Antibiotic resistance pattern shown by various pathogens, causing infections in neonates

This study was schemed to comprehend the latest kaleidoscopic trends of bacterial resistance in neonatal pathogens against all those antibiotics commonly employed as empirical therapy in neonates. The methodological approach included; isolation and subsequent identification of those pathogens having caused bacterial infections in neonates, application of antibiotic sensitivity testing and finally construing the conclusion depicting patterns of antibiotic resistance by various pathogens, isolated from neonatal biological samples. Antibiotic resistance patterns was evident in gram-positive as well as in gram-negative bacteria in all the eight species identified in this study. Even antibiotic drugs which are being commonly relied upon for treating multi-resistant bacterial infections, found to be in effective against many newly emerged resistant bacteria, when used alone. Resistance Antibiotics drugs against which most prominent resistance pattern emerged include; Amikacin sulphate, Linezolid, Piperacillin / Tazobactam, Amoxicillin / Clavulanic acid, Vencomycin, Cefoperazone / Sulbactam, Ceftriaxone sodium, Ciprofloxacin, Cefixime trihydrate and Imipenem. The inferred upshot suggests that antibiotic resistance is emerging fast and ever-changing phenomenon of antibiotic resistance has significantly reduced the therapeutic space to maneuver, particularly, in treating neonatal infections

Association of dental anomalies with different malocclusions in patients visiting Liaquat college of medicine and dentistry

The purpose of present study was to determine association of dental anomalies observed in various dental malocclusion patients visiting for Orthodontic treatment. Total of 600 patients [169 male, 431 female] having mean age 17.25+/-5.55 years were evaluated. This study showed that 61.2% of patients [n = 600] presented with at least one dental anomaly. Ectopic eruption was the most commonly found [46.8%], followed by Agenesis [missing tooth or teeth] 9.0%, canine impaction 4.0% and supernumerary teeth 1.3%. The frequency of theses dental anomalies were found higher in female than in males. Ectopic eruption [56% within malocclusions] was more frequent in patients with Class II div 1 malocclusion. No supernumerary tooth was found in Class II division 2 malocclusion rather more prevalent in class III malocclusion [2.5%]. Impaction was associated with Class II div 2 malocclusion [11.1%], at a higher prevalence than other types of malocclusions. Agenesis was associated with Class II div 2 malocclusion and class III malocclusion [14.8]. The correlations between dental anomalies and different types of malocclusion were found statistically significant. Within limitation of this study, Dental anomalies recorded frequently higher in females than male subjects, the reason may be the female patients being more esthetically conscious, visiting orthodontic treatment in Pakistan

Usefulness of hemodynamically distribution of intranodal vessels in differentiating metastatic neck lymph nodes - value of color doppler and spectral wave sonogram

Objective: To evaluate the diagnostic assessment of enlarged lymph nodes, based on its perfusion pattern by taking tissue diagnosis as gold standard

Study Design: Analytical study

Place and Duration of Study: Departments of Radiology and Pathology, PIMS Hospital, Islamabad, from February to May 2016

Methodology: Color sonography of patients with clinically, palpable cervical lymph nodes were carried by senior trainee under the supervision of senior radiologist. Ultrasound guided tissue diagnosis was obtained in all suspected malignant cases. Histopathology was taken as the gold standard for determining accuracy

Results: Accuracy, sensitivity and specificity, positive and negative predictive values of color Doppler ultrasound in detecting malignant cervical lymphadenopathy was found to be 88.46%, 86.05%, 79.31% and 92.50%, respectively with diagnostic accuracy of 86.95%, when intranodal vascular pattern on color Doppler imaging was analyzed. Using spectral wave indexes, the same values were 92.31%, 90.70%, 85.71%, 95.12%, respectively with overall diagnostic accuracy of 91.30%

Conclusion: Color Doppler sonography is much sensitive borderline than grey scale findings alone. Furthermore, lymph nodes appearing in the detection of malignant nodes on grey scale images can be reliably diagnosed on Doppler scan

Spontaneous pneumothorax in neonates: a comparison between efficacy of needle aspiration versus tube thoracostomy

