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Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.
Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.
Subject(s)
Humans , Bone Cements , Bone Transplantation , Curettage , Giant Cell Tumors , Knee/surgeryABSTRACT
Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.
Subject(s)
Humans , Erythropoietin , Anemia , Blood Transfusion , Preoperative Care , Iron Compounds/therapeutic useABSTRACT
@#The purpose of this study to determine the clinical characteristic of the associated risk factors of acute myocardial infarction patients (AMI) among the Hunan Han population in China. The retrospectively collected the records data of 595 both STEMI and NSTEMI patients from the first Xiangya hospital, Hunan, China over a period of January 2018 and December 2018. These studies revealed clinical characteristics with associated risk factors among acute myocardial infarction patients. A total of 595 diagnosed acute myocardial infarction patients participated in this study among males 70.9% and females 29% with mean age e 52.9+11.3 years. While 90% had STEMI and 9.9 % had NSTEMI. The chest pain 94.4%, 86% and shortness of breath 55%, 100% presented with STEMI and NSTEMI groups respectively. Smoking incidence in male subject 70.3% had higher than in female subject 29.1 % (P<0.05). Hypertension and diabetes mellitus found 59%, 69.5% in male participants as compared to 40.6%, 30.4% in female participants respectively (P<0.05). However, no statistical difference was found among dyslipidemia males 48.6% and females 47.4%. The most common type of AMI was STEMI and usually presented with chest pain and shortness of breath. The AMI patients were more found in male and common associated risk factors were smoking and hypertension followed by diabetes mellitus and dyslipidemia.
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Different surgical techniques and devices have been utilized for the closure of wounds but they are very expensive. We developed a new, easy and inexpensive dermatotraction technique based on the simple use of Ty-Raps by using biomechanical properties of the skin. In this article, we evaluated its feasibility, the costs, outcomes and the mean time to closure of wound. We concluded that the Top-Closure by Ty-Raps is an innovative technique for wound closure of medium to large skin defects. Complications and donor site morbidities were nil. We appreciate its low cost, general availability and effectiveness.
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Objective: To compare the safety, outcome and advantages of three port laparoscopic cholecystectomy vs. four port laparoscopic cholecystectomy
Study Design: Prospective descriptive study
Place and Duration of Study: The study was done at Combined Military Hospital Malir Cantt Karachi starting, from Mar 2013 to Oct 2015
Material and Methods: Total 200 patients who had undergone gall bladder removal laparospically were studied. Complication rate, duration of operation, insertion of 4th port, converting laparoscopic method to open, duration of hospital admission, early return to work and need of analgesics were studied in patients with three ports laparoscopic cholecystectomy [LC] vs. four ports LC
Results: A total of 200 patients who had removal gall bladder laparospically, three-port LC were performed in 117 [58.5%] patients and four-port LC was performed in 83 [41.5%] patient. There was no significant difference with respect to complication rate, converting to open technique and duration of operation were comparable to four ports LC. One patient required 4th port in left hypochondrium for liver retractor to retract enlarged left liver lobe
Conclusion: LC using thee ports can be performed safely when done by experts in this method. The said procedure has significant benefits over the conventional four-port method with respect to decreased use of pain killers and duration of hospital admission
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OBJECTIVE: Circulating microRNAs have been recognized as promising biomarkers for various diseases. The present study aimed to explore the potential roles of circulating miR-149, miR-424 and miR-765 as non-invasive biomarkers for the diagnosis of coronary artery disease in middle-aged (40–60-year-old) patients. METHODS: Sixty-five stable coronary artery disease patients (49–57 years old), 30 unstable coronary artery disease patients (49–58 years old), and 32 non-coronary artery disease patients (49–-57 years old) who were matched for age, sex, smoking habits, hypertension and diabetes were enrolled in this study. Total RNA was isolated from plasma with TRIzol reagent. Circulating miRNA levels were measured by quantitative real-time polymerase chain reaction. RESULTS: Circulating miR-149 levels were decreased 4.49-fold in stable coronary artery disease patients (1.18 ± 0.84) and 5.09-fold in unstable coronary artery disease patients (1.04 ± 0.65) compared with non-coronary artery disease patients (5.30 ± 2.57) (p<0.001). Circulating miR-424 levels were reduced 3.6-fold in stable coronary artery disease patients (1.18 ± 0.60) and 5-fold in unstable coronary artery disease patients (0.86 ± 0.54) compared with non-coronary artery disease patients (4.35 ± 2.20) (p<0.001). In contrast, circulating miR-765 levels were elevated 3.98-fold in stable coronary artery disease patients (6.09 ± 2.27) and 5.33-fold in unstable coronary artery disease patients (8.17 ± 2.77) compared with non-coronary artery disease patients (1.53 ± 0.99) (p<0.001). Receiver operating characteristic curve analysis revealed that the respective areas under the curve for circulating miR-149, miR-424 and miR-765 were 0.938, 0.919 and 0.968 in stable CAD patients and 0.951, 0.960 and 0.977 in unstable coronary artery disease patients compared with non-coronary artery disease patients. CONCLUSION: Our results suggest that circulating miR-149, ...
