Normal anatomical variations of renal artery pedicle: a review of 100 renal angiograms of healthy proposed renal donors

Objectives: To present variations in renal arterial anatomy. To document renal artery number, source, course and patterns

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Angiography suite, Radiology Department, Sindh Institute of Urology and Transplantation from May 2011 to Oct 2011

Materials and Methods: A total of 100 healthy adultswho underwent renal angiography for renal donor assessment in living related transplant programwere included. Both male and female with age group between 20-50 years having normal clotting profile, renal function and normal morphology on IVP were fully evaluated by predesigned performa including number, source, course and pattern of renal artery

Results: Out of 100 cases of healthy renal donors, 66 were male and 34 were female. Fifty four percent were in 20 - 30 years of age group while 30% between 31 - 40 years and 16% in between 41 - 50 years. In 56% right renal artery found to be higher than left, where as 40% had both the arteries at same level. Right renal artery longer in 52% and left in 46%. Only 2% had same length of both renal arteries. Regarding the number, 66% had bilateral single, 24% unilateral double, 6% bilateral double and only 4 % unilateral triple. Out of 100 renal donors with 200 renal pedicles [each donor having 2kidneys], single hilar artery seen in 75% in single hilum with inferior polar aortic branch in 14% and single hilar with suspicious polar aortic branch seen in only 4%. Double hilar arteries seen in 1% and hilar with extrahilar branch in 4%. Triple vessels found in 4% cases

Conclusion: The study shows that normal variation of vascular anatomy of renal pedicle is clinically very important to perform urological interventional procedures and transplantation. This study providesinformation concerning renal artery anatomy not only for interventional radiologists but also to urologic surgeon

Conservative and surgical management of otitis media with effusion in pediatric population

Objectives: The study was aimed to compare results of medical and surgical treatment of otitis media with effusion in terms of hearing improvement, determine recurrence of MEE and decide when to offer surgical treatment

Study Design: A descriptive study

Place And Duration: The study was conducted from June 2008 to December 2011 in ENT department of Khyber Teaching Hospital, Peshawar

Methodology: Sixty seven patients were selected for study. Every child with difficulty in hearing was examined with pneumatic otoscope for fluid level and tympanic membrane mobility. These children were investigated with tympanometry to confirm the middle ear effusion and pure tone audiometry for hearing threshold. X-Ray nasopharynx lateral view was performed to confirm the mass of adenoids. All of the patients were treated conservatively in the first phase. Those cases not responding to conservative treatment were treated with myringotomy and or adenoidectomy with and without ventilation tubes. Patients were followed for recurrence of MEE for 36 months

Results: Conservative treatment was tried in all patients. Middle ear effusion cleared in 71.5% [n.86] out of 120 ears. MEE showed no improvement in 28.5% [n. 34] ears. The failure was much less with ventilation tubes [5.0%]. The hearing level improved by 10 to 15 dB with ventilation tubes

Knowledge and perceptions of diabetes in urban and semi urban population of Peshawar, Pakistan

Diabetes mellitus is a major health issue in Pakistan. The aim of this study was to evaluate the knowledge and perceptions of diabetes in a sample population of Peshawar. This crosssectional, descriptive study was carried out in seven different localities of Peshawar. A sample of 305 residents were interviewed aged from 15-60 years and above, using a questionnaire specifically designed and translated into Urdu language for convenience of selected subjects. Knowledge of diabetes was suboptimal. The mean percentages of correct responses to questions regarding three classical symptoms and given complications were 47.1% and 30.8%. Excessive sugar intake, obesity, family history, lack of physical activities and stress were acknowledged by 46.2%, 42.3%, 39.3%, 33.4%, and 31.8% of the subjects respectively. Presence of family history and level of education were recognised to be associated with more knowledge. There is lack of awareness of major risk factors and some complications of diabetes mellitus. Level of education is a significant predictor regarding knowledge of diabetes and its prevention. Prevalence of diabetes has increased in Pakistan.

Justification of participation of human subjects in Phase 1 clinical trials: an ethical analysis.

Abstract: In the process of clinical trials, after ascertaining the safety of drugs or other therapeutic interventions in animals or in vivo, phase I clinical trials are conducted as initial step on healthy human volunteers (or patients with specific disease) to observe pharmacokinetics, safety and side effects associated with escalating doses of the drugs. Participation of human subjects having different biological system than animals is not without risks in these trials; this fact raises some important ethical issues. In the light of international research ethics guidelines, this paper analyses moral justification of use of humans as research subjects in phase I clinical trials, discusses what groups of participants should be involved, their economic status, questionable coercive effect of monetary remuneration on the subjects and soundness of informed consent obtained for the trials. These issues are also discussed in the perspective of four founding principles of bioethics i.e. autonomy, justice, beneficence and non-maleficence.