Background: Pneumothorax is an acute emergency and aspiration of the trapped air is almost always required and only in limited cases expectant management can be offered. Chest drains, needle aspiration and finally surgical intervention are needed depending upon the need of emergency

Objective: To compare the efficacy of intercostal chest tube and needle aspiration in cases with Pneumothorax in neonates

Methodology: It was a randomized control trial on 32 neonates presenting with nontension pneumothorax diagnosed clinically and on chest X ray and were randomly selected in two equal groups, A and B. Group A was treated with intercostal chest tube [ICT] and Group B underwent needle aspiration. This study was carried out at Arar hospital, Northern provinces, Saudi Arabia. These cases were then followed via clinical improvement and X ray chest to look for complete resolution. Outcome was observed in the form of complete resolution and time taken to resolution

Results: In this study, there were total 32 cases, sixteen in each group. In group A out of 16 there were 9 [56.25%] males and 7 [43.75%] females, while in group B there were 10 [62.50%] males and 6 [37.50%] females. The mean age of group A and B were 7.27+/-3.05 days and 7.34+/-2.93 days respectively. There was no statistical significant difference in socio-demographic factors of both groups. The complete resolution of the symptoms and radiological clearance was seen in 15 [93.75%] out of 16 cases of group A as compared to 13 out of 16 [81.25%] in group B with p=0.09. There was significant difference in mean duration of resolution which was 7.56+/-1.48 days in group A in contrast to group B with 4.78+/-0.92 days with p value of 0.01. There was no statistically significant difference in both groups regarding socio-demographic factors, pre term or term labor or side effect profile

Conclusion: Pneumothorax are not uncommon in neonates. ICT is a better treatment option regarding complete resolution. However, time taken to resolution is significantly shorter with needle aspiration

Iatrogenic facial nerve palsy in mastoid surgery

Introduction: The aim of this study is to see the incidence of facial nerve injury in mastoid surgery for chronic suppurative Otitis media active epithelial type and how can we reduce this incidence

Methods: We operated upon 165 patients for chronic suppurative otitis media active epithelial type and saw the facial nerve palsy intraoperatively and postoperatively. A total of 165 mastoid explorations were performed out of which Modified radical mastoidectomy was done in 155 cases. Radical mastoidectomy was done in 7 patients and combined approach tympanoplasty done in 3 patients

Results: In our series, only three patients got facial weakness 24 hours postoperatively which was grade 3 according to HB [House Brackman].Complete facial nerve recovery was achieved in all three cases with conservative treatment alone. Two patients developed labyrinthine fistula which was managed conservatively. In ten patients, facial nerve was exposed in tympanic segment of the middle ear cavity

Conclusion: Mistake that most likely occurred during mastoid surgery were drilling towards the antrum and going inferiorly. Short process of incus is good landmark to avoid facial nerve injury

Prophylactic use of gabapentin to reduce postoperative nausea and vomiting in patients undergoing diagnostic gynecological laparoscopy

Introduction: Postoperative nausea and vomiting [PONV] occurs in patients during the first 24 hours of the surgery. Many drugs have been used for the prevention and treatment of PONV. In this trial, we used gabapentin to evaluate its prophylactic effect in reducing the severity and incidence of PONV in patients undergoing diagnostic laparoscopic gynecological surgery

Methodology: This, double blind randomized controlled trial, was done in operation theatre complex over a period of six months. 140 patients undergoing diagnostic gynecological laparoscopic surgery were selected. Two groups were formed and 70 patients were recruited in each group using lottery method as method of randomization. Group C [control group] was given placebo medication orally two hours before surgery and group G [gabapentin group] received 600 mg of gabapentin orally two hours before the procedure. Standard general anesthesia technique was used in all patients and incidence and severity of postoperative nausea and vomiting [PONV] was recorded in these patients till 24 hours of laparoscopy

