ABSTRACT
Objective: This study was conducted to assess outcomes in patients with hydrocephalus who underwent ventriculoperitoneal shunting at Keen's point
Methods: This retrospective study was conducted in Combined Military Hospital [CMH] Peshawar. Time frame was four years from January 2011 to January 2015. The presenting complaints, clinical findings, investigations, treatment plans and surgical outcomes were noted. Ventriculo-Peritoneal [VP] shunting was done at Keen's point. The presence of shunt complications in the first week post-surgery was noted and at a three-month follow up in the outpatient department. General condition of the patient, shunt complications, presence of seizure and worsening of vision were noted
Results: Study included 143 patients, out of whom 46 were females and 95 were male patients. Most common causes of hydrocephalus were congenital [79]. Majority of adults had hydrocephalus due to central nervous system tumors while congenital hydrocephalus in children was most frequently due to aqueductal stenosis. Good clinical improvement was seen in 114 patients after shunt placement, satisfactory in 20 patients, 7 patients died while we observed no change in two patients
Conclusion: Our experience with VP shunting at Keen's point resulted in excellent outcomes. It can be used for the management of hydrocephalus both in pediatric as well as adult population
ABSTRACT
Objective: To present our experience of treating the club foot with the Ponseti way of conservative management. Study Design: Cross-sectional prospective study. Place and Duration of Study: Study was carried out at CMH Sialkot and CMH Rawalpindi, from Jun 2012 to Jun 2015
Material and Methods: A total of 39 children were treated by the same surgeon and 35 cases were included in this study. Ponseti method involves the non-surgical management of clubfoot, involving manipulation and casting techniques. The foot is systematically stretched as per Ponseti method into the normal shape and repeated casts are applied. Equinus is later treated by percutaneous tendoachilles tenotomy if required
Results: Our aim was over correction of the deformity before advising for foot abduction brace. Thirty one [88.57%] cases showed excellent results while we faced difficulty in achieving the required aim in 4 [11.43%] cases
Conclusion: Ponseti clubfoot management technique has reduced the need for extensive soft tissue release and major clubfoot surgery. This technique has been successful in our setup too. We recommend that it may be adopted as the gold standard for clubfoot treatment throughout the country and primary health care physicians should also be trained in this technique so that maximum people may benefit from this
ABSTRACT
Objective: The objective of this study was to determine in vitro MIC patterns of various therapeutic alternatives for the treatment of Salmonella Paratyphi A. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi, from Jun 2012 to May 2014
Material and Methods: Clinical samples were collected from suspected cases of salmonella infections. Culture was applied on Bactec 9050 special and/or standard media. Suspected Salmonella Paratyphi colonies were tested by API 20E and confirmed by serology. The isolates were also tested for resistance to ampicillin, cotrimoxazole, ciprofloxacin, ceftriaxone, doripenem, imipenem, ertapenem, aztreonam, moxifloxacin, cefpirome, cefepime, gatifloxacin, and chloramphenicol by Kirby-Bauer disc diffusion method. MIC [Minimum Inhibitory concentration] was done on MDR and ciprofloxacin intermediate or resistant cases by E-strips
Results: One hundred and eleven isolates of Salmonella Paratyphi were recovered from 2230 specimens. Resistance by disk diffusion technique noted in Salmonella Paratyphi A was ampicillin 60%, chloramphenicol 40%, cotrimoxazole 38%, ceftriaxone 7.9%, ciprofloxacin 8%, cefpodoxime 7.9%, imipenem and ertapenem 2.6%, aztreonam 1.3%, moxifloxacin 6.6%, and gatifloxacin 1.3%. No resistance was noted for doripenem and cefepime. MIC50 was 0.094 for Cefpirome, 0.125 Aztreonam, 0.25 imipenem and tigecycline, 2 cefpodoxime and 8 for azithromycin
Conclusion: Azithromycin, Aztreonam, Imipenem, tygecycline, cefpodoxime and cefpirome are potential therapeutic agents for resistant Salmonella Paratyphi A infections
ABSTRACT
Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK [polyetheretherketone] cages for cervical disc prolapse
Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK [polyetheretherketone] cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse
Results: Most of the patients had stenosis at the C5 / C6 [PEEK cage group 63% and titanium cage group 47.6%] and C6 / C7 [PEEK cage group 15.38% and titanium cage group 19.04%] cervical level. Bi-level involvement was also seen. In the patients who complained of brachialgia, total resolution of symptoms was seen after the operation. Three [2.01%] of the patients in titanium cage group, who presented with axial neck pain, continued to complain of pain after the operation. Four [2.6%] of the patients in PEEK [polyetheretherketone] cage group and 2 [1.3%] in titanium cage group complained of pain at the donor site [iliac crest]. Fusion rate was 100% with both titanium and PEEK [polyetheretherketone] cages at one year
