Incidence of different morphological types of sella turcica: Cephalometric study

Introduction: Sella turcica (ST) is a saddle-shaped structure located on the intracranial surface of the sphenoid bone in the middle cranial fossa. The sella turcica serves as an important anatomical reference in orthodontics partly because the s-point, placed centrally in the sella region, is a central fix point in cephalometric analysis and partly because the contour of the anterior wall is used in evaluation of craniofacial growth. Morphologically, three basic types - oval, round, and flat - have been classified, the oval and round types being the most common. Aim and objectives: To describe the predominant morphological shape of sella turcica. Materials and methods: Prospective clinical study which was conducted in the Postgraduate Department of Oral Medicine and Radiology of Government Dental College and Hospital Srinagar. This prospective study included total of digital lateral cephalometric radiographs of 180 patients (90 males and 90 females) between 12-65 years of age, Digital lateral cephalometric radiographs were taken by using CARESTREAM SC8100 machine Results: Morphology of sella turcica was found to be typical in just 33.9% of cases. Within the atypical sellae most had oblique anterior wall (27.2%), followed by double contour of the floor (15%), pyramidal shape (14.4%), irregular dorsum sella (6.7%) and bridging (2.8%). Conclusion: Morphological types of sella turcica in this study can be used as reference for additional investigators such as radiologists, orthodontists, maxillofacial surgeons, and neurosurgeons to interpret and plan surgical procedures involving the sellar region

EVALUATION OF ULTRASOUND THERAPY AND TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN REDUCING PAIN FOR TEMPOROMANDIBULAR JOINT DISORDER

Objective:Evaluation of reduction of pain using transelectric nerve stimulation (TENS) and ultra sound therapy in reduction of pain in temporomandibular joint disorders.Background: Common signs and symptoms involve mainly TMJ and masticatory muscles, Patients usually manifest pain in preauricular region, Joint click, Joint crepitus and restricted jaw movements. There is no well defined etiology or a single contributing factor although several associated factors have been identified as malocclusion, trauma, emotional stress, and par functional habits (e.g bruxism). Methodology: The study included a total of 30 patients who visited our OPD at PG Department of Oral medicine and Radiology ,Govt Dental College Srinagar during period(2020-2021) .Included patients were irrespective of Gender , were in age group 20-30 years, presented with signs and symptoms of pain in masticatory muscles being inclusion criteria, Patients were excluded on the basis of having any recent tmj dislocation , Hairy surfaces , radiculopathy or any other neurogical deficits A Procedure : total of 30 patients were selected , falling in our inclusion criteria , study and procedure is explained to them , the patients are advised to not take any analgesic drugs during this time ,Subjects are randomly divided into two groups Group A: TENS recived for a duration of 15 min Group B: Recived a continous mode of ultrasound of 3Hz for a duration of 5 min , after 4 weeks , VAS score of pain is taken again. Results: there was significant difference in mean values of VAS scoring between group A and group B , mean of group B being more than group A Conclusion : Hence in our study we conclude ultrasound is more effective compared to TENS in pain reduction for temporomandibular joint disorders

Hospital based randomized prospective study outcomes in colorectal surgery after bowel preparation

Background: Research of so many years from the procurable world data has shown that the reasons for most colorectal cancers occur due to change in life style the type of diet, smoking as well as the influence of the surrounding environment in which man lives and increasing age with only a minority of cases associated with genetic disorders. Colorectal cancer is the third most commonly diagnosed cancer. In the first half of the 20th century, mortality from colorectal surgery often exceeded 20%, mainly attributed to sepsis.Methods: The randomized prospective study was conducted on 202 colorectal cancer patients in the department of Colorectal division of General and Minimal Invasive surgery” Sher-i-Kashmir Institute of Medical Sciences, Srinagar.Results: Mean age of patients in Group 1 (with no mechanical bowel preparation (NMBP)) was 51±18.15 years while as same was 50±17.76 years for Group 2 (with mechanical bowel preparation (MBP)). Age range for Group 1 was 16-87 years and16-85 years for Group 2. Regarding outcomes, wound infections were 6.1% and 3.8% in Group 1 and Group 2 respectively. While disruption of anastomosis were 2.0% and 3.8% in group A and B respectively.Conclusions: Statistically no gross difference in terms of morbidity and mortality was found between the use of mechanical bowel preparation versus no use of mechanical bowel preparation in elective colorectal surgery. Elective Colorectal Surgery can safely be performed without enduring MBP in it as it does not possess any sorts of benefits.