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Aptitude , Deafness/rehabilitation , Language Development Disorders/rehabilitation , Narration , Sign Language , Education of Hearing Disabled , Language Development Disorders/diagnosis , Psycholinguistics , Reference Values , Semantics , Speech Production MeasurementABSTRACT
This study has been performed to evaluate the effectiveness of the continuing medical education [CME] program in upgrading knowledge and professional skills of attending doctors. An analysis of 12 seminars from March 2014 to November 2015 was conducted. Each time pre-seminar and post-seminar tests were carried out that contain multiple choice questions [MCQs]. Changes in scores were analyzed to study the impact of the seminars on attendees. A total of 900 doctors turned up for the 12 seminars, 400 were the university alumni members and 500 belong from the non-university sector. Senior faculty members and medical students were excluded. 69% of the participants were male and the rest were females. The results indicated that the lectures did not significantly improve the knowledge of most doctors whereas interactive sessions and workshops had a better impact. Most participants attended the CME programs under compulsion to acquire CME hours/points rather than enhancing their knowledge and skills. Studies time off is not institutionalized. On the basis of these findings it is concluded that a different approach is needed if long term goal of obligatory recertification is to be achieved
ABSTRACT
PakisVancomycin resistant Staphylococcus aureus [VRSA] has been reported from many parts of the world including Asian countries. Hence, main objective of study was to evaluate the possible occurrence of VRSA in hospitals of Lahore city and to ensure the effectiveness of various substitute therapeutic options. A total of 150 samples of pus/wounds were collected from three hospitals of the city and VRSA were isolated and confirmed through recommended method of Clinical and Laboratory St and ards Institute. Out of 51 [49.04%] methicillin resistant S.aureus [MRSA] isolates, 5 [9.8%] were found resistant to vancomycin. Minimum inhibitory concentration [MIC] of Linezolid [LZD], Moxifloxacin [MFX] and Clindamycin [CD] were calculated against VRSA isolates by broth microdilution test. All 5 [100%] isolates were susceptible to Linezolid and Clindamycin, while 4 [80%] were susceptible to Moxifloxacin. Ethanolic extracts of Turmeric, Mint, Cori and er, Garlic, Kalonji, Cinnamon and Cloves illustrate average MIC values of 140.8µg/ml, 563.2µg/ml, 486.4µg/ml, 614.4µg/ml, 409.6µg/ml, 281.6µg/ml and 64µg/ml, respectively against 5 VRSA strains. Concentration dependent increase in growth inhibition zones of ethanolic plant extract was recorded by agar well diffusion test. This study was helpful to find out the effective antibiotic against VRSA. Plant extracts encompass anti-staphylococcal activity and this finding dem and s necessity of further exploration of potential found in these natural herb.