Conclusion: Results with titanium and PEEK [polyetheretherketone] cages are excellent. There was no significant difference in clinical and radiological outcome between two groups of patients [p > 0.05]. Fusion rate was 100% at one year with both cages
ABSTRACT
Although infections with fungi, such as Rhizopus species, usually occur in diabetics or immunocompromised patients, they can also rarely affect immunocompetent individuals. We present a case of disseminated infection with multiple cold abscesses in a 13-year, otherwise healthy girl caused by Rhizopus arrhizus
ABSTRACT
Objective: To evaluate the diagnostic efficacy of laparoscopy in ill-defined recurrent chronic abdominal pain
Study Design: Prospective study
Place and Duration of Study: Surgical department, Military Hospital Rawalpindi, from Jul 2011 to Dec 2013
Material and Methods: A total of 102 patients who presented to surgical department with chronic recurrent abdominal pain of unknown etiology and underwent diagnostic laparoscopy were included in our study. Patients with acute onset of abdominal pain, hemodynamically unstable, pregnant or those in which diagnosis can be made by radiological techniques were excluded from our study. Patient's demographic data, clinical findings and laparoscopic findings were recorded. Finally data was analyzed by using SPSS version 21
Results: Out of 110 patients 96 were female while remaining 14 were male. The age range of the patients was 20-70 years with mean age of 50 +/- 10 years. The most common site of pain was lower abdomen while mean duration of abdominal pain was 34 weeks. Laparoscopic findings include acute recurrent appendicitis in 32 [29.09%] patients, cholecystitis with biliary sludge in 14 [12.72%], pelvic inflammatory disease in 12 [10.90%], ovarian cyst in 11[10%], adhesions in 10[9.09%], intestinal tuberculosis in 8 [7.27%], mesenteric lymphadenitis in 7 [6.36%], lymphoma in 4 [3.63%], ectopic pregnancy in 3 [2.7%], CA gallbladder in 2 [1.81%], meckels diverticulum in 2 [1.81%], endometriosis in 2 [1.81%] and crohns disease in 1 [0.9%] patients. Mean operative time was 48 min while average hospital stay was 2-3 days. No major complications were noticed
Conclusion: Laparoscopy in our clinical setup has significant role in diagnosing cases of vague abdominal pain which cannot be diagnosed by routine investigations
ABSTRACT
Objective: to determine the in vitro disk diffusion and MIC patterns of the therapeutic alternatives for Salmonella Typhi
Study Design: a cross-sectional study
Place and Duration of Study: armed Forces Institute of Pathology, Rawalpindi, from June 2011 to May 2013
Methodology: clinical samples were collected from suspected cases of Salmonella infections. Culture was obtained on standard media. Suspected Salmonella colonies were tested by API 20E and confirmed by serology. The isolates were tested for resistance to various antibiotics by Kirby-Bauer disc diffusion method. MIC was done on MDR and ciprofloxacin intermediate or resistant cases by E-strips for selected antibiotics
Results: one hundred and twenty-eight isolates of Salmonella Typhi were recovered from 2230 specimens. Resistance by disk diffusion technique was 72% for ampicillin, 41.2% for cotrimoxazole, 38% for chloramphenicol, 8% for ciprofloxacin, 4.7% for cefpodoxime, 3.5% each for ertapenem aztreonam and moxifloxacin 2.4% for ceftriaxone and 2.3% for doripenem. No resistance was noted for imipenem, cefepime and gatifloxacin. Imipenem MIC[90] was 0.38 and MIC[50] was 0.25. For cefpirome, MIC[90] was 0.64 and MIC[50] was 0.09. For aztreonam, MIC[90] was 0.12 and MIC[50] was 0.09. For cefpodoxime MIC[90] was 0.75 and MIC[50] was 0.38. For azithromycin, these values were 16.0 and 7.0; and for tigecycline they were 0.25 and 0.09
Conclusion: imipenem, azithromycin, tigecycline, aztreonam, cefpodoxime and cefpirome are potential therapeutic agents for resistant Salmonella Typhi infection
ABSTRACT
Hepatitis B virus is causing serious health concerns in countries like Pakistan. In Khyber Pakhtunkhwa province, 0.6 milion people were estimated to be infected with this virus in 2008. The authors aimed to assess knowledge regarding vaccination, testing and routes of transmission of hepatitis B virus among people of Khyber Pakhtunkhwa, as such knowledge among masses will help limit the infection. People belonging to 12 different districts of Khyber Pakhtunkhwa province were interviewed over a period of 5 months from October 2013 to February 2014. A pre-tested questionnaire was used and in-person survey of randomly selected 1,938 people was carried out throughout the province. Ninety-nine percent people said they knew about hepatitis B virus and 42% said they had got tested for it too. Out of them, 63.2% knew that a vaccine is available for hepatitis B virus. The proportion of respondents, who said hepatitis B virus can spread by sharing razors, toothbrush, syringes or sexual contact, was 97.94%, 95%, 99.3% and 77%, respectively. Only 28.7% knew, it can also spread vertically from mother to child during childbirth. People were quite aware of the routes of transmission of this disease, but they lacked knowledge regarding vaccination and prevention of this menace. Settings should be set up where routine preventive care and immunization services are provided