Study on rationality of different fixed dose drug combinations in tertiary care hospital: an evaluation study

Background: The fixed dose drug combinations (FDCs) of drugs is defined as product of two or more active ingredients in a defined composition. There is a need to study the pattern of prescription from time to time to evaluate their rationality. In this context we undertook this study to know the prescription pattern of FDC in our setting. To study the rationality of different prescribed FDCs.Methods: This is a prospective study which is carried out in NIMRA Institute of medical sciences which is a tertiary care teaching private hospital. For this study we have collected one thousand prescriptions of patients for 3 months that is from 10th March 2017 to 25th of June 2017 including both in-patients as well as outpatients. Selection criteria of patients mainly basing on their willingness to give prescriptions. Institutional ethical committee permission was taken for the study. The prescribed FDCs were compared with the essential drug list of FDCs approved by Drugs Controller General of India, July 2018. we have used descriptive statistics to analyze data. The percentage of FDCs used in each class and their contribution to overall FDCs were calculated.Results: In a total of 2952 drugs were prescribed, of this 747 were FDCs and 2205 were non FDCs. In the prescribed FDCs 89.2% drugs were rational and 10.8% drugs were irrational.Conclusions: From this study, we can conclude that 10.8% of irrational prescription of fixed dose drug combinations are prescribed in Nimra Institute of Medical Sciences which is a tertiary care teaching private hospital.

Comparative study of hypoglycemic activity of Morus alba with oral glibenclamide in streptozotocin induced diabetic rats

Background: Diabetes is a chronic metabolic disorder that continues to present a major worldwide health problem, characterized by absolute or relative deficiencies in insulin secretion and/or insulin action associated with chronic hyperglycaemia and disturbances of carbohydrate, lipid, and protein metabolism. It is fast growing disease, gains the status of a potential epidemic in India with prevalence of more than 62 million diabetic individuals currently diagnosed with the diabetes.Methods: The study was conducted at Department of Pharmacology, Kurnool Medical College, Kurnool for a period of 1 year from January 2017 to December 2018. Animals used were albino rats, of Wistar strain, weighing between 150-200gm of either sex. The animals were divided into six groups as: control group (I); pathogenic control group (II) injected intravenously (i.v.) with single dose of STZ (60mg/kg); Morus alba stem bark extract (group-III; 200mg/kg), and group-IV (400mg/kg); group-V animals treated with glibenclamide (5mg/kg, p.o.) following STZ treatment; group-VI, animals treated with bark extract per se (400 mg/kg).Results: The results of this study showed a significant decrease blood glucose level, glycosylated heamoglobin level, and reduction in glutathione and insulin level after STZ administration. These parameters were significantly (p<0.05) reversed by extracts dose dependently.Conclusions: Thus, authors conclude that M. alba stem bark extracts produced significant antidiabetic and antioxidant effect which might be due to the presence of bioactive components such as phenolic and flavonoid content in the extract. The study warrants the need for further evaluated in certain other models of diabetes.

A randomised study of evaluation of antiulcerogenic activity of quercetin in rats

Background: Peptic ulcer is very common disease. Peptic ulcer results probably due to an imbalance between aggressive factors (acid, pepsin, H. pylori) and defensive factors (gastric mucus, prostaglandins and bicarbonate secretion). Whatever may be the cause of peptic ulcer, it is the gastric acid that prevents ulcer healing and maintain the ulcer. Therefore, most of the drugs available for treatment of peptic ulcer either neutralize the secreted acid or decrease the acid secretion.Methods: The study was conducted on albino rats (Wistar) of 200-250g and maintained under standard conditions (room temperature 24-27oC and humidity 60-65%) with 12h light and dark cycle. The food in the form of dry pellets (Amrut Lab., hyd) and water were available ad libitum. The animal experiments were approved by the ethics committee of the institute.Results: In pyloric ligation model, the rats pre-treated with quercetin showed highly significant protection (p <0.001) when compared to control group and significant protection when compared to ranitidine pre-treated group (p <0.05). In indomethacin model, both quercetin and ranitidine pre-treated groups showed significant protection when compared to control group (p <0.01).Conclusions: In conclusion, it appears that quercetin possess anti-ulcerogenic principles like flavanoids, phenolic compound and caratinoid. These phytoconstituents provides protection against gastric mucosal damage induced by pylorus ligation, aspirin and ethanol, through inhibition of gastric acid, pepsin, histamine and free radical and stimulation of mucus secretion.

