The role of hyperbaric oxygen therapy in Fournier's Gangrene: A systematic review and meta-analysis of observational studies

ABSTRACT Purpose: Management of Fournier's Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG. Materials and Methods: This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis. Results: There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 - 0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95% CI: -7.68 - 7.33; p=0.96) and the number of debridement procedures (MD 1.33; 95% CI: -0.58 - 3.23; p=0.17) were not significantly different. Conclusion: HBOT can be used as an adjunct therapy to prevent an increased risk of mortality in patients with FG.

Effect Of Low-Impact Aerobic Dance And Zumba Exercises On Body Fat Percentage In Obese Women

@#The purpose of this study was to examine the effect of low-impact aerobic dance and zumba exercises in reducing the percentage of body fat in obese women in terms of the Body Mass Index (BMI). Forty obese women (mean age 33.9±7.1 years) were selected and divided into two experimental groups, namely: low-impact aerobic dance (n=20) and zumba (n=20). The participants were also divided based on the BMI which gave the mild and severe obesity groups. The research instrument was a skinfold caliper which was used to measure the thickness of the body fat. The experiment was carried out 3 times a week for 8 weeks and the participants from both groups performed exercises for a duration of 60 minutes. The analysis of data between the experimental groups showed that there were significant differences between these exercises (r=0.005; p<0.05), the levels of obesity (r=0,000; p<0.05), and there were interactions between the exercises and the levels of obesity (r=0,000; p<0,05), from the pre-test to the post-test. The results showed that low-impact aerobic dance was more effectively used in reducing the percentage of body fat in obese women at the severe levels while zumba was effectively used in reducing the percentage of body fat in obese women with mild obesity, therefore the two exercises had an influence in reducing the percentage of body fat.

Mini Hydrocelectomy – Outcome of A Short Term Study and Comparison with Conventional Jaboulays Technique

Background: Hydrocele is among the commonest benign conditions of scrotum. Its incidence is around 1% in adult male population with a predilection for males above 40 years of age. Conventional surgical procedures like Jaboulays Eversion of Sac (EOS) and Lords plication of redundant tunica vaginalis remain the most commonly used procedures used in the treatment of idiopathic adult hydrocele. Both procedures are invasive and are associated with durable success and low incidence of recurrence. These procedures are however associated with many post-operative complications like pain, hematoma, infection, persistent swelling and induration of scrotal skin, wound related complications, chronic pain and reduced fertility. All these translate into high morbidity, loss of work hours and increased surgical expenses. To avoid / minimize these complications associated with plication or excision of the redundant hydrocele sac fenestration has been proposed as a minimal access procedure. Fenestration exposes the secretory surface of the tunica vaginalis sac to the lymphatic-rich subcutaneous tissues, from where the hydrocele fluid is cleared off the scrotal cavity.  Methods: The present study was carried out in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard during the time period of June 2014 - December 2015. 120 patients of primary vaginal type hydrocele with ASA grade 1 were randomly allocated into two groups of 60 patients each – one group for the Mini-Hydroceletomy MiH-(Group A) and the other group for routine Jaboulays EOS (Group B). All the patients were followed up for a period ranging from 6-18 months. Results: Mean age of patients was 42 years for jabouleys and 45 for mini hydrocelectomy group. Mean hydrocele volume for Group A was 240 ml and for group B was 252 ml. Average time for the procedure in group A was 10-12 min (mean 11min) and for group B was 25 -30min (mean 27min). In Group A, Average incision length was 2.1 cm whereas in Group B it was 5.4 cm. Conclusions: We hereby present our experience that mini-hydrocelectomy (MiH) technique to be the procedure of choice for medium sized uncomplicated hydroceles.

Diagnostic accuracy of diffusion weighted magnetic resonance imaging in malignant breast lesions, keeping histopathology as gold standard

Objective: To determine the diagnostic accuracy of Diffusion Weighted Magnetic Resonance Imaging/Apparent and Diffusion Coefficient [DWI/ADC sequences] in malignant breast lesions taking histopathology as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Combined Military Hospitals Quetta and Peshawar, from Sep 2013 to Mar 2015 and Armed Forces Institute of Radiology and Imaging Rawalpindi, from Apr 2015 to Dec 2015