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To determine the clinical outcomes of acute abdominal pain and evaluation of symptoms and signs in children admitted in pediatric surgery department. Cohort study. This study was conducted in Department of Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who presented to emergency department with complaint of acute abdominal pain of less than 5 days duration and admitted in pediatric surgery department were included. Presenting symptoms, signs, hospital course of patients and discharge diagnosis were recoded. Data was analyzed by SPSS. Out of 73104 patients who were seen in Paediatric emergency 1420 [1.94%] were referred for surgical evaluation. Out of these 157 children were admitted. Six patients left against medical advice so 151 patients were studied. Patients were divided into acute appendicitis, non-specific pain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acute appendicitis was diagnosed in 61[40.4%] patients. The patients who were admitted and no cause of pain abdomen could be found in them, were included in non-specific pain abdomen group. NSPA group had 39 [25.8%] patients. Rests of the 51 [33.8%] patients were included in miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliac fossa, guarding, rebound tenderness and tachycardia were all significantly higher in patients with acute appendicitis. Most of the children with acute abdominal pain would not require surgery. Detailed history and thorough physical examination is cornerstone of the diagnosis
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Objective: To determine the acceptance of retinal screening, Laser uptake and subsequent follow-up in diabetic patients attending the Diabetes Centre of Diabetic Association of Pakistan [DAP], Karachi
Study Design: Observational case series
Place and Duration of Study: Diabetic Centre of Diabetic Association of Pakistan [DAP], Karachi, from January 2011 to December 2012
Methodology: All the diabetic patients were screened for Diabetic Retinopathy [DR] with non-Mydriatic Fundus Camera [NMFC]. Patients with DR were examined by the ophthalmologist using fundus lens and slit lamp. DR was graded for severity on the basis of modified Airlie House Classification. Patients with Sight Threatening Diabetic Retinopathy [STDR] were advised Laser treatment. Each patient was followed-up for at least 6 months. The records of patients recommended Laser were retrieved, and called for re-examination
Results: Retinal screening was accepted by all of the 8368 registered diabetics attending DAP Centre. On fundus photography, 21.2% [1777] individuals were found to have DR. Seven hundred and five [39.5%] patients were found to have STDR. Laser was advised to 96.4% [680] of STDR patients; amongst whom 70.5% [480] accepted Laser treatment. Out of 480 patients who had Laser treatment, 21.2% [107] turned out for follow-up after 6 months
Conclusion: Acceptance of retinal screening and Laser application was good; but follow-up was suboptional
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Objective: To compare the efficacy of fistulotomy versus fistulectomy in the treatment of low lying anal fistula in male patients
Study Design: Randomized clinical trial
Place and Duration of Study: Surgery Department, CMH Multan and CMH Malir, from Aug 2008 to Oct 2013
Patients and Methods: Study was done on 262 patients. Patients with anal fistula were divided by simple random allocation into groups A [fistulotomy] and B [fistulectomy]. The patients with simple low anal fistula without any comorbids were included in the study and the patients with recurrent fistula, high fistula or those having any comorbid were excluded from the study. Data was analysed using SPSS 17. Descriptive statistics applied for both quantitative and qualitative variables. Mean and standard deviation for quantitative and frequencies and percentages for qualitative data
Results: Total 262 patients were selected having low lying anal fistula and operated as group A - fistulotomy and group B - fistulectomy, each group constituted of 131 patients each. The operating time was found to be shorter for group A [14.29+3.24 minutes] and group B [25.92 +3.60 minutes]. The group A patients were discharged earlier [3.73 + 0.65 days] than group B [4.88 + 0.35 days]. In group A incidence of postoperative bleeding [0.8%], infection [2.2%] and recurrence was [10.7%]. While in group B bleeding [3.1%], infection [3.8%] and recurrence was [15.3%]. Severity of postoperative pain [as assessed by Numeric Rating Scale] was higher in group B as compared to group A. The healing time was shorter in group A [4.04 + 0.33 weeks] as compared to group B [4.57 + 0.497 weeks] and the patients of group A returned to normal activity earlier [10.9 + 2.05 weeks] than group B patients [15.54 + 0.51 weeks]
