Thrombotic Thrombocytopenic Purpura: our clinical experience

Objectives: To assess clinical presentation and outcome of patients with thrombotic thrombocytopenic purpura [TTP] in our setup

Study Design: Descriptive study

Place and Duration of Study: Combined Military Hospital [CMH] Peshawar, from Feb 2016 to Aug 2017

Patients and Methods: In a prospective design, patients diagnosed to be suffering from TTP, were included in this study. Detailed history along with physical examination and thorough investigation of all cases was carried out and collected on proformas. The diagnosis of TTP in our study was done by demonstration of significant schistocytes [more than 1 percent] on peripheral blood film. The patients were treated with steroids and plasma pheresis and in some cases with weekly Rituximab for 4 weeks. The patients were followed up in outdoor clinic on monthly basis

Results: Being a very rare disease, only 11 patients suffering from TTP reported during the study period. They were followed prospectively with a mean duration of follow-up of 11.23 months [ +/- SD 5.57]. All patients [100 percent] had anaemia, thrombocytopenia and acute kidney injury. Fever was seen in 54.4 percent patients and 63.6 percent patients had neurological involvement. A likely secondary cause of precipitation of TTP was found in 54.5 percent cases. The mortality rate was 18.2 percent

Conclusion: TTP is a challenging disease for intensive care specialists and can be fatal without effective treatment. A high index of suspicion followed by early diagnosis and prompt treatment can save life. Documentation of deficiency of plasma ADAMTS13 activity is not essential for the diagnosis of TTP and plasmapheresis is the treatment of choice

frequency of smear positive malaria and socio-demographics factors of patients visiting the microscopy center of a tertiary care civil Hospital, Khairpur

Objective: The aim of the study was to determine the frequency of smear positive malaria and sociodemographic factors of patients visiting the Microscopy center of Civil hospital Khairpur

Methods: A cross-sectional study was conducted January 2016 to April 2016 by using structured questionnaire to assess frequency of smear positive malaria among patients visiting Microscopy center of Civil Hospital Khairpur. About 138 patients who were prescribed Malaria Parasite [MP] Test by the doctors were selected by using consecutive sampling technique and interviewed regarding their socio-demographic characteristics. Data was entered and analyzed by using SPSS version 21

Results: Out of total 138 participants, 55.5% were males, Majority were less than forty years of age with highest range of 25-40 years. Malaria parasite test was found to be positive in 6.5 % participants and the most common identified species was Plasmodium Vivax

Conclusion: This study suggests that Malaria is endemic in certain areas of Khairpur District and Plasmodium Vivax is the most common species affecting the people who visited Microscopy centre for the Malaria Parasite [MP] test. Health education and community participation would be needed to eliminate the Malaria from community

Incidence of bony injuries among medicolegal cases at forensic medicine department, nishtar medical college, multan

To evaluate the incidence of bony injuries and soft tissue injuries among the medicolegal cases reviewed at the forensic medicine department, NMC, Multan

Material and Methods: A study of 397 medico legal cases was carried out at Forensic medicine department, N.M.C Multan during the month of October, November, December 2007, to evaluate the incidence of bony injuries and soft tissue injuries

Results: It was observed that male cases were dominant and cases of fight were also predominant and were the leading cause of injury, while the second commonest cause was road side accidents. The most common bony injuries in the form of fractures were related to the skull and face, while the second commonest were those related to the fractures of long bones, including tibia, fibula, radius and ulna

Pharmacognostic studies on roots of Operculina turpethum Linn

Adulteration of drug is a huge problem when using herbal drugs in disease condition and utilization of herbal drugs in such condition is not free from doubt. In this paper we have presented the methods of standardization [macro and microscopic features, fluorescence characteristics under UV light and quantitative analysis on the basis of colour reactions] of Operculina turpethum Linn, root to establish the quality and purity of this valuable and popular remedy which is beneficial in a variety of disorders

Prophylaxis of postoperative nausea and vomiting: a comparison of droperidol alone with droperidol plus dexamethasone combination

Adequate control of postoperative nausea and vomiting [PONV] and early return to normal activity are important anesthetic goals. We compared the efficacy of droperidol alone with droperidol plus dexamethasone combination for preventing PONV. A prospective, randomized, double-blind study. June 2002 to November 2004, at Department of Anesthesiology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz [Iran]. Two hundred, ASA grade I-II, ambulatory gynecological surgical patients of ages 18-70 yrs received 2.5 mg of droperidol at the time of induction of general anaesthesia. At the end of the operation, group A [n = 100] received 2 ml of intravenous isotonic electrolyte solution [0.9% sodium chloride] and group B [n = 100] received 2 ml of intravenous dexamethasone [8 mg]. A standard general anesthetic technique and post op analgesia were used throughout the operation. PONV were assessed 2, 4 and 12 hours after the operation. The incidence of postoperative nausea decreased significantly in group B as compared to group A [23% vs. 49%], as was the incidence of vomiting [12% vs. 39%] [p - 0.014]. Mean duration of nausea was 34 minutes in group A and 23 minutes in group B [p < 0.001]. We conclude that addition of 8 mg of dexamethasone to droperidol prophylaxis is more effective than droperidol prophylaxis alone for successful control of PONV

