Laparoscopic versus open appendicectomy: a non-randomized comparative study

Background: Appendicectomy is one of the most common surgical procedures performed in emergency surgery. Despite this, there is still lack of consensus about the most appropriate technique for appendicectomy. In this longitudinal analysis, we aimed to compare the outcomes of laparoscopic appendicectomy (LA) and the conventional technique or open appendicectomy (OA) in the treatment of acute appendicitis.Methods: A non-randomized longitudinal comparative study was conducted in NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India. From November 2017 to October 2019, 53 patients underwent OA and 59 underwent LA, making a total number of patients included in this study to be 112 (n). The two groups were compared for operative time, length of hospital stay, postoperative pain, post-operative ileus and complication rate.Results: Laparoscopic appendicectomy was associated with a shorter hospital stay (4.34±1.37 days in LA and 5.09±1.71 days in OA, p<0.01), with a lower post operative pain score [VAS] (2.93±0.80 in LA and 4.62±0.92 in OA, p<0.001). Operative time was shorter in the open group (42.70±12.05 min in OA and 43.39±16.59 in LA). Complications were lesser in the LA group with a significantly lower incidence of wound infection (3.4% in LA and 13.2% in OA).Conclusions: Laparoscopic approach is safe and efficient in appendicectomy and it provides clinically advantages over open method (shorter hospital stays, lower post op pain, early food tolerance, earlier return to work and lesser wound infection) against only marginally longer operative time.

Frequency of different congenital anomalies in prenatally valproic acid treated chick embryos

Objective: To determine the frequency of different congenital anomalies in surviving chick embryo on hatching after the prenatal administration of valproic acid by comparing with age-matched controls

Study Design: Experimental study

Place and Duration of Study: Anatomy Department, College of Physicians and Surgeons Pakistan [CPSP] Regional Centre, Islamabad, from February 2010 to February 2011

Material and Methods: Thirty fertilized chicken eggs were injected with valproic acid, incubated and then evaluated for different gross congenital anomalies, on hatching or day 22 of incubation whichever was earlier. Chicks of this group were labeled as experimental group-A. Similarly, another group of thirty fertilized chicken eggs labeled as control group-B, underwent sham treatment using normal saline. The weight and length of alive chicks, the total number of chicks with gross anomalies and the number of different types of gross anomalies in both groups were noted and statistically compared

Results: In control group-B, 28 chicks hatch out on 21 day of hatching with no visible gross deformities. Whereas in experimental group-A, 23 chicks were alive, out of which, 9 chicks were with delayed hatching on 22 days of hatching. The chicks with gross deformities were 8 [p=0.0008] which included: limb abnormalities [i.e. inverted feet] in 6 chicks [p=0.006], eye abnormality [i.e. closed palpebral fissure of both eyes] in 2 chick [p=0.2], 1 chick showed multiple deformities including gastroschisis, closed palpebral fissures and inverted foot [p=0.45]

There were behavioral changes in 10 chicks [p=0.0001]. There was statistically significant difference in their weights [p=0.03]

Conclusion: Prenatal exposure of chick embryos to valproic acid increased the incidence of different gross deformities

Effects of glucose administration on development of sclera in chick embryos

Objective: To determine the effect of glucose administration on the development of sclera in the chick embryo Gallus domesticus

Study Design: Experimental study

Place and Duration of Study: Anatomy Department, CPSP Regional Centre, Islamabad, from January 2013 to January 2014

Methodology: The study was carried out in two main groups, control A and experimental B, which were subdivided into three subgroups comprising 30 eggs each. The group A was injected with normal saline [0.3 ml] in the egg albumen. The group B was injected with 0.3 ml of 5% w/v solution of glucose equivalent to 15 mg of glucose. Subgroups A1 and B1 were opened on day 10 of incubation. Subgroups A2 and B2 were sacrificed on day 12 of incubation. Eggs from subgroups A3 and B3 were opened on day 15 of incubation. Experimental subgroups were compared with matched control subgroups and quantitative data was analysed statistically

Results: Administration of glucose resulted in changes in thickness of sclera. The mean thickness [[micro]m] of sclera at day 10 of incubation was 43.54 +/-2.45 in control subgroup and 43.03 +/-5.86 in the experimental subgroup [p=0.673]. The mean thickness [[micro]m] of sclera at day 15 of incubation 77.48 +/-8.32 in control subgroup and 73.99 +/-8.62 in experimental subgroup [p=0.145]. The mean number of chondrocytes/unit area of hyaline cartilage of sclera in day 10 was 17.40 +/-1.44 control subgroup and 14.57 +/-1.87 in the experimental subgroup [p < 0.001]. The mean number of chondrocytes/unit area of hyaline cartilage of sclera on day 15 was 10.02 +/-0.86 in the control subgroup and 9.54 +/-0.59 in the experimental subgroup [p=0.025]. There was disrupted ossicular formation indicating adverse effects on the development of bony sclera as well