Conclusion: In male patients suffering from simple low lying anal fistulas, fistulotomy has a definitive superiority over fistulectomy and is recommended to be adopted as primary surgical modality for the treatment
ABSTRACT
To evaluate the usefulness and safety of early versus late oral intake after appendectomy. Randomized clinical trial. Combined Military Hospital Multan from August 2008 to February 2009. One hundred patients with uncomplicated acute appendicitis, undergoing appendectomy under general anesthesia were included in the study and randomly divided into two equal groups. Early oral intake group [group A] was allowed fluids, when patients were out of effects of general anesthesia. Delayed fed [group B] was started oral fluids, on appearance of normal bowel sounds or passage of flatus. Low residue solid diet was started, after tolerance of oral fluids, in both groups. Early oral intake resulted in start of solid diet earlier by average 9 hours; these patients had normal bowel sounds, and passed flatus, earlier, after 4 hours and 5 hours as compared to late feeding group. Six [12%] patients had mild ileus in early fed group whereas 4[8%] patients in delayed fed group had mild ileus. Thirty eight [76%] early fed patients were very satisfied, as compared to 29 [58%] delayed fed patients. The hospital stay was prolonged by 2 days in delayed fed group. Early oral feeding implemented after appendectomy is safe and effective, with a shortened hospital stay as the primary benefit in patients after appendectomy
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To determine the frequency, severity and risk indicators of diabetic retinopathy [DR] in patients with diabetes attending a primary care diabetes centre. This observational study was conducted at Diabetic Association of Pakistan - a World Health Organization collaborating center in Karachi, from March 2009 to December 2011. Registered patients with diabetes were screened by two field fundus photographs. Retina specialists graded the signs of retinopathy according to diabetic retinopathy disease severity scale. Of total registered diabetic patients [n=11,158], 10,768 [96.5%] were screened for DR. Overall DR was found in 2661 [24.7%] patients. DR was found in decreasing order of frequency in patients with type 2 [n= 2555, 23.7%] followed by patients with type 1 diabetes [n=101, 0.93%] and patients with gestational diabetes mellitus [GDM] [n=5, 0.46%]. Among patients with DR, signs of non-sight threatening retinopathy was dominant. Females and patients of working age group predominantly had retinopathy. Type 1 patients >16 years and type 2 patients < 5 years of history of diabetes had sign of retinopathy in increased frequency. Every forth patient with diabetes in this large cohort had signs of diabetic retinopathy. Females and patients in working age group predominantly had retinopathy. Type 2 patients with short while type 1 patients with long history of diabetes most frequently had DR. Dissemination of the present study findings may help in increasing the awareness of this serious complication of diabetes
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The study was conducted to identify clinical features significantly associated with histopathologically proven appendicitis in children. Cross-Sectional Observational. This study was conducted in Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who underwent appendectomy for acute appendicitis during the study period were included. Patients who had appendectomy for any reason other than appendicitis were excluded. Presenting symptoms, signs, hospital course of patients and histopathological diagnosis were recoded. Data was analyzed by using SPSS. Sensitivity, specificity, positive predictive value and negative predictive value for each symptom and sign were calculated. Out of 1420 patients who were evaluated during the study period for acute abdominal pain, 70[5%] were diagnosed with acute appendicitis. Four patients left against medical advice so 66 patients were studied. Patients were divided into acute appendicitis and non-inflamed appendix group on the basis of histopathology of resected appendix. Acute appendicitis was confirmed histologically in 43 [65%] cases and perforated appendicitis was found in 8 [12%]. No evidence of acute inflammation was found in 15 [22%] cases. Among clinical features only involuntary guard [p-value 0.01] and rebound tenderness [p-value 0.004] were significantly different among acute appendicitis and non-inflamed appendix group. Total leukocyte count more than 11,000 was significantly higher in acute appendicitis group. The cornerstone of diagnosis of acute appendicitis in children is thorough history and meticulous physical examination. Involuntary guard, rebound tenderness and total leukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases of appendicitis
