ABSTRACT
Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. [1] To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. [2] To examine the resistance against various antibiotics. 6 months. Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean+S.D and qualitative variables, were recorded as frequencies and percentages. Out of 80 patients with suspected SBP 38[47.5%] were culture positive while 42[52.5%] were culture negative. Among these 14[36.84%] showed gram positive growth and 20[52.63%] gram negative growth while 4[10.52%] showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone and augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36[95%] followed by cefoperazone 35[92%]. Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome
ABSTRACT
To determine the effectiveness of intraoperative 360 degree retinal photocoagulation in the management of giant retinal tears [GRTs]. Departments of Vitreoretina, Al Shifa Trust Eye Hospital, Rawalpindi. From 2000 to 2004. Sixteen eyes of 16 consecutive patients with GRTs were operated at Al Shifa trust eye hospital. Eyes included in this study underwent pars plana vitrectomy, perfluorocarbon liquid injection, 360 degree retinal photocoagulation and silicone oil exchange. Retinopexy was applied to the edges of the tear through endolaser photocoagulation and extended over 360 degree to the peripheral attached retina. No scieral bijckle was placed in any of these cases. The extent of the GRT was 180 degree or greater in four eyes and 90 degree to 180 degree in twelve eyes. The lower edge of the GRT was located in the inferior quadrant in fourteen eyes. PVR was grade A in five eyes, grade B in eight eyes and grade C in three eyes. In 12 [75%] of the 16 eyes, the retina was successfully reattached after surgery and 360 degree laser photocoagulation. The silicone oil was removed after a mean period of twelve weeks. Two of the four eyes were successfully reoperated by performing relaxing retinotomies. At the end of the follow up, the retinal was reattached in 14 [87.5%] of the 16 eyes. The mean follow up period was 14 months [range 5-23 months]. The success rate of management of GRTs with pars plana vitrectomy, internal temponade and 360 photocoagulation of the retina without scleral buckle is high