Management of empyema thoraces in our setup

To find out the proper method of management of empyema thoraces to be adopted according to the stage of disease. Prospective study. This study was carried out at Children Hospital Complex, Multan in department of Paediatric Surgery from January 2003 to December 2005 for a period of three years. Fifty patients of post pneumonic empyema thoraces were managed from January 2003 to December 2005. All of them were included in the study. On basis of history, examination and investigations disease was staged as I, II and III. In addition to antibiotics according to culture and sensitivity, intercostals chest tube drainage was performed in all the patients of Stage-I and II. Out of fifty patients thirty four [68%] were male and sixteen [32%] female. Thirty nine [78%] were under 5 years and eleven [22%] of 6-12 years of age. Right side was involved in thirty two [64%] and left side in eighteen [36%]. Twenty nine [58%] were suffering from Stage-I, thirteen [26%] Stage-II and eight [16%] from Stage-Ill. Intercostals chest tube drainage was performed in Stage-I and II. All of the twenty nine [100%] of Stage-I and five out of thirteen [38%] of Stage-II recovered successfully. Thoracotomy was performed in all eight patients of Stage-III straight forward and eight out of thirteen of Stage-II who did not recovered after chest tube drainage. Fifteen out of these sixteen [94%] recovered, one [6%] developed sepsis and expired on 6[th] day after thoracotomy. Tube drainage is very much successful in Stage-I. Early thoracotomy is an excellent option to treat Stage-II and III. Pus drainage facilitative measures are helpful in evacuation of the pus and expansion of lungs

effect of fasting on QT Interval

QT interval reflects the total duration of ventricular depolarization and repolarization in the ECG. Experimental hypoglycaemia and spontaneous clinical episodes of hypoglycaemia lead to the lengthening of the heart rate corrected QT interval or QTc. This is associated with elevated risk of sudden death. To find out the effect of fasting blood glucose levels on QT interval and the corrected QT interval [QTc]. Fasting and post prandial blood glucose levels and ECG of healthy young adults were studied and QT interval, RR interval and QTc were determined. The fasting QTc came out to be 0.408 +/- 0.020 as compared to the post prandial value of 0.380 +/- 0.019. The student's t test showed a highly significant value [p<0.0001]. There is significant prolongation of QT interval and QTc during fasting but within normal physiological limits

Radisection of multiperforated mesiobuccal root of maxillary first molar

It was common saying that "treatment of a diseased tooth is extraction of the tooth." Advancement in dental sciences, production of newer materials and use of modern technology by dental professionals has proved this saying wrong today, dentist around the world perform treatment of teeth that once would have been removed. Root resections, hemisection, root amputation and bicuspidization are all established dental procedure mentioned in the books of endodontics[1]. Radisection is a newer terminology of removal of roots of maxillary molars[2]. The root resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth[3]

Anastomotic leak after small gut surgery

Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the quality of surgical care provided. [1].To define factors associated with leakage of small gut anastomosis. [2] To find technique of small gut anastomosis associated with lowest risk of anastomotic dehiscence. Retrospective, Descriptive 02 Years [May 2003 to May 2005] This study was conducted at Surgical Unit-II, Allied Hospital, Punjab Medical College, Faisalabad from Dec 2003 to May 2005. A total number of 36 cases were included in this study comprising of both adult male and female patients developing anastomotic dehiscence following resection and end to end anastomosis of small gut. Peritonitis was the risk factor identified in 69% of the patients. Hypovolemic shock both preoperatively and in the immediate postoperative period was noted in 56% cases while 83% of the patients with anastomotic dehiscence had haemoglobin concentration less than 10g%. High concentration of blood urea was noted in 42% of the cases. It turned to normal as soon as the hypovolemia was corrected in these cases. Small gut anastomosis done in emergency setting [75% cases] was associated with increased risk of anastomotic dehiscence as compared to the dehiscence noted in 09 cases [25%] operated on elective list. Three different techniques were used for small gut anastomosis. The rate of anastomotic leakage ranged from 19-45%. Peritonitis, hypovolaemia and low hemoglobin alone or in combination are associated with increased risk of small gut anastomotic leakage especially after emergency surgery. Single layered extramucosal interrupted anastomosis was associated with less risk of dehiscence than the full thickness and continuous extramucosal anastomosis