Material and Methods: After informed consent, patients scheduled for biopsy of a suspicious breast lesion on sonomammography and/or mammography [BIRADS IV and V], fulfilling the inclusion criteria were evaluated with breast MRI including Diffusion Weighted Imaging [DWI] sequence using b-values of 0 and 750 mm[2]/sec. Apparent Diffusion Coefficient [ADC] values for the breast lesions were also calculated. MRI findings were correlated with histopathological results

Results: A total of 299 cases were included in the study. Mean age of the study population was 45.73 years [SD +/- 15.02] with a range of 18 to 89 years. On histopathology 77.9% [n=233] lesions turned to be malignant and 22.1% [n=66] were benign. On DWI 73% [n=219] lesions showed restricted diffusion and were labeled malignant while 27% [n=80] lesions showed facilitated diffusion and were considered benign. The mean apparent diffusion coefficient value of the malignant breast lesions was significantly lower than that of the benign breast lesions [p-value<0.001]. The calculated sensitivity, specificity, positive predictive value and negative predictive values of DWI/ADC mapping in differentiating between malignant and benign lesions were 92.2%, 93.9%, 98.1% and 77.5% respectively. The diagnostic accuracy was found to be 92.6%

Conclusion: DWI is a non-invasive diagnostic modality for diagnosing malignant breast lesions. It can be used to reduce the number of unnecessary biopsies and it may help in reaching a definite diagnosis in cases where a suspicious breast lesion cannot be biopsied because of its small size or unsuitable location

In vitro antioxidant and hepatoprotective activities of Paeonia emodi [Wall] rhizome methanol extract and its phenolic compounds rich fractions

The present study aimed to quantify the total phenolic content in Paeonia emodi rhizome methanol extract and its fractions and then evaluate the in vitro antioxidant and hepatoprotective activities of fractions rich in phenolic compounds. Maximum quantity of total phenolic content was observed in butanol [112.08 +/- 5.5 mg GAE/g dw] and chloroform fraction [107.0 +/- 3.5 mg GAE/g dw] followed by methanol extract [94.2 +/- 4.4 mg GAE/g dw], aqueous fraction [92.9 +/- 2.5 mg GAE/g dw], ethyl acetate [62.3 +/- 8.3 mg GAE/g dw] and n-hexane fraction [51.6 +/- 7.2 mg GAE/g dw]. The fractions rich in total phenolic content were evaluated for in vitro antioxidant activity based on 2, 2-diphenyl-1-picrylhydrazyl [DPPH] scavenging assay. The butanol and chloroform fraction showed significantly [P<0.05] higher radical scavenging activity with IC50 values of 6.5 and 7.05 +/- 2.5 ppm respectively. Positive correlation [R square=0.95] was observed between total phenolic content and in vitro antioxidant activity. The fractions rich in phenolic compounds were also evaluated for their hepatoprotective activity in paracetamol intoxicated mice. Five days oral administration of these fractions at a dose of 300 mg/kg body weight restored the serum ALT, AST and ALP levels of paracetamol intoxicated mice to normal level. From the results of the present research it was concluded that the butanol and chloroform fractions of P. emodi rhizome methanol extract are rich in phenolic compounds and strong antioxidant and effective in attenuation of hepatotoxicity

A brief review on medicinal plant Tagetes erecta Linn.

Medicinal plants, its derivatives and characterized secondary metabolites are widely used for medicinal purposes, are becoming popular all over the world as a natural alternative to synthetically produced chemicals both in Traditional and Allopathic system of medicine. The beneficial effect of herbal medicine typically result from the combination of secondary metabolites produced in the herbs such as glycosides, alkaloids, flavonoids, tannins, gums etc. There is a need for the documentation of research work carried out on these herbs, hence forth timely review on the herb Tagetes erecta Linn. Methodology used in the review is based on the published original research articles through exhaustive search through scientific databases; Saudi Digital Library, Pubmed, and Science Direct etc. Reviewed parameters are ethonomedicinal uses chemical constituents and pharmacological and non Pharmacological studies on medicinal plant Tagetes erecta Linn.

