prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar

Objective: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan

Methods: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant

Results: Majority of the patients meeting the criteria of this study were male 147 [54.9%] with a mean age of 54.8. The most common source of sepsis was lung infections [42.2%] followed by urinary tract infections [18.7%], soft tissue infections [6.3%] abdominal infections [6%] and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment [1.086 [1.002 - 1.178], 0.046]. Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients [Model 1: R2 0.32, p=0.000], and upon involvement of the organ complications the risk of mortality was observed to 42.0%

Conclusion: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive

Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia

Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic [DMTAC]. This study aimed to assess the clinical outcomes of patients managed by pharmacists [DMTAC], in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c >/=8% were recruited and arbitrarily divided into the intervention group [usual care plus DMTAC] and the non-intervention group [usual care only]. Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally [pre and post analysis] between the groups. Data analysis was done using PASW 18[registered] version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c [-0.90% vs. -0.08%, p=0.011] and fasting blood glucose levels [-3.45mmol.l vs. +0.79mmol/l, p=0.002] reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol [LDL-C] were also significantly reduced in the intervention group [TC -0.34mmol/l, p=0.018] [LDL -0.45mmol/l, p=0.001]. In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients

Complications of total extraperitoneal [TEP] repair for adult inguinal hernia

Objectives: To evaluate results of laparoscopic total extra peritoneal repair for inguinal hernia in terms of complications. Setting: Surgical Unit 3, Allied Hospital, Faisalabad. Period: From March 2013 to February 2016. Study Design: Simple Descriptive Study

Patients and Methods: 114 patients over the age of 30 years underwent TEP repair for unilateral reducible inguinal hernia. Complications assessed included pain score assessment, analgesia requirement, time taken to return to normal activity and complications like intraperitoneal injury, conversion to open procedure, seroma and hematoma formation and surgical site infection

Results: Out of the 114 patients, 6 [5.26%] needed TEP converted to open and none suffered from serious complication during the procedure. 8 [7.01%] developed postoperative hematoma, 7 [6.14%] developed seroma and 5 [4.38%] developed surgical site infection. Postoperative pain assessment at 8 hours after surgery showed 42[36.8%] patients required extra analgesia while 13[11.4%] patients required extra analgesia 24 hours after surgery

Antimicrobial activity of Nigella sativa L. seed oil against multi-drug resistant Staphylococcus aureus isolated from diabetic wounds

Microbial resistance to existing antibiotics has led to an increase in the use of medicinal plants that show beneficial effects for various infectious diseases. The study evaluates the susceptibility of multidrug resistant Staphylococcus aureus to Nigella sativa oil. Staphylococcus aureus was isolated from 34 diabetic patient's wounds attending the Renaissance hospital, Nsukka, Southeast Nigeria. The isolates were characterized and identified using standard microbiological techniques. Isolates were cultured and a comparative In vitro antibiotic susceptibility test was carried out using the disk diffusion method. Of the 34 samples collected, 19[56%] showed multidrug resistance to the commonly used antibiotics. Nigella sativa oil was then studied for antibacterial activity against these multidrug resistant isolates of Staphylococcus aureus in varying concentration by well diffusion method. The oil showed pronounced dose dependent antibacterial activity against the isolates. Out of 19 isolates, 8[42%] were sensitive to undiluted oil sample; 4[21%] of these showed sensitivity at 200 mg/ml, 400 mg/ml and 800 mg/ml respectively. Eleven [58%] of the isolates were completely resistant to all the oil concentrations. The present study, reports the isolation of multi-drug resistant S. aureus from diabetic wounds and that more than half of isolates were susceptible to different concentrations N. sativa oil

Frequency and distribution of dental caries in teeth and arches of patients examined at Punjab Dental Hospital, Lahore

Worldwide prevalence of dental caries is very high reaching to more than 95% in developing countries. . Dental caries is a multi-factorial, dynamic and infectious microbiologic disease process resulting from imbalance in the physiologic equilibrium between the tooth mineral and the plaque liquid. The study design was cross-sectional. This study aim was to evaluate the frequency and distribution of dental caries in teeth and arches of caries patients reporting to department of Operative dentistry at Punjab Dental Hospital, Lahore. Total of 15323 patients with caries reporting to the OPD of Operative dentistry at Punjab Dental hospital were examined with age range of 10 to 60 years or more. Frequency of carious teeth in age group 20-29 years was maximum and minimum in age group 60 years or more. Dental caries was more prevalent in mandible [53%][n=8162] than in maxilla[47%] [n=7158]. In both the arches, first molars were the most frequently affected teeth by caries. Caries was found to be more prevalent in mandible than maxilla

Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

<p><b>OBJECTIVE</b>To determine the prevalence, clinical significance and the associated risk factors of potential drug-drug interactions (DDIs) at internal medicine ward of University of Gondar (UOG) hospital.</p><p><b>METHOD</b>A prospective cross-sectional study was conducted on patients treated in internal medicine ward of UOG hospital from April 29, 2013 to June 2, 2013. Data was collected from medical records and by interviewing the patients face to face. Descriptive analysis was conducted for back ground characteristics and logistic regression was used to determine the associated risk factors.</p><p><b>RESULT</b>In our study, we have identified a total number of 413 potential DDIs and 184 types of interacting combinations with 4.13 potential DDIs per patient. Among 413 potential DDIs most were of moderate interactions 61.2% (n=253) followed by 26% (n=107) of minor interactions and 12.8% (n=53) of major interactions. There was significant association of occurrence of potential DDIs only with taking three or more medications.</p><p><b>CONCLUSION</b>We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.</p>

Ibuprofen versus acetaminophen premedication on success of inferior alveolar nerve block in irreversible pulpitis

To compare impact of ibuprofen and acetaminophen premedication on the efficacy of inferior alveolar nerve block in irreversible pulpitis. Randomized controlled trial. Operative Department, AFID Rawalpindi from 18 September 2007 to 17 September 2008. Three hundred and sixty patients with irreversible pulpitis were divided into two groups. At base line patients pain was recorded. Ibuprofen was given to patients in group A and acetaminophen to group B patients. Patients were given drugs in tablet form. After 30 minutes cold test with ethyl chloride was done and patient pain was recorded on visual analogue scale. Inferior alveolar nerve block was administered. Forty five minutes from base line cold test was performed and pain was recorded. Access to the endodontic cavity with round bur in high speed handpiece was made and patient response was noted. Inferior alveolar nerve block was successful if patient had no pain to cold test at 45 minutes and on access to cavity preparation. Data was analyzed by SPSS version 12. There was no statistically significant difference between ibuprofen and acetaminophen on success rate of inferior alveolar nerve block in patient with irreversible pulpitis. Ibuprofen and acetaminophen premedication has similar efficacy on success of inferior alveolar nerve block in patients with irreversible pulpitis.

Hepatitis C; association of interferon-ribavirin therapy with hearing loss

The objective of this study was to determine association of Interferon-Ribavarin therapy with hearing loss in patients suffering from Hepatitis 'C'. Quasi-experimental study. Otolaryngology Department Combined Military Hospital Rawalpindi from 09 June 2006 to 08 June 2007. Consenting sixty patients of Hepatitis C divided into two equal groups of 30 each, [group A receiving Interferon-Ribavarin therapy and group B, not receiving it] during the study period fitting the inclusion criteria were selected. Pure Tone Audiometery including both air and bone conduction performed as base line data at commencement of therapy and then at the end of therapy [after six months]. Patients were sampled by Convenience [non-probability] technique. The number of patients who were found to have defined hearing loss was 06 [20%] in Group A [n=30] and 05 [16.67%] in Group B [n=30]. Chi Square test was applied which showed a p-value of 0.739 which is highly insignificant. Interferon-Ribavarin Therapy does not have a significant association with hearing loss in patients of Hepatitis 'C

Tuberculous lymphadenitis at Penang general hospital, Malaysia

To evaluate the incidence, treatment and clinical outcomes of tuberculous [TB] lymphadenitis at Penang General Hospital, Malaysia. Penang General Hospital is the referral center for all tuberculosis patients in the state of Penang. Patient records were reviewed to identify patients with confirmed diagnosis of TB lymphadenitis between January 2006 and December 2008. Data were analyzed using SPSS version 15. Of 1,548 tuberculosis cases, 109 [7.0%] patients had TB lymphadenitis. The mean age was 36.4 +/- 12.87 years and of the 109 patients with TB lymphadenitis, 35 [33.0%], 37 [34.0%] and 36 [33.0%] were observed for 2006, 2007 and 2008, respectively. Ethnically, 45 [41.3%] were Malay followed by 37 Chinese [33.9%]. Among risk factors for TB lymphadenitis, HIV and diabetes mellitus were seen in 17 [15.6%] and 11 [10.0%] patients, respectively. Cough and fever were the most frequently reported symptoms. In a majority of cases [n = 90, 82.5%] positive results were obtained for fine-needle aspiration [FNA]. Directly observed therapy was given to all patients. Sixty-two [56.9%] patients were successfully treated, and 5 [4.6%] patients died during the treatment. There was no increase in the incidence of TB lymphadenitis over the 3-year study period. The incidence was slightly higher in male than female gender and in Malay [ethnic group]. Diabetes mellitus and HIV were the most commonly reported risk factors. FNA is the most reliable diagnostic test

Dens invaginatus: aetiology, classification, prevalence, diagnosis and treatment considerations

Dens invaginatus is a developmental malformation of teeth.Affected teeth show a deep infolding of enamel and dentine starting from the foramen caecum or even the tip of the cusps and which may extend deep into the root. Teeth most affected are maxillary lateral incisors. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Root canal therapy may present severe problems because of complex anatomy of teeth. Aetiology, classification, prevalence, diagnosis and treatment considerations are reviewed