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Foreign body ingestion is relatively common in the paediatric population and most object pass through the gastrointestinal tract spontaneously. With the popularity of small magnetic toys, there have been numerous reports of magnet ingestion with morbidity and even mortality. We report a case of 3-years old boy who presented with clinical features of subacute intestinal obstruction with no history of foreign body ingestion. On exploratory laparotomy, he was found to have multiple small bowel perforations due to two small magnets. Magnets were removed and perforations repaired. The aim of this report is to aware paediatricians of the importance of early surgical referral in case of magnet ingestion, to prevent severe complications
Subject(s)
Humans , Male , Intestinal Obstruction/etiology , Magnets , Intestinal Perforation/etiology , Foreign-Body Migration/prevention & control , LaparotomyABSTRACT
Blood borne diseases impose heavy burdens on national economies and individual families due to costs arising from acute and chronic morbidity and mortality. Globally, 2 billion people are infected with hepatitis B virus [HBV]. An estimated 170 million persons are chronically infected with hepatitis C virus [HCV] and 3-4 million persons are newly infected each year. Transmission of hepatitis B and C through infected needles, blades, etc. is well known. Barbers are the important parts of community, as almost every man needs at least monthly visit to barber for hair dressing or shaving. In Pakistan the prevalence of shaving by barbers is reported to be as high as 34%-49% of the male population and it is important to know how barbers perceive the risks in relation to prevention of transmission of hepatitis B and C. To assess the knowledge and attitude of barbers regarding HBV and HCV and find out practices among barbers which may be responsible for transmission of HBV and HCV. Cross-Sectional Study. This study was carried out in the Larkana city during the months of March 2010 to April 2012. A list of the barbers was obtained from the union of barbers and sample was drawn from that sampling frame. There were 422 barbers shops in the city. For sampling purpose Larkana city was arbitrarily divided into five zones [East, West, Central, South and North] and then 10 shops randomly selected from each zone. There were 156 barbers available and eligible for interview. After informed verbal consent, 132 barbers agreed to participate in the study. Data was entered, analyzed by Statistical Program for Social Sciences [SPSS] version 13. A total 132 barbers were interviewed. The mean age of respondents was 28 +/- 10 years, mean years of experience in barbering was 12.7 +/- 10. More than half [63.6%] respondents were married. Majority of the respondents [84.8%] were resident of urban areas. 64% barbers have had knowledge that hepatitis B and C can be transmitted through blood transfusion and sexual contact. Only 6.1% had been vaccinated against the hepatitis B. 70% of the barbers disposed of used blades in regular garbage. 82% washed hands before and after shaving each client, 92.4% cleaned their instruments with disinfectant after shaving the, 99.2% barbers change the blade for each client. The knowledge of barbers regarding the transmission of hepatitis B and C was fairly good but majority of the barbers were not vaccinated against Hepatitis B though they were knew that vaccine is available against the hepatitis B
Subject(s)
Humans , Barbering , Hepatitis C/transmission , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Hepacivirus , Hepatitis B virusABSTRACT
OBJECTIVE@#To examine the plasma adiponectin concentration in coronary heart disease (CHD) patients combined with abnormal glucose metabolism, and to explore the clinical significance of adiponectin.@*METHODS@#Eighty-seven hospitalized CHD patients confirmed by coronary angiography from August 2009 to April 2010 at Xiangya Hospital were enrolled and divided into 3 groups according to their glucose metabolic state: 31 patients were selected as a simple CHD group, 28 were selected as a CHD combined with impaired glucose tolerance group (CHD+IGT group), and the other 28 as a CHD combined with diabetes mellitus group (CHD+DM group). The 31 healthy subjects who got health checkup at the same time were enrolled as a normal control group (NC group). Plasma adiponectin was measured by enzyme linked immunosorbent assay. The height, weight,waistline and blood pressure of all the subjects were checked, and the fasting blood glucose (FBG), insulin, lipids, high-sensitivity C-reactive protein (hs-CRP), free fatty acids (FFA), the liver function and the renal function were checked as well. The body mass index and the homeostasis model were assessed for insulin resistance.