Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Comparison of lipid profile and apoprotein in sedentary workers and those involved in regular exercise

One of the important effects of exercise on human body is on the metabolic system especially on lipids; elevated lipids and lipoprotein are risk factors for coronary heart disease. This case-control study was conducted to compare the lipid profile and apo-protein B levels in sedentary workers and subjects involved in regular exercise. The study was conducted at Women Medical College Abbottabad, from July 2004 to January 2005. Subjects were civilians and army men involved in regular exercise for more than 6 months duration [test group] and sedentary workers [control group]. The age, body weight, height, waist hip ratio and other related findings were recorded on a special proforma. Fasting blood samples were taken and were analyzed for lipid profile and apoprotein B levels. Statistical analysis was done by the Chi square and the Student t tests and level of significance was recorded. The subjects comprised 29 army men, 24 civilians and 39 sedentary workers. Significant differences were found between the control and test groups for WHR, total cholesterol, HDL, LDL, Triglycerides, Apo B, and Cholesterol/HDL ratio; in addition the civilian group also showed significant differences from the control group in BMI values. Although LDL levels were lower in army than sedentary group, the difference was statistically nonsignificant. Significant differences were found between the army and civilian groups in age, HDL, Triglycerides and Apo B values. Long term aerobic exercise has beneficial effects in decreasing Apo- protein B levels, LDL levels and total cholesterol /HDL ratio. Exercise habits should be encouraged in general population to decrease the cardiovascular disease risk

Homicidal deaths by firearms in Dera Ismail Khan: an autopsy study

Determine homicidal deaths due to firearm injuries in the district of Dera Ismail Khan [D. I. Khan] of the North West Frontier Province [NWFP] of Pakistan. District Head Quarters [DHQ] Teaching Hospital and the Department of Forensic Medicine and Toxicology of the Gomal Medical College. D. I. Khan. The study was conducted over 1 year. Data collected included all reported unnatural deaths from the urban areas of the district on which autopsies were conducted in the department. A total of 97 autopsies were conducted in 2004 of which 63 were homicidal deaths [64.9%]. All homicidal deaths were caused by firearm injuries and all were males. The most common firearm weapons [87.3%] were high velocity firearms [Kalashnikov, rifles, pistols] followed by low velocity rifled weapons [9.53%] and shot guns [3.17%]. A total of 77 injuries were found on different areas of the bodies, giving an average of 1.2 injuries per person. The head, neck and face sustained the highest number of injuries [49.1%], followed by thorax and abdominal area [19.4% and 18.1% respectively]. Extremities including buttock and genital areas were least affected [18.1%]. All reported homicides were caused by firearm injuries. The issues of possession of legal as well as illegal firearms and their use in cultural activities needs to be changed in order to reduce violent deaths

Epidemiological risk factors and composition of urinary stones in Riyadh Saudi Arabia

The purpose of this study was to perform the chemical analysis of stones to know the pattern of biochemical composition of stones and to determine epidemiological risk factors for stone formation in Riyadh Saudi Arabia. 307 renal stones were analyzed during one year period from September 2000 to August 2001. These stones were sent to central lab Riyadh for analysis from different hospitals attached to this region. The stones were analyzed by semiquantitative method. The kits supplied by Maascia Bruneli SPA. [Italy] was used for chemical analysis of stones. The powered stones and standards both were analyzed for uric acid, cystine, oxalate, carbonate, phosphate, ammonia, calcium and magnesium contents. Male to female ratio was 5:1. The stone frequency was 2.5 times more in Saudis as compared to non-Saudis. Maximum number of stones were analyzed in peak summer months. Calcium oxalate stones were the commonest followed by uric acid and phosphate stones. No cystine stone was found in the series analyzed. From the study of epidemiological factors it seems that the Saudis are more prone to development of stones. A clear stone season seems to exist in the area corresponding to the summer months. The relative increased frequency of stones in the region indicates that nutritional, environmental and genetic factors play a role in the occurrence of stones

Intussusception in infants and children - an analysis of 130 cases in Abbottabad and Hazara division

Intussusception is the commonest cause of intestinal obstruction in children. We reviewed 130 cases over a period of 10 years at DHQ hospital, Abbottabad to assess their mode of presentation, methods of investigation, management and out come. A retrospective review was performed of the case notes of presentation, investigation, management and subsequent out come. Although majority of patients presented with the classical triad of abdominal pain 88%, vomiting 82% and rectal bleeding 54%. There were some who varied in their mode of presentation. A presumptive initial diagnosis of infective diarrhoea or colitis and referral for a medical rather than surgical opinion was made in 86 [69%] cases. Hydrostatic reduction was done in 79% of cases, 29 being successful. Laparotomy was done in 101 cases. In 6 patients [6%] spontaneous reduction occurred between barium enema reduction and subsequent laparotomy. Simple manual reduction after laparotomy was done in 45 cases. Resection of the gangrenous intestine was done in 13 patients. In the rest of 37 patients, various operations like right hemicolectomy and appendectomy were done. The male to female ratio in our series was almost equal. No variation in the relationship between incidence and season or type of feeding was found. Ilecocolic intussusception was found to be the commonest type at the laparotomy in our series