IRF6 rs2235375 single nucleotide polymorphism is associated with isolated non-syndromic cleft palate but not with cleft lip with or without palate in South Indian population / Polimorfismo de nucleotídeo único do gene IRF6 rs2235375 está associado com à fenda palatina isolada não sindrômica, mas não com fenda labial com ou sem fenda palatina em população do sul da Índia

Abstract Introduction Transcription factors are very diverse family of proteins involved in activating or repressing the transcription of a gene at a given time. Several studies using animal models demonstrated the role of transcription factor genes in craniofacial development. Objective We aimed to investigate the association of IRF6 intron-6 polymorphism in the non-syndromic cleft lip with or without palate in a South Indian population. Methods 173 unrelated nonsyndromic cleft lip with or without cleft palate patients and 176 controls without clefts patients were genotyped for IRF6 rs2235375 variant by allele-specific amplification using the KASPar single nucleotide polymorphism genotyping system. The association between interferon regulatory factor-6 gene intron-6 dbSNP208032210:g.G>C (rs2235375) single nucleotide polymorphism and non-syndromic cleft lip with or without palate risk was investigated by chi-square test. Results There were significant differences in genotype or allele frequencies of rs2235375 single nucleotide polymorphism between controls and cases with non-syndromic cleft lip with or without palate. IRF6 rs2235375 variant was significantly associated with increased risk of non-syndromic cleft lip with or without palate in co-dominant, dominant (OR: 1.19; 95% CI 1.03-2.51; p = 0.034) and allelic models (OR: 1.40; 95% CI 1.04-1.90; p = 0.028). When subset analysis was applied significantly increased risk was observed in cleft palate only group (OR dominant: 4.33; 95% CI 1.44-12.97; p = 0.005). Conclusion These results suggest that IRF6 rs2235375 SNP play a major role in the pathogenesis and risk of developing non-syndromic cleft lip with or without palate.

Resumo Introdução Fatores de transcrição constituem uma família de proteínas muito diversa envolvida na ativação ou repressão da transcrição de um gene, em um determinado momento. Vários estudos usando modelos animais demonstraram o papel dos genes do fator de transcrição no desenvolvimento craniofacial. Objetivo Nosso objetivo foi investigar a associação do polimorfismo IRF6 intron-6 na fenda labial não sindrômica com ou sem fenda palatina em uma população do sul da Índia. Método Um total de 173 pacientes com fenda labial não sindrômica com ou sem fenda palatina e 176 controles sem fendas foram genotipados para a variante IRF6 rs2235375 por amplificação alelo-específica utilizando o sistema KASPar de genotipagem de polimorfismo de nucleotídeo único. A associação entre o polimorfismo de nucleotídeo único Fator 6 Regulatório do Interferon (IRF6) intron-6 dbSNP208032210:g.G>C (rs2235375) e o risco de fenda labial não sindrômica com ou sem fenda palatina foi investigado pelo teste qui-quadrado. Resultados Houve diferenças significativas nas frequências de genótipos ou alelos do rs2235375 SNP entre controles e casos com fenda labial não sindrômica com ou sem fenda palatina. A variante IRF6 rs2235375 foi significativamente associada ao aumento do risco de fenda labial não sindrômica com ou sem fenda palatina em modelos codominantes, dominantes (OR: 1,19; IC 95%: 1,03-2,51; p = 0,034) e alélicos (OR: 1,40; IC 95%: 1,04-1,90; p = 0,028). Quando a análise do subgrupo foi realizada, um risco significativamente aumentado foi observado no grupo Fenda Palatina Isolada (OR dominante: 4,33; IC 95%: 1,44-12,97; p = 0,005). Conclusões Esses resultados sugerem que o polimorfismo de nucleotídeo único IRF6 rs2235375 desempenha um papel importante na patogênese e no risco de desenvolvimento de fenda labial não sindrômica com ou sem fenda palatina.