Management of crown-root fracture - a case report

This case report describes the management of an oblique crown-root fracture of maxillary left lateral incisor. After removal of the fractured fragment, endodontic treatment, the remaining tooth was provisionally restored. The tooth was then orthodontically extruded by 3 mm to raise the defect supraginigivally. Periondontal fibres were cut with a surgical blade. A metallic screw type post was inserted in the root and core was built with composite restoration. Porcelain fused to metal crown was fitted over the core built up. This case report demonstrates that a multidisciplinary treatment approach to an oblique subgingival crown-root fracture is a reliable and predictable option to save a tooth

Nail mine in stomach

Ingestion of foreign bodies is a common clinical scenario in any emergency department. Presence of thousands of ingested foreign bodies inside stomach is a rare scene. However, only a few such cases have been reported. Here we present a case of young adult man with known psychiatric disorder, having 2562 nails in his stomach leading to gastric outlet obstruction. Gastrotomy was employed to relieve the stomach of this mine of nails. Later psychiatric care was also provided

study of Pakistan hajj medical mission in comparison with six other medical missions during 2008

To describe constitution, capabilities and functioning of Pakistan Hajj Medical Mission [Pak HMM] in comparison with six other medical missions during Hajj-2008. A comparative cross-sectional study. Pak HMM Hospital, Makkah Mukarramah over a period of 06 weeks during Hajj season-2008. Besides Pakistan, six other medical missions were visited and their heads requested to answer a specially designed questionnaire prepared in English. Constitution, capabilities and functioning of Pak HMM was compared with other missions. Data was managed and analyzed using computer programme SPSS-10. Pak HMM was selected 12 weeks, whereas other missions were selected 06-24 weeks [mean=16.33+8.62] prior to Hajj season [p=0.66]. The doctor: hajj ratio at Pak HMM was 1:1650, whereas it was 1:180-1:2188 [mean =1:807.16+708.56] at other missions [p=0.32]. during peak days, average daily out-patient attendance of Pak HMM was 6000, whereas it was 2000-4000 [mean = 2833.33 + 816.49] at other missions [p=0.016]. Six [85.71%] medical missions including Pak HMM had indoor facilities, routine diagnostic facilities and were able to perform minor surgical procedures under local anaesthesia. Number of fully equipped ambulances for critical evacuation of patients in Pak HMM was none whereas in other missions, it ranged from 0 to 16 [mean = 6.33+ 7.45]. Pak HMM is neither selected well in time nor involved in pre-Hajj medical assessment of the intending hujjaj. Although Pak HMM provides health care facilities to Pakistani hujjaj to the best of its capabilities, its indoor facilities, selection and utilization of specialists doctors as well as trained staff and ambulance evacuation of critically sick patients are not adequate

Status of hepatitis B vaccination amongst health care workers and their knowledge about prevention strategies

To assess the status Of Hepatitis B Vaccination Amongst Health Care Workers [HCW] and Their Knowledge About Prevention Strategies. A questionnaire based report. National Institute of Child Health, Karachi from January 2006 to April 2006. Three hundred and eighteen health care workers [age range 20-59 years] filled the questionnaire. Amongst them 186 [58.49 percent] were male. The study showed that 159 [50 percent] were completely vaccinated, 59 [18.55 percent] partially vaccinated and 100 [31.44 percent] were unvaccinated. The study also showed that among vaccinated HCW, 21 [13.20 percent] had their antibody titer done. Only 25 [15.72 percent] had booster dose. Needle stick injury was reported by 174 [54.71 percent] health care workers. Out of this only 56.60 percent had complete vaccination. Only 181 [56.91 percent] health care workers wear gloves while handling blood and blood products. Awareness among health care workers about getting them vaccinated is present but it did not materialize in actuality. The reasons mentioned are not forthcoming with, when one calculates the life long complications that may result from not getting vaccinated. The careless attitude in their clinical practice expose them to the risk of getting infected with contaminated materials

High-dose iodine 131 treatment of hyperthyroidism: experience at King Faisal Specialist Hospital and Research Centre

We have treated 186 Saudi patients [110 females, 76 males] with hyperthyroidism in the last 10 years. Case records of 100 patients were randomly selected for review. The female: male ratio was 1.4:1. The thyroid gland was diffusely enlarged in 46%, small, nodular, or gritty in 46%, and impalpable in 8%. Thyroid scanning revealed diffuse isotope uptake in 40% and patchy uptake in 60%. Ablative doses of 10 or 15 mC[i] of iodine 131 were given to 78 patients. The patients who become hypothyroid have been followed for a median of 18 months. Of these, 37% were hypothyroid at 3 months, 58% at 6 months, 36% at 9 months, and 68% at 12 months. The clinical presentation of hyperthyroidism appears to differ in Saudi Arabia compared with Western countries. The female: male ratio is significantly lower [P< 0.001], and classical Graves' disease less frequent. In large countries where follow-up may be difficult, ablative radioiodine treatment and subsequent thyroxine replacement have advantages over other treatment