Conclusion: Administration of glucose caused alteration in the histology of sclera in developing chick embryos

effect of prenatal administration of sodium phenytoin on the survival and hatching of chick embryos

Objective: To determine the effects of prenatal exposure to sodium phenytoin on survival and hatching of chick embryos

Study Design: Experimental study

Place and Duration of Study: This study was carried out in the Anatomy Department, Regional Centre of College of Physicians and Surgeons, Islamabad from January 2012 to January 2013

Materials and Methods: The study was carried out on three experimental [B1,B2,B3] and three control [A1,A2,A3] groups. The chick embryos of the experimental groups were injected with 3.5 mg of sodium phenytoin per egg whereas the controls were administered same volume of normal saline just before incubation. The experimental group was dissected on day 4, day 9 and day 22 or hatching whichever was earlier. The survivability was compared with age-matched controls

Results: Survival was less in the experimental groups as compared to the controls. The percentage of mortality was 3.84% in group B1, 14.28% in group B2 and 21.42% in group B3. This difference between control and experimental groups was found to be statistically significant [p<0.05]. In group B3, 90% of the live chicks were able to crack open the shell on their own. Rest of the chicks had to be assisted after waiting till 22nd day of the incubation. All of the chicks belonging to the control group A3 cracked open the shell on their own on the 21[st] day of incubation but this difference between groups A3 and B3 regarding mode of hatching was found to be statistically insignificant [p 0.1812]

Conclusion: In this study, prenatal sodium phenytoin exposure resulted in decreased chick embryo survival with increasing embryonic age and increased duration of exposure but there was no significant effect on the hatching of the chicks

developmental gross morphology of pancreas in chick embryo after prenatal administration of valproic acid

To determine the effects of prenatal administration of valproic acid on the developmental gross morphology of pancreas in chick embryo. Experimental study. Anatomy Department, Regional Centre, College of Physicians and Surgeons, Islamabad, from February 2010 to February 2011. An experimental group-A and control group-B, comprised of 30 eggs each. Freshly laid fertilized chicken eggs of experimental group were injected with valproic acid, incubated and hatched. Eggs of control group underwent sham treatment using normal saline. The chicks were sacrificed on hatching or day 22 of incubation, whichever was earlier. The pancreata of only alive chicks of both groups were dissected out, and evaluated for gross morphology in terms of length and weight by statistically comparing with control ones. Then pancreata were stained with aldehyde fuchsin and orange-G stain to study other obvious histological effects, if any. Chicken embryos exposed to valproic acid in ovo, showed significant decrease in length and weight of pancreata. The mean of length [cm] of pancreata in group-A was 2.208 +/- 0.166, and group-B was 2.300 +/- 0.102 [p=0.008]. The mean of weight [g] of pancreata in group-A was 0.032 +/- 0.009, and group-B was 0.048 +/- 0.005 [p=0.001]. Valproic acid exposure showed retarding effect on the gross development of pancreas as depicted by decrease in the length and weight of pancreata

Maximum surgical blood order schedule in a newly set-up tertiary care hospital

Limited availability and supply necessitates the rational use of blood and blood products and avoidance of unnecessary transfusion. A study was carried out in our tertiary care hospital over a period of two years to determine the usage of blood during different surgical procedures. Therefore, the ratio of units cross-matched to units transfused and transfusion probability were calculated. In this study, besides identifying the cases in which blood wastage was present, different factors and circumstances which affect Maximum Surgical Blood Order Schedule [MSBOS] were also noted. After ethical committee approval and informed consent, 305 patients, ASA I and II, were inducted who were scheduled for elective surgical procedures. Parameters recorded were age, sex, hemoglobin, hematocrit, number of blood units crossmatched, duration of surgery, blood loss, type of anesthesia, cross-match to transfusion ratio [C/T], transfusion probability and transfusion index. Among 305 patients, in the Obstetrics and Gynecology group the C/T ratio was 2.4 in cesarean section, in Surgery group it was maximum in open cholecystectomy [11], in the Urology group it was 6 in carcinoma bladder, in the spine surgeries it was 2.6 and in PDA ligation it was 7. By a team approach involving the surgeon, anesthesiologist and hematologist we can reduce the number and pattern of ordering blood for various surgeries

