac. About 77% [n=77] of patients had clear amber coloured fluid, about 13% [n=13] had serous fluid with calcifications, about 07% [n=07] had pussy fluid and only 03% [n=03] had bloody fluid in the sac. Therefore about 90% of the patients had hydrocele [n=90], about 07% had pyocele [n=07] and only 03% of patients had haematocele [n=03]. No malignancy was found in this study. Most of the patients coming in this hospital with pure cystic scrotal swellings had hydroceles [90%], some of the patients had pyoceles [07%] while few had haematoceles [03%]. All most all cystic scrotal swellings were benign in nature and no malignancy was found in this study

Intestinal tuberculosis - a common cause of intestinal obstruction

To assess the prevalence and presentation of intestinal tuberculosis in cases of mechanical bowel obstruction. Retrospective study from Oct. 1999 to Sept. 2005. Surgical Unit I, Abbasi Shaheed Hospital, Karachi. All patients [> 10 years of age] presenting with mechanical bowel obstruction. The data and files of all the cases of dynamic bowel obstruction was retrieved and analyzed with reference to age, sex, symptomatology and examination findings, investigations, aetiology, surgical procedures performed and outcome. A total of 163 patients were admitted with mechanical bowel obstruction over a period of six years. The ages of the patients varied between 10-74 years, maximum cases being seen between 30-40 years, with a male preponderance [60.1%]. Abdominal pain [40.5%], vomiting [20.2%] and constipation[16. 0%] were the prominent modes of presentation. Intestinal Tuberculosis [70.6%] was the most common cause of intestinal obstruction, followed by irreducible inguinal hernias [17.2%] and malignancies [7.4%]. Less than half [46.0%] the tuberculous patients were already on anti-tuberculous treatment at the time of presentation. About 9% of the tuberculous cases were managed conservatively, while the rest were operated upon; right hemicolectomy being the most frequent [47.6%] procedure performed. Histopathology was positive for tuberculosis in all the cases. Five patients of intestinal Tuberculosis died due to Tuberculous peritonitis. Intestinal Tuberculosis is the leading cause of mechanical bowel obstruction in our part of the world. Many patients of abdominal tuberculosis, managed conservatively on anti-tuberculous treatment, develop signs and symptoms of acute obstruction. Hence early surgical intervention is recommended to improve the morbidity and mortality of such patients