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Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla.
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Background:Dysphagia is a commonly encountered clinical problem & limited data exist regarding the spectrum of dysphagia etiologies in this region. Our aim was to access the spectrum of dysphagia etiologies in North India. Methods: This was a prospective analysis of data collected over a period of four years for patients presented with complaint of dysphagia. All consenting patients presented with dysphagia irrespective of age, sex, duration and etiology of dysphagia were enrolled. After detail history, clinical examination and base line investigations, all patients underwent upper GI endoscopy, findings were noted and biopsy taken in case of pathological lesion found during endoscopy.Results:A total of 58 patients presented with symptoms of dysphagia were enrolled in this study. Among these patients 37 were male and 21 were female and age ranges from 17- 100 years. Thirty one patients were diagnosed to have benign pathology, four had moderate to severe dysplasia and 23 were diagnosed to have malignant pathology. Most common benign etiology was GERD and most common malignant etiology was squamous cell carcinoma. Conclusion: Squamous cell carcinoma and GERD are two most common etiologies for dysphagia in our study group. Dysphagia was more common in males and malignant dysphagia was more in elderly smokers and naswar users.
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Background: Tissue harmonic imaging (THI) is a newer method that can diagnose and differentiate various types of pancreatic masses. The aim of this study was to evaluate the efficacy of tissue harmonic imaging for detection and differentiation of pancreatic masses and its comparison with conventional B-mode ultrasound, biphasic CECT abdomen and tissue diagnosis. Methods: 31 patients who presented with a suspicion of pancreatic mass clinically or radiologically were enrolled in this study. All patients underwent both conventional B-mode ultrasound abdomen and THI. Biphasic CECT abdomen was done for diagnostic reference. Pancreatic lesions were documented regarding site, size, internal architecture, and status of peri-pancreatic vessels. The USG diagnosis was compared with biphasic CECT and tissue diagnosis. Results: There was statistically significant difference between THI and conventional B-mode USG in visualization of image quality (p<0.001) and solid-cystic differentiation (SCD) (p=0.001). Taking tissue diagnosis as the standard, out of the 25 (80.6%) cases which were diagnosed as malignant on USG and biphasic CECT, 18(72%) cases were confirmed to be malignant on tissue diagnosis. There was no statistically significant difference between biphasic CECT and USG (conventional B-mode and THI) in the diagnosis of benign and malignant masses in pancreas (p=1). Conclusions: THI is superior to conventional B-mode USG in the Sonography of pancreatic masses because THI has better overall image quality, lesion conspicuity, visualization of lesion margin and fluid–solid differentiation. It should be routinely utilized as part of the diagnostic workup of patients with pancreatic masses.
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Objective: To scrutinize patterns of multi-drug-resistant uropathogenic Escherichia coli (UPEC) strains and particularly of fluoroquinolone-resistance this is an alternative choice for the treatment of urinary tract infections. Methods: Bacterial samples (n = 250) were collected from out-patients from August 2012 to August 2014 Islamabad. Antibiotic susceptibility profiling and determination of mini-mum inhibitory concentrations (MICs) and minimum bactericidal concentrations were performed according to the guidelines of Clinical and Laboratory Standards Institute (CLSI, 2012). Genes, qnrA, qnrB and qnrS were identified by DNA amplification and sequencing. Results: The highest percentage of UPEC isolates were resistant to co-trimoxazole (82%) followed by cephalothin (80%), 2nd Gen, 3rd Gen and 4th Gen cephalosporins, respectively. Resistance against gentamicin, amikacin remained 29% and 4%. For other drugs including nitrofurantoin, tetracycline, carbapenem and beta-lactam inhibitors remained below 10%. Altogether, 59% of the isolates were resistant to at least three antibiotics including one fluoroquinolone. Overall, MICs for ciprofloxacin remained (MIC≥256 mg/mL) and for levofloxacin (MIC≥16 mg/mL and 32 mg/mL). No significant differences were observed regarding MIC values of extended spectrum b-lactamase (ESBL) and non-ESBL producers. For qnrS and qnrB positive isolates MICs remained above 32 mg/mL. Prevalence of UPEC was significantly higher among females and 40% of the isolates were ESBL producers. Conclusions: Higher percentages of ESBL producing UPEC were associated with uri-nary tract infections. Moreover, the majority of these isolates were multi-drug resistant and fluoroquinolone-resistant.