Bone marrow changes in human malaria: a retrospective study

The bone marrow reports of 1966 patients admitted to a provincial teaching hospital between January, 1992 to April, 1995 were retrospectively analyzed. Twenty-six [1.3%] bone marrows showed the presence of malarial parasites. Sixteen [62%] patients had Plasmodium falciparum 9 [34%] Vivax malaria and one [4%] mixed infection. All these patients gave a history of prolonged illness and had low parasite counts. Plasmodium vivax malaria was not associated with any significant pathology in the bone marrow, except iron deficiency anaemia. The bone marrows with Plasmodium falciparum malaria showed myeloid hyperplasia, erythroid hyperplasia, megaloblastosis and hypoplasia in different proportions. No evidence of dyserythropoiesis was found in this series. The possible mechanisms producing these changes and the factors responsible for the discrepancy in bone marrow findings in different geographical areas are discussed

Tumor necrosis factor in falciparum malaria

To investigate the relationship of TNF alpha levels to Plasmodium falciparum [PF] infection, plasma TNF alpha concentrations were measured in Pakistani adults and children with mild, severe, cerebral and chronic falciparum malaria and healthy [control] subjects. The initial geometric mean plasma concentrations of TNF alpha in adult patients with severe malaria [187.6 pg/mL] were significantly higher than mild malaria patients [87.1 pg/mL, P < 0.001]. TNF alpha levels were not correlated to parasite density, cerebral malaria, young age, hypoglycemia or fatal outcome; however, they were associated with severe anemia, and hepatic and kidney dysfunction. TNF alpha levels were not significantly increased in 16 patients with hyperparasitemia and were significantly elevated [P < 0.02] in chronic malaria patients as compared to control subjects. TNF alpha levels were elevated independently in patients with anemia, hypoglycemia [P < 0.001, P < 0.05], and hepatic and kidney [P < 0.001 each] dysfunction. In this study, high TNF alpha levels were associated with several manifestations of severe malaria and were not specific to cerebral malaria and hyperparasitemia

Falciparum malaria-an experience with 100 cases

Clinical details and present day problems faced in 100 cases of Falciparum Malaria [FM] are reported. Eleven percent had taken chloroquine prior to reporting to us. The parasite density lacked correlation with the severity of disease. Pattern of fever varied markedly but 10% were afebrile throughout and presented only with body ache and malaise. Cerebral malaria was present in 11% patients. Jaundice was present in 18% patients. Other symptoms were vomiting 44%, severe headache 12%, pain abdomen 7%, loose motions/dysentery 11%, and cough 8%, while bleeding diathesis was present in 7% [3 melena, 2 epistaxis, 1 bleeding gums and 1 haematuria]. Severe anaemia was present in 10% of cases. Splenomegaly was present in 65%, hepatomegaly 29% and hepatosplenomegaly 21%. Congenital malaria was present in only one [1%] patient. Mild malaria patients were treated with chloroquine, while severe malaria patients were cured with quinine for 7 days. Blackwater fever was present in 2%. Patients with blackwater fever were cured with steroids and chloroquine. 12% patients had chronic malaria. 83% of these patients presented with anaemia. Self medication, haphazard therapy and the slogan "Fever May Be Malaria, Take Chloroquine" can lead to problems in Falciparum Malaria. Clinical immunity and parasite strain may act as virulence factors

prospective study of enteropathogens and their sensitivity pattern in children with bloody diarrhoea/dysentery at Peshawar

Over a six months period, 1262 children with diarrhoea were studied prospectively at Postgraduate Medical Institute, Lady Reading Hospital Peshawar. This accounted for 19.4% of total admissions in the Paediatric Unit during the study period. One hundred and ten stool samples of children with bloody diarrhoea/dysentery were evaluated for enteropathogens and their sensitivity pattern. Out of the 110 samples, 29 samples [26.36%] yielded bacterial growth, with Shigella in 19[17.27%], E.coli in 8 [7.27%] and Salmonella in 2 [1.82%]. All organisms were found to be resistant to Co-trimexazole, Ampicilin and gentamycin, while all, except one were found sensitive to Nalidixic acid

Study of risk factors in coronary heart disease

Study of risk factors was conducted in 92 patients suffering from acute attack of myocardial infarction, admitted to Coronary Care Unit, Mayo Hospital, Lahore. The diagnosis of infarction was based on clinical history, ECG findings, enzyme and isoenzyme studies. Among the major risk factors smoking was at the top and 67per cent of patients were smokers. Hypercholestrolaemia was found in 30 per cent, Hypertension in 16 per cent and Diabetes mellitus in 14 per cent of patients. The role of minor risk factors like age, sex, occupation, genetics and stress was also studied. The age range was 20-89 years

Study of lipoprotein profile in myocardial infarction

Serum cholesterol and lipoprotein levels were measured in thirty patients of myocardial infarction [23 males and 7 females] admitted to a coronary care unit Mayo Hospital Lahore. The patients were divided into two main groups, which were further classified in various subgroups according to age. The results were compared with eighteen healthy males and five female subjects. The serum cholesterol was higher in all age groups in patients than in normal controls. The HDL cholesterol concentration was lower in patients with different age groups of either sex when compared with healthy controls. The inverse relationship of HDL cholesterol in patients with myocardial infarction was evident