Anterior cage fixation for dorsal spine injuries - one year study

This study was conducted during the year 2004 at Lahore General Hospital, Unit 1, department of Neurosurgery. We operated on 37 patients for thoracic cage interbody fixation after trauma. Age range was from 15 to 70 years. Maximum number of cases [41%] was between 21-30 years of age. Male involvement was seen in 29 [79%] patients. Majority [65%] belonged to rural community and agriculture and industry were the major setup of injury. Majority belonged to poor socioeconomic class i.e., 83% [31]. Level of injury was 37% upper dorsal spine, Main fracture types were burst fractures, compression fractures and fracture dislocations. Correction of deformity was achieved in majority of cases. Associated chest injuries were seen in 28% cases. Timing of surgery was as early as possible but it ranged from 2 hours to as long as 3 months. Neurological deficit ranged from complete paraplegia to power grade 4. Complications of the procedure are cage displacement in 6%, loosening in 5% and infection in 8%. Neurological statu s improved in 88% while kyphosis improvement occurred in 77% of the patients. Anterior cage fixation is a safe and effective treatment method for traumatic dorsal spine instability involving vertebral bodies

Management of idiopathic detrusor instability by bladder drill

Detrusor instability which is characterized by involuntary detrusor contraction is managed by behavioral-oriented technique so called bladder drill. Twenty patients were treated by bladder drill for eight weeks, 09<45%] had complete cure and 11<55%] had partial cure of their symptoms when compared both before and after treatment. Overall success was found to be 100%

Clinical chemistry laboratory testing; Evaluation at Quaid-E-Azam medical college, Bahawalpur after autonomy

To determine the affect of autonomy on clinical chemical testing in pathology department Quaid-i-Azam Medical College and to assess the change in the attitudes of laboratorians and physicians Retrospective and comparative. 1-11-93 to 01-11-03. A retrospective study was carried out from 1-11-93 to 01-1103 in which records from 1-11-93 to 1-11-03 were collected and evaluated. Separate record of each month's revenue from clinical chemistry section was calculated. In order to determine what changes have been brought about after autonomy a universal questionnaire was used to assess the attitudes of physicians and surgeons of hospital inquiring whether they noticed any improvement in the efficiency of clinical chemical test results after autonomy. 620 doctors were interviewed through structured questionnaire. The questionnaire was designed to assess the knowledge, attitude and practices of doctors towards autonomy. In order to determine that who is the most beneficent of autonomy, different records were collected and discussions were made with consultants. Autonomy brought about a healthy change in the staff of clinical chemical section. Quality control has improved the morale of lab staff since technical deviations are more readily identified and corrected within the lab, gross errors are rarely found by the clinicians and so their respect for and confidence in the lab has strengthened Replenishment of chemicals/reagents are timely made. The number of available test has significantly increased which in turn has significantly raised the revenue generated since autonomy is awarded. Pilferage of chemicals has been stopped. Turn around time has been decreased. Clinical Chemical section participates in External Quality Assessment Scheme, NEQAPP [National External Quality Assessment Program Pakistan], which is an essential pad of the routine of a well-run lab. Patient is the most beneficent since autonomy is awarded to QMC/BVH, BWP. A significant improvement in the efficiency of the analytical performance has strengthened the faith of laboratorians and physicians in the test results after autonomy

Unusual presentation of echinococcal cysts

We report a case of echinococcal disease affecting the brain and the kidney. The case is unusual because of multiplicity of the intracerebral lesion and sparing of the liver and lungs. The intracerebral lesion was presented with epileptic convulsions. This was successfully treated surgically. Subsequently renal echinococcal cysts were identified. These were treated by partial nephrectomy due to the location of the cysts. The patient is disease free at 8 years

Upper urinary tract stone disease in children

The urolithiasis has become a significant health problem in our population. Symptoms of urinary calculi in children vary with age. Treatment option should be directed towards renal parenchyma. OBJECTIVE: To find out various modes of presentation. To find out the advantages of to treatment modalities in children with urinary stone disease. SETTING: The study was conducted in urology department Mayo Hospital Lahore. STUDY DESIGN: Forty children below the age of fourteen years with upper urinary tract stone disease were studies in two groups. Group A thirty patients were treated by open surgery and Group B ten patients with extracorporeal shockwave lithotripsy. PERIOD: Oct 1996 to Sep 1997. Results showed 97% success rate in open surgery and 80% in ESWL. CONCLUSIONS; ESWL is a safe, non invasive and effective modality in small sized stones in children. Traditional open surgery may be the preferred treatment for paediatric urolithiasis in a developing country like Pakistan because of poverty, poor long term follow up due to lack of health education and infrequent availability of the facility in government sector