Platelet count in Malaria patients

Malaria is a major health problem in the tropics with high morbidity and mortality. This study is conducted to analyse the effects of malaria on platelets. This prospective study was conducted on 200 diagnosed cases of malaria in Department of Medicine, LUMHS, Jamshoro/Hyderabad from February to December 2010. The diagnosis of malaria was carried out by thin and thick blood films. Platelet count was performed using an automated counter. Thrombocytopenia was classified as mild [50-150x10[3] cells/microl], moderate [20-50x10[3] cells/microl] and severe [<20x10[3] cell/microl]. The age of patients ranged from 16 to 80 [28 +/- 10.5] years, median age was 30 years. Among the study population, males were 124 [62%] and females were 76 [38%]. Out of them 105 [52.5%] were cases of Plasmodium falciparum, 93 [46.5%] were of P. vivax, and 2 [1%] were of P. malaria. The data showed that 171 [85.5%] patients were having low platelet count; 141 [70.5%] had mild, 21 [10.5%] moderate, and 9 [4.5%] had severe thrombocytopenia. Twenty-nine [14.5%] patients had normal platelet count. Malaria is associated with different degrees of low platelet count with rarely increased bleeding tendency

Organ Transplantation And Vulnerable Donors: Donation Under Emotional Compulsion.

Abstract: During last few decades advancements in medical knowledge and technologies have increased the practice of organ donation. Organ transplantation, on one hand gifts renewed life to the donors, while on the other hand unwanted ethical practices in the field exploit vulnerable donors, such as trend of ‘transplantation tourism’ involving non-related live donors. Beyond this, some delicate and intriguing situations bring the physicians at cross-roads in cases of live related donors’ transplantation. In this paper, I would like to discuss and analyze a case of live donor (un-married girl), where overtly consents to donate kidney to her brother who is breadearner of their joint family. By consenting to donate, the girl jeopardizes her matrimonial proposal as her fiancé is uncertain about her post-donation health status. The transplant clinician, aware of this fact faces ethical dilemma, whether to perform transplantation surgery so as save the life of ailing patient or to abandon it in order to save the future marriage of the girl from being broken. The case highlights multiple ethical issues in Asian socio-cultural context. I have attempted to disentangle the dilemma by applying Mc Donald and Rodney’s framework of ethical decision making.

Informed Consent: Protecting Patients Or Salvaging Physicians.

Abstract: History of tradition of following ethical code in medical practice is very ancient and it could be traced as back as 3500 year old document of Ebers Papyrus (Berdon 2000). Later Greek and Egyptian teachings also emphasized upon ethical practices in medicine. But the concept of formally taking consent (and informed consent) with emphasis on patients’ rights and his/her autonomy emerged in early 20th century when some law suits were filed in courts, particularly in USA. Later the well known infamous atrocities carried out by Nazi doctors on prisoners during Second World War and consequent verdict by Nuremberg tribunal and milestone declaration of Nuremberg made a land mark in the history of medical ethics and provided a ground on which the doctrine of ‘Informed Consent’ is built. This paper discusses and analyzes various ethical issues related to informed consent. How the obligation of taking informed consent was established in the clinical practice and biomedical research. Discusses whether informed consent is a moral obligation or legal necessity with reference to various historical cases and presentation of views by some authors. This paper also analyzes famous legal litigations that helped to provide foundations for the patients’ rights and autonomy in clinical, such as cases of Shoendorff v. New York Hospital of 1914; Prince v. Massachusetts litigation of 1944; Canterbury v. Spence lawsuit of 1972; Large v. Superior court of Arizona legal case of 1986 and Younts v. Francis Hospital suit of 1986. A discussion is also made regarding five universally accepted components of informed concept (disclosure to the patient/research subject, comprehension by the patient, his/her competency, voluntariness and willingness), which are variously and sometimes conflictingly interpreted in different contexts and situations. Situations are highlighted where these problems create ethical dilemmas and legal conflicts in clinical and research environment and a reference is made to ongoing discussion whether informed consent has been primarily devised for protection of the patients or it is a tool to rescue physicians when they are brought to courts to face law suits.

Physicians' dilemma: care of terminally III patient in utilitarian perspective

Tremendous developments in medical science and technologies have modified the course and consequences of many diseases. Victims of fatal injuries can now be saved and given gift of life with the assistance of medical technologies. This bright aspect of medical advancements is coupled with ethical issues, particularly in patients having negligible chances of passing life without support of vital devices or having no hope of regaining quality-health. Care of these patients is not free of ethical dilemmas. To continue aggressive intervention or give it up and let the nature take its course, are the two choices before attending physicians. Selection of choice is not an easy task, both for physicians and the relatives. Resulting issue of euthanasia in the later option has been debated in the literature since last few years. Here, I have attempted to analyze this issue in the perspective utilitarianism

Conflict of autonomy and paternalism in clinical practice: which is to be prioritized?