Morphological study of chick heart at different stages of development

Objective: The objective of this study was to study chick heart at different stages of development to serve as a normal baseline

Study Design: Descriptive study

Place and duration: Department of Anatomy, Islamabad Regional Centre of College of Physician and Surgeon, Pakistan from February 2006 to February 2007

Methodology: Ninety chicken eggs were divided into three groups based on the day of sacrifice. Group 1 and 2 were sacrificed at day 7 and 10 of incubation respectively, and group 3 on hatching or day 22 whichever was earlier

Results: At day 7 all the heart chambers were formed along with atrioventricular valves; however semilunar valvular cusps had rounded primordia. Elastic fibres could not be stained in great vessels of day 7 hearts in contrast to day 10 and newly hatched chick hearts where elastic fibres were well stained. In a newly hatched chick heart the semilunar valvular cusps were thin and slender

Conclusion: Chick heart is a useful tool to study the effects of external teratogens on developing heart

Biochemical profiling of inborn errors of purine and pyrimidine metabolism by high-performance liquid chromatography - a strategy to improve childhood mortality and morbidity in Malaysian children

The epidemiology of inborn errors of purine and pyrimidine [PnP] metabolism in developing countries is unknown. Facilities for the analysis of PnP metabolites in Malaysia are currently lacking owing to limited resources and expertise in this field. To achieve the correct diagnosis for these disorders is a time-consuming and costly process. The tests are not readily available for our seriously ill patients.. The primary aim of this study was to establish a simple and cost-effective method using rapid-resolution high-performance liquid chromatography [RR-HPLC] for the diagnosis of inborn errors of PnP metabolism among Malaysian children who are suspected to have disorders of PnP metabolism. The secondary aim was to study the epidemiology and biochemical phenotype in our patients. The analytical method was developed using a reversed-phase high-performance liquid chromatography [RP-HPLC] with C[18] column coupled to a diode array detector for simultaneous determination of the PnP metabolites. A total of 1499 patients were studied. 556 healthy children and adults were recruited as normal controls to establish age-related reference ranges and urinary uric acid - creatinine ratios. The method established was able to separate up to 18 PnP metabolites in a single analytical run time of 28 minutes. Good precision [coefficient variation of < 2%] and a linearity range up to 2000 micro mol/l [r2 > 0.9993] was also observed. Recoveries were 99.8-108.4fi for the tested metabolites. The detection limit of 2.18-12.5 micro mol/l was adequate to detect patients with slightly increased concentration of these metabolites. Age-related reference ranges among our population were established and were used for diagnostic interpretation related to this group of disorders. Twelve patients [0.8%] were diagnosed, including four with combined molybdenum cofactor deficiency, three with isolated sulphite oxidase deficiency, two with thymidine phosphorylase deficiency, one with adenylosuccinate lyase deficiency and two with dihydropyrimidine dehydrogenase deficiency. Four cases of urea cycle defects were also detected. The method that we developed was proven to be efficient, reliable and sensitive enough to be applied in our clinical laboratory for the diagnosis of inborn errors of PnP metabolism disorders among Malaysian children. Early recognition and correct diagnosis allowed prompt treatment, better outcome and genetic counselling

Effect of ethanol vapour exposure on survival of chick embryos

To determine the survival of chick embryos after ethanol vapour exposure by noting the number of dead and alive embryos and comparing with age-matched controls. Study Design: Experimental study. Place and Duration of Study: Department of Anatomy at the regional centre of College of Physicians and Surgeons, Islamabad, from February 2006 to February 2007. Chicken eggs, placed in an incubator, were exposed to ethanol vapours produced through a specially designed vapour chamber. The experimental group was dissected on day 7, day 10 and day 22 or hatching whichever was earlier and compared with age-matched controls. The proportion of ethanol vapours in the incubator was monitored with a breathalyzer. No statistical difference was seen in the survival of day 7 alcohol-exposed embryos and their age-matched controls. The survival of day 10-control embryos was significantly higher than alcohol exposed group of same age. The embryos exposed to ethanol vapours from day 1 to day 10 and then followed till hatching or day 22, whichever was earlier, had significantly lower survival than age-matched controls. In this study, ethanol vapour exposure decreased embryo survival with increasing embryonic age and increased duration of exposure

