Predictive factors for intraoperative blood Loss during percutaneous nephrolithotomy

Objective: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy [PCNL] and correlate them with outcome

Study Design: Analytical study

Place and Duration of Study: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016

Methodology: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major > 2 gm/dl. Factors such as age, gender, comorbidities, body mass index [BMI], operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses

Results: Total 305 patients were enrolled in the study. Median age was 37 [27.5-49.1] years with predominantly males [n=217, 71.8%]. Median BMI was 27.3 [24.6-31.4] Kg/m[2] and mean stone size was 2.7 [2.1-3.4] cm. Two hundred and ninety-seven [97.7%] stones were radio-opaque. Operative time was 95 [60-127] minutes. There were 50.8% patients who had moderate drop in hemoglobin [1-2 gm/dl]. Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 [84%] patients. Thirty [9.8%] patients needed blood transfusion. None of the patients required angioembolisation

Conclusion: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL

Craniofacial measurements for the determination of occlusal vertical dimension and gender dimorphism in a section of Pakistani population

The objective of this study was to check the authenticity of various facial measurement theories, their implementation among Pakistani population and comparison of these measurements in male and female. Prospective Comparative The study was conducted in Department of Prosthodontics, College of Medicine and Dentistry, The University of Lahore, Pakistan from March 2014 to September 2014. Thirteen different measurements were taken on fully dentate subjects. All measurements were taken on fully dentate subjects in centric occlusion. The craniofacial distances were measured using Boley's guage of [Tricle] brand while the distance from chelion to chelion along the curvature of the lips was measured using a flexible scale. Results were statistically analyzed by using SPSS version 20. Ten measurements showed significant gender dimorphism [p <0.05]. However, there were three measurements, hair line to right eyebrow line, center of pupil of right eye to center of pupil of left eye and outer canthus of right eye to inner canthus of right eye multiplied by two, which revealed close approximation in male and female [p > 0.05]. There is no significant gender difference in these three measurements for the determination of OVD among Pakistani subjects

Determination of occlusal vertical dimension by correlating hand, thumb and index finger length with craniofacial measurements

The objective of this study was to compare the craniofacial measurements with body measurements and their implementation among the Pakistani population. Prospective / comparative study. This study was conducted at University College of Dentistry, The University of Lahore from January 2014 to March 2014. Measurements were taken on 300 fully dentate patients with their teeth in centric occlusion. Results were statistically analyzed by using SPSS version 20. Height of the face to height of the hand, Length of the nose to length of the thumb and Distance from tip of index finger to tip of the thumb and chin-nose distance were measured. All these measurements showed a statistically significant p-value thus indicating no correlation with each other. These measurements had no close approximation to each other and with original occlusal vertical dimensions [OVD] among Pakistani population as compared to others races

Brucella melitensis presenting as erythema nodosum-like lesions

Brucellosis is a chronic granulomatous zoonosis with protean manifestations. Cutaneous involvement in Brucellosis is a relatively rare phenomenon. We describe a case of Brucella melitensis infection presenting with erythema nodosum like skin lesions involving palms and soles in a 70 years old lady

Predictors of positive thallium 201 single photon emission computed tomography in patients of end stage renal disease

To study coronary artery disease [CAD] risk factors predicting positive thallium-201 single photon emission computed tomography [SPECT] indicating underlying CAD among patients of end stage renal disease. This cross-sectional [analytical] study was done at Department of Cardiology, Punjab Institute of Cardiology, from April 2004 to Dec 2007. One hundred consecutive patients with ESRD undergoing thallium SPECT as a routine screening test before renal transplant were studied. Dipyridamole thallium SPECT was performed in patients who were unable to exercise. Thallium SPECT was positive in 47 [47%] cases. There were significant differences in age, underlying diabetic nephropathy and total cholesterol levels among patients positive and negative on thallium SPECT. Among the risk factors age and underlying diabetic nephropathy were significantly associated [p<0.05] with a positive thallium SPECT in patients with ESRD. Positive thallium SPECT indicating underlying CAD was observed in a significant number of patients with ESRD awaiting renal transplant. Presence of advanced age and underlying diabetic nephropathy predict a positive thallium SPECT in this population

Chicken pox associated thrombocytopenia in adults

To determine the frequency and magnitude of thrombocytopenia associated with chicken pox in adults. Observational descriptive study. Combined Military Hospital, Attock, from July 2003 to June 2004. All patients of age 15 years and above with history of fever, followed by appearance of the typical vesicular chicken pox rash, were inducted after informed consent. Two milliliters of whole blood was collected on day 1 of admission, and blood counts were performed. Patients were admitted and given 800 mg oral acyclovir, 5 times/day, for 7 days, in addition to symptomatic treatment. Patients were followed till 8 weeks. A total of 410 patients of chicken pox were received, out of which 270 were included. Age of patients ranged between 15 and 40 years with median age of 21 years. Platelet count on the day of admission ranged between 29 x109/L to 513 x109/L, mean platelet count 178 x109/L. Platelet count < 150 x109/L was detected in 80/270 [30%] patients. Platelet count in thrombocytopenia patients was from 29 x109/L to 149 x109/L with mean 121 x109/L. Thrombocytopenia recovered within 02 weeks in 78/80 [97%] patients. In 2 patients, thrombocytopenia recovered in 3 weeks. None of the patients developed purpuric spots, ecchymosis or bleeding manifestations. Thrombocytopenia in chicken pox is a common entity. Platelet count remains above 25x109 /L, which is usually not associated with bleeding manifestations. None of the patients in this series developed purpura. No specific pattern of total leukocyte counts was predictive of the progression or regression in platelet count