@*RESULTS@#1) Plasma adiponectin in the CHD group, the CHD+IGT group, and the CHD+DM group was all lower than that in the NC group (P<0.05); 2) Compared with the CHD group, the plasma adiponectin in the CHD+DM group was the lowest, followed by the CHD+IGT group, and there was significant difference in the 3 groups (P<0.05); 3) Plasma adiponectin level was positively related with the high density lipoprotein cholesterol-C (HDL-C) (r=0.483, P<0.01), while it was negatively related with the hs-CRP and Gensini score (r=-0.489, P<0.05;r=-0.252, P<0.05).@*CONCLUSION@#Plasma adiponectin concentration is reduced in the CHD patients, and significantly reduced in CHD patients combined with abnormal glucose metabolism. Plasma adiponectin concentration decreases significantly with the severity of abnormal glucose metabolism. CHD and the abnormal glucose metabolism are important influence factors for plasma adiponectin. That plasma adiponectin level significantly decreases may be the superimposed results of CHD and abnormal glucose metabolism. Plasma adiponectin combined with HDL-C, hs-CRP and Gensini score may provide the reference in the judgement of the severity of CHD patients with abnormal glucose metabolism.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adiponectin , Blood , Coronary Disease , Blood , Metabolism , Diabetes Mellitus, Type 2 , Blood , Insulin Resistance , PhysiologyABSTRACT
To determine the effectiveness and duration of postoperative pain relief after local infiltration of tramadol in comparison with bupivacaine, in adult hernia surgery. Quasi experimental study. Department of Surgery, Combined Military Hospital Rawalpindi. Study was conducted on 60 patients aged between 20-60 years with elective mesh repair of inguinal hernia. Patients were divided into two groups of 30 patients for 0.25% bupivacaine [group A] and tramadol [group B]. Patients were assessed for pain at 1, 6, 12, 18 and 24 hours following surgery using visual analogue pain score [VAPS]. Patients with score =5 were given rescue analgesia in the form of 75 mg intramuscular diclofenac sodium. Comparison of first analgesia requirement time and the VAPS between the two groups was done using "t" test taking a p-value of <0.05 as significant. Patients in group A had a mean age of 46 +/- 11.03 years whereas in group B the mean age was 46 +/- 11.39 years. Mean visual analogue pain score after 1 and 6 hours of operation was 2.73 and 4.7 respectively in group A while it was 1.43 and 3.43 in group B. VAPS after 24 hours of operation was 3.47 in group A and 2.53 in group B. Mean time when 1st dose of rescue analgesic used was 8.20 hours in group A and 11.60 hours in group B. independent sample t-test for VAPS between the 2 groups revealed a highly significant difference [p-value <0.05] at 1, 6, 12 and 24 hours but no significant difference was seen at 18 hours. Independent sample t-test for time required for rescue analgesia and total number of doses required was also highly significant [p-value <0.05] between the two groups. Locally infiltrated tramadol provided an improved postoperative analgesia in comparison to bupivacaine and decreased the requirement of postoperative analgesics with early patient mobility and discharge
Subject(s)
Humans , Tramadol , Bupivacaine , Anesthetics, Local , Anesthesia, Local , Hernia, Inguinal/surgery , Analgesia , Pain MeasurementABSTRACT
To see the effect of combined oral contraceptive pills on Body Mass Index [BMI] of women. A descriptive study. The study was conducted at Family Planning Centers at social obstetrical unit Baqai Medical University and Reproductive and Health Sciences [RHS] Institute, a family planning unit, at Jinnah Post Graduate Medical Center Karachi, from November 2010 to April 2011. This study was carried out on 50 patients of reproductive age 20-40 years. Patients with Cardiac, Renal and Liver syfunction were excluded. Diabetic women taking sedative and hypnotics, anti-tubercular treatment were also excluded. All routine investigations were performed. BMI was done on initial visit re-evaluated after one, three and six months and data was analyzed. Fifty women were selected. They were divided into four categories, Control [category 0] i.e. before the start of COCPs, after 1 month [category 1], 3 months [category 2] and 6 months [category 3]. On initial visit mean BMI of control is found to be 22.53 +/- 1.92. Category 1 showed mean BMI of 22.53 +/- 1.92 kg/m2 while BMI of category 2 is 22.53 +/- 1.92 kg/m2 category 3 is 22.91 +/- 1.87. After completion of study mean increase in BMI of category 3 was 0.38 kg/m[2]. Mean increase in BMI of category 3 is negligible