Sexual dimorphism using mandibular canine in establishing sex identity among Kashmiri population – A clinical study

Gender determination in forensic investigation is of immense medico legal importance especially in mass disaster. Teeth are excellent tools for identification as they are resistant to physical and chemical agents. The aim of the present study was to investigate gender dimorphism by measuring the linear dimensions of mandibular canine width and inter canine width among Kashmiri population. The study consists of 125 subjects selected from outpatient clinic of oral medicine and radiology, 64 were males and 61 were females. The age groups selected were in range from 18-24 years. There was statistically significant difference in canine width on right and left sides and inter canine distance between males and females (p value less than 0.05). These parameters can be helpful in determining the gender of the unknown deceased person in forensic investigations among Kashmiri population

Renal clearance and urinary excretion of omeprazole in healthy female volunteers in Pakistan

Omeprazole is a widely prescribed proton pump inhibitor to treat various gastric acid hyper secretion disorders. The present study was designed to evaluate the renal clearance and urinary excretion of omeprazole in eight healthy female volunteers to increase the understanding of the contributing factors such as demographics variability in the renal clearance and urinary excretion of omeprazole under indigenous conditions. The urine and blood samples were collected 0.5, 1, 1.5, 2, 3, 4, 6, 8 hours after oral administration of enteric coated omeprazole [20 mg] and drug concentration in the samples was determined by High Performance Liquid Chromatography [HPLC] with C18 column and UV detector. Urinary excretion and renal clearance of omeprazole was calculated and data was statistically analyzed by using regression/correlation technique. Endogenous creatinine was also measured by reagent kit available in the market. The results indicate that mean diuresis was 0.0172+/-0.0029 ml/min/kg. While the mean values of renal clearance of creatinine and omeprazole were 1.315+/-0.103 and 0.066+/-0.0042 ml/min. kg, respectively. Whereas, clearance ratio was 0.055+/-0.007 which indicates back diffusion. The cumulative percentage of dose excreted was 6.71+/-0.358. A significant [p<0.05] negative correlation [r= -0.457] between clearance ratio and urine pH of omeprazole reflecting glomerular filtration reabsorption of drug at kidney tubular level while significant [p<0.05] negative correlation [r= - 0.681] between clearance ratio and plasma concentration of omeprazole indicates the involvement of active tubular secretion of drug. It can be concluded that during glomerular filtration, omeprazole diffuse back/reabsorption. Therefore, Urinary excretion of omeprazole in indigenous healthy female subjects was observed to be lower than given in the literature values

Apert Syndrome: report of a rare congenital malformation

A rare case of an adult male with malformation of the skull, face, hands and feet called acrocephalosyndactly or Apert syndrome is presented. Its probable cause, features and treatment is discussed. It is a unique case who survived upto the age of 32 years without any operative intervention and adjusted in the society though he has all the stigmas of the above syndrome. We have concluded and made a point that in the adult sufferer, facial deformity is not so important and urgent for the treatment than syndactyly, which handicaps the sufferer in performing the daily routine work

Routine use of Glidescope and Macintosh laryngoscope by trainee anesthetists

Objective: to compare intubating conditions, success rate, and ease of intubation by anesthesia trainees using Glidescope Videolaryngoscope [GVL] compared to Macintosh laryngoscope [MCL]

Study Design: comparative study

Place and Duration of Study: king Khalid University Hospital, Riyadh, Saudi Arabia, from January 2012 to February 2015

Methodology: eighty adult patients ASA I and II with normal airway, scheduled to undergo elective surgery requiring endotracheal [ET] intubation were enrolled. Patients were randomly divided into 2 groups: GVL and MCL. All intubations were performed by trainee residents having experience of more than 1 year and who had successfully performed more than 50 tracheal intubations with each device. Glottic view based on Cormack and Lehane's [C and L's] score and percentage of glottis opening [POGO] score, time to successful intubation, need of external pressure, and overall difficulty scores were compared using either GVL or MCL

Results: view of glottis based on C and L's classification was better [p < 0.001] and POGO score was higher [88.25 +/- 22.06 vs. 57.25 +/- 29.26, p < 0.001] with GVL compared to MCL. Time to intubate in seconds was [32.90 +/- 8.69 vs. 41.33 +/- 15.29, p = 0.004] and overall difficulty score was less 2.78 +/- 1.39 vs. 4.85 +/- 1.75 [p < 0.001] using GVL compared to MCL

Conclusion: residents found ET intubation to be faster and easier with superior glottic view using GVL compared to MCL in patients with normal airway

Unilateral Meniere's disease; intra tympanic injection of low dose gentamicin in the treatment