Enlarged solitary neck node: a study of 75 patients

The objective of the study was to evaluate the causes of enlarged solitary lymph node of wore than one month duration in the neck. This study was conducted at Departments of ENT and Head and Neck Surgery Postgraduate Medical Institutes, Peshawar from January 2005 to Dec, 2006. A total of 75 patients were included. All the patients were evaluated through detailed history and clinical examinations. Beside these, laboratory, radiological, endoscopic. Fine Needle Aspiration Cytology and histological studies were performed. A total of 75 patients with mean age of 35 years were studied during this period Male to female ratio was 1.2:1. Out of 75 patients, 29 [39%] were metastatic, 27 [36%] tuberculous, 16 [22%] had lymphoma and 1 [1.5%] each of toxoplasmosis, infectious mononucleosis and sarcoidosis. As malignancy was the commonest cause of solitary neck lymphadenopathy, so every patient especially old age group should he properly investigated to exclude metastatic diseases

Treatment of muscle invasive bladder tumor comparison between chemotherapy and cystectomy

Bladder Tumor is the second most common cancer of the genitor-urinary tract. Male to Female ratio: has been demonstrated as 3.5:1. To compare the efficacy of combined chemotherapy/or radical cystectomy with or without urinary diversion. The present study was conducted on 26 consecutive patients of either age and sex having histologically proven muscle invasive transitional cell carcinoma of the bladder .These patients were selected from different hospitals in Lahore including Lahore General Hospital, Mayo Hospital, Shaikh Zaid Hospital, and Services Hospital from 1994-1996. These patients were thoroughly investigated. At the initial diagnosis 18-30% of patients of bladder tumors are muscle invasive and 70% superficial. Although radical cystectomy is the treatment of choice for invasive bladder tumor, bladder-sparing technique are more often being used e.g. TURGB and Intra-vesicle chemo/immunotherapy in superficial bladder cancer, TURGB and Systemic chemotherapy in muscle invasive tumor. The use of combination Chemotherapy in advance disease is routine e.g. CMV and MVAC. In our present study a total of 26 consecutive patients of either age or sex having histologically proven muscle invasive tumor of bladder were included. These patients were collected from different hospitals at Lahore, from 1994 to 1996. Out of these 26 patients, 13 patients were included in group-A, [they were given MVAC chemotherapy] and the remaining 13 patients were included in group B, [in these patients cystectomy and urinary diversion were done]. It is concluded that the result using combined Chemotherapy MVAC are better [20%] as compared to total cystectomy/urinary diversion [12.23%] after one year follow up

Efficacy and safety of intra-vesical B.C.G in superficial bladder tumor after TURGB

To determine the effectiveness, safety and side effects of intra-vesicle B.C.G immuno-therapy in superficial bladder tumor after TURGB. Observational study / Quasi-experimental. Bolan Medical College Teaching Hospital Quetta, from August, 2004 to July, 2008. Patients age ranges from 40 to 75 years.21 males and 4 females, with proven superficial bladder tumor [Ta-Tl]were included after TURGB in this study. These 25 patients underwent intra-vesicle immunotherapy [BCG.].These patients were followed up for two years and extent of improvement in presenting symptoms, recurrence of tumor, side effects and complications were noted. Out of 25 patients 23 patients [92%] received BCG immunotherapy after TURGB. Out of these 23 Patients 15 patient [65.2%] showed complete response and 6 patients [26.08%] showed partial response while remaining 2 patients [8.69%] had constant progression in disease and underwent cystectomy. It was concluded that B.C.G immunotherapy is very effective and save patients from recurrence and cystectomy

Presentation of nasopharyngeal carcinoma

To know the common and early presenting features and the presenting age of nasopharyngeal carcinoma. Material and This was a descriptive study. The study was done at the ENT department Hayatabad Medical Complex, Peshawar from 1st January 2001 to 31st December 2001. A series of 50 patients admitted to the ENT department Hayatabad Medical Complex, Peshawar were included in the study. A questionnaire was made to collect all the necessary information and data regarding the disease from patients. All the patients had thorough physical examination and were subjected to all the available investigations. The average age of presentation for male patients was 42 years and females 35 years. Thirtyfour were males and sixteen females. Out of 50 patients, 38 [76%] presented with neck mass, 28[56]% with aural symptoms, 30[60%] nasal symptoms 22[44%] had other miscellaneous presentation like headache, diplopia, neuropathies, hoarseness, dysphagia etc. Nasopharyngeal carcinoma can occur in both sexes with no age exemption. By knowing the various presenting modes of Nasopharyngeal carcinoma like neck mass, aural and nasal symptoms, we can make an early diagnosis and treat the patient with good results

Basic considerations in cleft lip reconstruction

Reconstruction of a congenital lip is a simple procedure, but not as simple as "freshen the edges and approximate the wound". To have a good cosmetic and functional results a background knowledge of embryology and precise recognition of anatomical structures and land marks of the lip and its surrounding structures are necessary