In developed and Western countries, last few decades have witnessed shift in the right of clinical decision making from physicians' paternalism to patients' autonomy. Application of these changed norms to developing courtiers where literacy rate and knowledge level is much lower than developed countries is viewed as paradox. This article discusses consequences of pro-patients' autonomy model of decision making in our society and explores the measures to address its drawbacks

Medical training and ethical conduct: do they develop parallel or otherwise?

Teaching of biomedical ethics as a part of curriculum to undergraduates of medical universities is in practice in western countries for many decades. It has been started in some Pakistani medical institutes as well. The objective is to make them aware and prepare for recognizing ethical issues and dilemmas in their clinical rotations. This study was conducted in three medical colleges of province of Sindh to find out how well informed and practical they are in terms of identifying and approaching ethical issues. The study was based upon questionnaire response to problems related to patients rights, ethical dilemma etc. The participants included 421 medical students and 101 postgraduate trainees. The results showed significant difference in identifying ethical dilemmas, where medical students who had been taught as what they are, easily recognized them while most of the postgraduate students failed to do so. It is thus concluded that ethics as a subject must be incorporated in medical curriculum both at under and postgraduate level

Removal of coins from upper oesophgus under local anesthesia

To know the safety of coin extraction from upper esophagus by using Magill forceps and laryngoscope, under local anesthesia. This prospective study includes four hundreds patients with coin stuck at the upper end of esophagus, referred to us from emergency department form Jan 2004 to Dec. 2004. We used both Magill forceps and Mackintosh Laryngoscope for coin extraction. A total of 400 patients were treated in one year, majority were children between 2-5 years of age. Males were 202 [50.5%] and females were 198 [49.5%]. Three hundred and forty patients [85%] presented with in 24 hours while 60 patients [15%] presented after 24 hours. At presentation, 360 [90%] had difficulty in swallowing and excessive salivation while remaining 10% had vomiting and cough. Out of 400 coins, 296 [74%] were of two rupees while remaining 105 [26.3%] included one and five rupees coins. Three hundred and twenty [80%] coins were removed in first attempt while 65 [16.2%] require more than one attempt. We failed in 15 [3.75%] cases. Minor complications occurred with this method in 19 [4.75%] while one child develop neck abscess [0.25%].Coin extraction from upper esophagus, using Magill forceps and laryngoscope under local anesthesia is a safe and effective method

Growth and yield of rice as affected by transplanting dates and seedlings per hill under high temperature of Dera Ismail Khan, Pakistan / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Studies were initiated for two consecutive years to find out the effect of time of transplanting and seedlings hill(-1) on the productivity of rice in Dera Ismail Khan district of North West Frontier Province (NWFP), Pakistan. The experiment was laid out in a randomized complete block design with split plot arrangements. Main plots consisted of four transplanting dates viz. 20th and 27th of June and 4th and 11th of July while sub-plots contained 1, 2, 3 or 4 seedlings hill(-1). Among transplanting dates, June 20th planted crop gave highest paddy yield and net return with 1 seedling hill(-1). It explains that the use of more seedlings hill(-1) not only adds to cost but is also a mere wastage of natural resources. Based on research findings, we conclude that the use of 1 seedling hill(-1) is most appropriate for timely sowing otherwise 4 seedlings hill(-1) should be used to compensate for the yield gap in late transplanted rice.

Snake bite; demographic features, manifestations, complications and treatment

To find out demographic features, manifestations, complications and effects of treatment in victims of snake bite in Multan region. Design: Prospective observational study. Period: 1986 to 1996 Material and Methodss: All the patients coming to the Nishtar Hospital Multan with history of snake bite between 1986 and 1996 were included in the study. Their demographic features and manifestations of snake bite were recorded. In addition to general measures, antivenom if indicated was given and its effects noted. A total of 134 patients of snake bite, 103 males and 31 females, with age ranging from 1-84 years [mean 25 years] were studied. Snake was seen in 54% cases, 60% patients were bitten during the dark, 52% patients were bitten on the foot, 79% patients received first aid, either cut or bandage. Local pain and swelling, nausea, vomiting, fever and spontaneous bleeding were common manifestations, 49.7% patients required local treatment, 2.2% patients required respiratory support. Antivenom was given to 62.6% patients, 2.2% patients showed severe anaphylactic reactions and antivenom was withheld. Average dose of antivenom given was 60 ml. 1.4% had toe amputation and 2.2% patients died. Conclusion; Spontaneous bleeding is the most common manifestation of snake bite in this area. Antivenom can be successfully given to a large majority of victims if reactions are treated and effects of antivenoming: can be life saving