ABSTRACT: Meniere's disease is chronic progressive disease with unclear idiopathic etiology and symptomatic improvements with treatment

Objectives: To analyze the efficacy of low dose intratympanic injection of gentamicin for vertigo control in unilateral Meniere's disease. Study Design: Quasi experimental study. Settings: Department of ENT, PIMS, NESCOM and IMDC Islamabad

Materials and Methods: Gentamicin was used intra tympanically in this multicentre study of 75 patients over a period of 8.5 years between 1[st] January 2005 to 30[th] June 2013 in definite Meniere's disease according to the 1995 Document of American academy of otolaryngology- Head and Neck Surgery [AAO-HNS].All these centers followed same criteria and procedures. Single dose of 1 ml Gentamicin solution 40 mg/ml was instilled in the middle ear through the grommet under microscope and followed up for 3 months and two years. The staging of disease [hearing thresholds] the degree of disability [frequency of attacks per month] and the functional level were assessed before and after treatment

Results: Among 75 patients, 41 were female and 34 were males between age ranges of 25 to 70 years. Most of the patients in the study had stage 2 [23/75] and stage 3 [41/75] Meniere's disease. About 68[91%] patients were having good control of vertigo at the end of two year of intratympanic gentamicin without any loss of hearing

Conclusion: A single Low dose intratympanic gentamicin is effective in controlling vertigo in patients with Meniere's disease with no further deterioration in hearing for at least two years follow up

A Haemodynamic Analysis to Assess the Safe Dose of Carvedilol across Different Child Class of Liver Disease.

Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear. Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis. Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response. Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively. Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were nonresponders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor. After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001). Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.

Nasopharyngeal angiofibroma? Does tumor stage influence recurrence in nasopharyngeal angiofibroma?

Juvenile nasopharyngeal angiofibroma [JNA] is an uncommon tumor constituting less than 1% of all head and neck tumors. Tumor has an aggressive local behavior if left untreated. Surgery is the mainstay of treatment with no common consensus on a single approach. Tumour stage and surgical approaches are the major determinants of tumour recurrence. To evaluate the influence of stage of tumor in recurrence in nasopharyngeal angiofibroma. Descriptive study. Department of ENT and Head and Neck Surgery, PIMS, Islamabad and Ayub medical institution, Abbottabad. Jan 2010 to Jan 2014. Consisting of 34 diagnosed cases of nasopharyngeal angiofibroma. CT-scan was done in all patients and were treated surgically except one patient who was irradiated. All patients were followed up for one year. Among 34 patients, 24 patients were classified as stage III, 4 were in stage II and 5 were in stage IVa and one in stage IVb. 17.6% [6/34] of patients had disease recurrence. Stage IVb was treated by radiotherapy while the rest were treated surgically. Patients were followed up for one year both by clinical examination and imaging. Recurrence was found in 5 operated patients and residual disease in stage IV b. 1 [20%] patient of stage Iva disease and 4 [16%] patients of stage III disease had disease recurrence. Disease recurrence/ residual is directly related to the tumour stage in nasopharyngeal angiofibroma

Knowledge and practice of implant-retained restorations among dental students in Saudi Arabia

The aim of the study was to assess the knowledge and practice of implant retained restorations [IRR] among senior dental students in Saudi Arabia. Four hundred questionnaires were distributed among senior dental students of five dental schools in Saudi Arabia. Student's knowledge was assessed regarding which implant restoration [cement retained restoration [CRR] or screw retained restoration [SRR]] better provides the desired clinical properties. Students' practice of IRR, perception of their knowledge and need for further education related to IRR were also assessed. Descriptive statistics and chi-square test were employed to assess collected data. Three hundred and fifty four senior dental students responded at a response rate of 88.5%. Thirty three percent respondents did not have any practical experience of IRR. Students showed a clear preference for CRR with regards to aesthetics [71.4%], passive fit [55.3%], fabrication ease [57.3%] and fracture resistance [40%]. SRR were considered to provide better retention [59.6%], soft tissue health [51.1%] and ease of retrievability [72%]. Nearly 40% of students agreed that they did not get sufficient information related to IRR in undergraduate courses. Clinical training of IRR is compromised in the undergraduate curriculum in dental schools of Saudi Arabia. The knowledge of dental students regarding IRR was broadly in line with current evidence

Localized benign lesions of oral cavity: a clinicopathological study of 95 cases: a retrospective analysis 2012-2014