Unicystic ameloblastoma: a distinct clinicopathologic entity

Unicystic/ Cystic ameloblastoma [UCA] is a single cystic cavity which shows ameloblastomatous differentiation in the lining. First introduced in 1977, it contends on being a separate clinico pathological entity than the solid ameloblastoma. The clinical and radiographic features of UCA, its differential diagnosis, histopathology and current concepts of management have been discussed. This is a review article

Effect of passive tobacco smoking on fertility of female mice

To determine the adverse effects of passive tobacco smoking on fertility of female mice and the preventive role of antioxidants, if any Randomized controlled trial. Anatomy Department, CPSP Regional Centre, Islamabad, from February to July 2005. One hundred and seventeen female mice [Balb C] were selected by random sampling. They were mated and grouped as C [n=30] control, S [n=40] exposed to passive smoke in a whole body exposure chamber and SV [n=37] exposed to smoke and given antioxidants [vitamin C, E]. At 19 days postcoital they were sacrificed and the number of pregnant animals, fetuses and resorption cases were counted. Histological study of uteri without fetuses was done in H and E stained sections for confirmation of pregnancy. Percentages were calculated and Chi-square test was used to calculate statistical significance. The percentage of pregnancies was 55.00% in S and 80.00% in C [p=0.029]. The percentage of animals with more than 11 fetuses was 5.0% in S and 33.30% in C [p=0.001]. The percentage of animals with resorption was 31.80% in S and 0.00% in C [p=0.005]. These values in SV were 64.86%, 18.90% and 20.80%, which were not significantly different from S [p=0.378, 0.216, 0.390 respectively]. Histological study of resorption sites revealed decidual reaction/ remnants of the placenta. Passive tobacco smoke has adverse effects on fertility of female mice, which were not prevented by antioxidants. Either those were due to other chemicals present in smoke, or the antioxidants were inadequate to neutralize the free radicals

Effects of quality of water on enteric disorders of protozoal origin

Enteric disorders of protozoal origin i.e. Amoebiasis and Giardiasis are a major health problem in India. They are mostly water-borne. The prevalence of these disorders largely depends on quality of water consumed. The quality of water in India is. still below the recommended standards i.e. zero coliform per 100 ml of water [W.H.O., 1984].The present study, which was conducted in Jamalpur a suburb of Aligarh District [U.P.], included a total of 1270 individuals. The period of study was one year. Water supply in these houses was mainly [89.2%] from standpost. A few have access to piped water supply, The occurrence of Amoebiasis was very high i.e. 20.1% which was found mainly after 19 years of age. The average episode of Amoebiasis in standpost group and piped water group was 3 and 4 respectively.In standpost group majority of sample [87.3%] was contaminated as compared to piped water supply. The morbidity rate was higher in males than in females. The frequency of Amoebiasis was 18.8% and Giardiasis 25.2%. The occurrence of Giardiasis was common in 1-12 years of age and Amoebiasis had no specific group. The frequency according to standpost group and piped water group for Amoebiasis was 15% and 13.1% while Giardiasis 20.1% and 17.5% respectively. Giardiasis was more common in both source of water supply than Amoebiasis. The morbidity rate in standpost group was slightly higher

Mammographic criteria for determining the diagnostic value of microcalcifications in the detection of early breast cancer

Objective: To evaluate the importance of microcalcifications in the detection of breast carcinoma in conventional mammography

Material and Methods: This prospective study was carried out at Aga Khan University Hospital [AKUH]. Mammograms of 68 patients with microcalcifications were evaluated. Craniocaudal and oblique views of both breasts were acquired on routine basis with cone compression and magnified views when required

Results: Among 68 patients with microcalcifications, 61 [89%] had clustered microcalcifications while 7 patients [10.29%] had scattered microcalcifications. Microcalcifications can occur in benign and malignant diseases. While evaluating clustered microcalcifications, few criteria have been established to determine malignant clustered microcalcifications, these include specific and nonspecific criteria. Among specific and statistically significant criteria for malignant microcalcifications, which were identified in this study, were irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. In a cluster total number of >30 microcalcifications and at least 10 microcalcifications/cm2 of a cluster are also important in diagnosing a malignant cluster, but are included in nonspecific criteria because they can be present in benign diseases also. Scattered bilateral microcalcifications are usually present in benign breast diseases, but in this study, two patients with breast cancer had profuse bilateral scattered microcalcifications

Conclusion: This study shows that specific and statistically significant criteria for malignant microcalcifications, are irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. Scattered bilateral microcalcifications are usually present in benign breast diseases, but irregular shape and development of new calcifications among diffusely scattered bilateral calcifications, on follow up study, should also raise suspicion for being malignant