Prevalence of pulmonary tuberculosis among diabetics

This study was performed in the department of medicine, B. V. Hospital, Bahawalpur, Pakistan, between January 2001 and December 2001. Prevalence of pulmonary tuberculosis in 100 diabetic patients admitted consecutively in medical wards was calculated and compared with 100 non diabetic controls admitted consecutively during the same period. In this study the calculated prevalence of pulmonary tuberculosis among diabetic patients was 9.5% compared to non-diabetic patients who had prevalence of 2.08% [P-Value< .002] indicating 7.5% higher risk in diabetic patients. The purpose of this study was found out the prevalence of pulmonary tuberculosis among patients with tuberculosis

Hypertriglyceridemia and low HDL-cholesterol are the major lipid abnormalities in normal Pakistani adults: are these contributing to the high rates of coronary artery disease in this population?

Objective: Lipid abnormalities are related to enhanced risk of developing cardiovascular disease. The objective of the study was to investigate variability in lipid profile in Pakistani normal adults [from the personnel of 4 tertiary care hospitals] by age, gender, body mass index [BMI] and smoking, and to determine the prevalence of hypertriglyceridemia, hypercholesterolemia, low HDL-cholesterol and isolated low HDL-cholesterol in this population

Method: Serum samples from 323 normal healthy subjects [236 males and 87 females, age 30-70 years] from the personnel of the Aga Khan University, Civil Hospital, Karachi, Armed Forces Institute of Cardiology and Military Hospital, Rawalpindi were analyzed for total cholesterol, HDL-cholesterol and triglycerides using kit methods. LDL-cholesterol was determined using the Friedewald formula

Results: Mean +/- SD concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were found to be 165+/-37 mg/dl, 37+/-11.5 mg/dl, 98+/-34 mg/dl and 155 +/- 88 mg/dl, respectively. Mean levels of total cholesterol were found to be significantly higher in hypertriglyceridemia [>200mg/dl] than normotriglyceridemia [181+/-30 mg/dl vs 160+/-38 mg/dl; p=0.001]. Mean concentration of HDL-cholesterol in the younger age group [50 years] group [39.6+/-11.7 mg/dl vs 33.4+/-9.7 mg/dl; p=0.001]. Similarly, mean concentration of HDL-cholesterol in females was significantly higher compared to males [44.3+/-14 mg/dl vs 34.9+/-9.1 mg/dl; p=0.001]. In hypertriglyceridemia [>200 mg/dl], mean HDL-concentration was significantly lower compared to normotriglyceridemia [33.4+/-8.3 mg/dl vs 38.9+/-12 mg/dl; p=0.001]. The combined effect of age, gender and triglyceridemia was found to be significantly associated with HDL-cholesterol concentration [p25], triglyceride levels were significantly higher compared to those with BMI<25 [180+/-107 mg/dl vs 144+/-71 mg/dl; p=0.001]. Levels of triglycerides were, therefore, significantly associated with gender and BMI [p<0.001; R2 =0.076]. LDL-cholesterol levels were not found to be significant by age, gender, smoking, BMI and triglyceridemia. Smoking had no significant effect on lipid levels of male healthy subjects. Frequencies of hypercholesterolemia, hypertriglyceridemia, low HDL-cholesterol and isolated low HDL-cholesterol were found to be 17.6%, 26.9%, 45.8% and 29.4%, respectively. High prevalence values of low HDL-cholesterol and isolated low HDL-cholesterol are reported for the first time in Pakistani normal adults and require further studies at the community level

Conclusion: High levels of triglycerides and low levels of HDL-cholesterol are the most prominent abnormalities in Pakistani adults working in tertiary health care centers