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Objective: To evaluate physico-chemical properties and antimicrobial potential of indigenous honey samples against different reference strains including Escherichia coli ATCC 8739, Enterobacter aerogenes ATCC 13048, Pseudomonas aeroginosa ATCC 9027, Bacillus subtilis ATCC 6633, Staphylococcus aureus ATCC 25923, Salmonella typhi ATCC 14028, Klebsiella pneumonia ATCC 13883, Aspergillus niger ATCC 16404, Rhizopus oligosporus PCSIR1, Candida albicans ATCC 14053 and Candida utilis ATCC 9950. Methods: By using standard methods samples were evaluated for their antimicrobial properties including additive effect of starch and non-peroxidase activity, antioxidative properties (phenol contents, flavonoid contents, 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity). Prior to this evaluation, complete physico-chemical properties including pH, color, ash contents, protein contents, moisture contents, hydroxymethyl furfural contents, total sugar contents, reducing sugar and non-reducing sugar contents were analyzed. Results: Relatively higher ash contents were found in the Siddar honey i.e. (0.590 0±0.033 6)%and small honey showed relatively higher protein contents i.e. (777.598±9.880) mg/kg. The moisture contents of tested honey samples ranged between 13.8%-16.6%, total sugar contents from 61.672%-72.420%and non-reducing sugar contents from 1.95%-3.93%. Presences of phenolic contents indicate higher antioxidant potential of these honey samples. All bacteria showed clear inhibition zones in response to tested honey samples whereas fungi and yeast showed inhibition at higher concentrations of these honey samples. For Escherichia coli, Bacillus subtilis, Salmonella typhi, Pseudomonas aeroginosa and Aspergillus niger, overall the small honey showed the higher activity than other honey samples. Conclusion: Physico-chemical analysis of honey samples confirmed good quality of honey according to the standards set by European Union Commission and Codex Alimentarius Commission. Evaluation of these honey samples confirms antimicrobial potential of particular types of honeys indigenous to Pakistan.
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Background: Although pancreatic trauma is uncommon, it poses a diagnostic and therapeutic challenge. Any delay in diagnosis raises morbidity and mortality. This study highlights the current management and outcome in patients of pancreatic trauma at a single tertiary care center. Methods: This is a retrospective analysis of prospectively collected data of 24 patients diagnosed to have pancreatic trauma. Collected data was analyzed for age, gender, mechanism of injury, hemodynamic status at presentation, initial serum amylase levels, CECT abdomen findings, AAST-OIS grade of pancreatic injury, injury to other organs, management, complications and outcome. Results: The mean age of these 24 patients was 25 years; 19 were male and 5 females. The mechanisms of pancreatic trauma included blunt abdominal trauma in 21 (87.5%) cases and penetrating injury in 3 (12.5%). Seven (29.16%) patients were managed by non-operative management and 17 (70.83%) underwent surgery. Complications were more frequent in the operative group as compared to the non-operative group. Neither endocrine deficiency nor any mortality was noted in the non-operative management group; while there were 2 cases of endocrine deficiency and 3 mortalities in the operative group. Conclusions: Pancreatic trauma is more common in young male patients and more commonly inflicted by motor vehicles accidents. Low grade blunt pancreatic injury in hemodynamically stable patients and selected patients with high grade blunt pancreatic injury can be managed successfully by non-operative management with no increase in morbidity or mortality and most patients with high grade blunt pancreatic injury and those having penetrating injuries need surgical intervention.