The purpose of this study was to establish frequency and distribution of different histopathological aspects of biopsies of oral localized benign lesions [fibrous or haemorrhagic]. Ninety-five cases of oral biopsies obtained over a period of one year and 7 months from 1st June 2012 to 31st January 2014 at Government Dental College and Hospital, Srinagar were retrospectively reviewed. The lesions were classified into either fibrous or soft hemorrhagic lesions. Clinical data regarding age, gender, characteristics [site, color, size, surface, consistency and base] of lesions were obtained for each case. Of all the 95 cases studied clinically 69 [72.6%] were histologically diagnosed as fibrous and 26[27.4%] were found to be soft haemorrhagic lesions. Among the fibrous lesions, irritational fibroma was the most frequent [81.2%] and among the hemorrhagic lesions pyogenic granuloma [65.4%] was found to be the most frequent. Majority of the fibrous lesions were located in the buccal mucosa [30.4%] and the greater number of soft hemorrhagic lesions were located on the maxillary gingiva [53.8%]. From the study it can be stated that with regard to frequency and distribution, we found significant differences with respect to gender, age and location between the different oral lesions. The data presented in this study can be used to develop a clinical impression of such lesions frequently faced by the oral physician

Comparison of the effect of pre-operative single oral dose of Tramadol and Famotidine on gastric secretions pH and volume in patients scheduled for laparoscopic cholecystectomy

To evaluate and compare the effects of pre-operative single oral dose of tramadol and famotidine on gastric secretions pH and volume in patients electively scheduled for laparoscopic cholecystectomy. Randomized control trial. Department of Anaesthesia, King Saud University Riyadh, Saudi Arabia, from August 2011 to June 2013. Ninety adult, ASA-I and II patients scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned to receive pre-operatively either placebo [Group-C, n=30], oral tramadol 100 mg [Group-T, n=30] or famotidine 40 mg [Group-F, n=30]. After induction of general anaesthesia, gastric fluid was aspirated through orogastric tube. The gastric secretions volume and pH was measured using pH meter. There was no statistically difference between groups in age, weight and gender. The gastric secretions mean pH was 2.06 +/- 0.22,2.04 +/- 0.20, 5.79 +/- 0.77 and volume was 0.59 +/- 0.17, 0.59 +/- 0.14 and 0.28 +/- 0.16 ml/kg in Group-C, Group-T and Group-F respectively. There was a significant statistical difference in the mean pH values between Group-C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. Statistically significant difference was also found in the mean gastric secretions volume between Group - C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. There was no significant difference in the mean gastric fluid pH values [p=0.99] and mean gastric secretions volume [p=0.99] between Group-Tand Group-C. As compared to famotidine, pre-operative single oral dose of tramadol was unable to elevate the desired level of gastric fluid pH [> 2.5] and decrease in gastric secretions volume [< 0.4ml/kg]

Laparoscopic cholecystectomy in acute gallstone pancreatitis in index hospital admission: Feasibility and safety

Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease [Ranson Score <3] and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11727. 22 [57.8%] patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten [26.3%] patients were referred for ERCP and endoscopic sphincterotomy and 11 [28.9%] were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days [range 4-10]. Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded, two patients [9%] had minor complications. Laparoscopic cholecystectomy can be safely performed in selected cases of mild gallstone pancreatitis in order to prevent further attacks of acute pancreatitis and Other consequences Of d6l3y8[] treatment. Furthermore it resolves the problem of noncompliance of patients in third world countries where many patients are lost for definitive treatment

State of health; assessment in Pakistani labor force in Gulf states

The plight of surgical diseases in Pakistani workers in the gulf countries is highlighted. To highlight the health problems of Pakistani workers in GS. It is done by taking the information from the expatriates returning from the gulf states who present to us in the foundation hospital, Rajana, district Toba Tek Singh [TTS], for the treatment of various surgical illnesses. It is concluded that Pakistanis working in the gulf countries are not satisfied by the treatment received in those states. Only one out of 50 patients was satisfied with the treatment he got for his disease

Cholecysto hepatic duct; a rare case presentation

A rare congenital anomaly of extra hepatic biliary tract is presented. Its embryology and treatment is discussed. It is concluded that every abdominal surgeon should be aware of such extra hepatic anomaly in detail to avoid prolonged drainage of bile from the drainage tube, even death after cholecystectomy