Results: Severity of PONV was graded from mild to severe. There was no PONV in 25 patients [35.7%] in group C and 47 patients [67.1%] in group G. It was mild in severity in 8 patients [11.4%] in group C and 5 patients [7.1%] in group G, moderate in 31 patients [44.3%] in group C and 15 patients[21.4%] in group G and severe PONV was seen in 6 patients [8.6%] in group C and 3 patients [4.3%] in group G [P=0.003]. Postoperative nausea and vomiting within 24 hours after procedure was present in 45 patients [64.3%] in group C and 23 patients [32.9%] in group G. Results were significant between two groups after statistical analysis with p value of 0.001

Conclusion: Administration of 600 mg of gabapentin two hours before diagnostic gynecological laparoscopy decreases the frequency and severity of PONV

Ways to manage hepatitis C without cirrhosis: treatment by comparison of coded eastern medicine hepcinal with interferon alpha 2b and ribavirin

Hepatitis C virus [HCV] infection is a serious and significant global health problem in the Pakistan and elsewhere. In majority of cases HCV infection remains asymptomatic but in advance cases it may progress to fibrosis of liver, shrinkage of liver cells or failure of liver. The hepatitis C may progress to cause liver cirrhosis that mostly develop in 20% of the affected patients in 20 years with an increased risk in male, alcoholic drink, immune-compromised and who acquire HCV infection after the age of 40 years. This was an open-label prospective study conducted on 66 clinically and immunologically diagnosed cases of HCV infection. In Hepcinal treated group, there were significant improvement in HCV associated symptoms compared to control group [p<0.05]. While Interferon therapy resulted in significant improvement in serological response [55.88%] compared to Hepcinal treated patients [46.88%]. It was concluded that Hepcinal has shown better clinical response but no significant serological response [p=0.3244] and it might be an alternative therapy to treat hepatitis C infection and to prevent its progression into chronic ailment

Bedside ultrasonography: a useful tool for traumatic pneumothorax

Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax

Study Design: Analytical study

Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015

Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard

Results: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33% and 54.76%, respectively and specificity of 100% for both modalities

Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk

Management of trigeminal neuralgia pain by peripheral absolute alcohol nerve block among oral and dental patients at Victoria hospital/Quaid-e-Azam medical college, Bahawalpur

Objective: To determine peripheral absolute alcohol nerve block for the management of trigeminal nerve pain and its complication among oral and dental patients

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Dept of Oral and Dental Surgery along with few referral from the Neuro-Surgery at Bahawal Victoria Hospital a tertiary care hospital attached with the Quaid-e- Azam Medical College, Bahawalur in Southern Punjab from January 2013 to December 2015

Materials and Methods: A total of 125 patients have been included Before administering the peripheral alcohol nerve block 1.8ml of lignocaine local anesthesia injection was given to anaesthetize patient nerve involved. The study subjects consists of the patients suffering from trigeminal neuralgia diagnosed clinically based on specific signs and symptoms of neuralgia pain. The study variables were duration of pain relief by peripheral nerve block and any complication, duration of re-injection to measure repeated nerve block, study subject age, gender, area of residence, socio-demographic characteristics, patients history of therapeutic treatment. Data was collected on specifically designed questionnaire and analyzed on SPSS 20.0 and presented in tabulated form as frequencies of the above mentioned variable along with their percentages, mean and standard deviations

Results: Total of 125 patient hospital records who received absolute alcohol with history of re-injection has been included in this study. Peripheral absolute alcohol nerve block was effective ranging from minimum of 3 to 17.45 months, the mean duration of pain relief was 8.35 months with standard deviation of 4.5 months and there was gradual decrease in the pain relief after repeated re-nerve block from our study data set. Some of the patients were referral from Dept of Neurosurgery of our institution who were not fit for neurosurgery, so advised for local peripheral absolute nerve block. There was no significant report of complication except mild to moderate pain, swelling, trismus, burning sensation, dysesthesia, fibrosis of soft tissues and only 04 subjects report of injection site infection

Conclusion: Absolute alcohol nerve block to be less invasive in dental office management and relatively more efficacious for neuralgia pain relief to reduce patient morbidity and cost effective for patients who do not have relief on conventional carbemazipine drug therapy and being disease of elderly age who are usually medically compromised as not being fit for surgery or willing for relatively costly and invasive neurosurgery procedure

Comparative clinical efficacy and safety of coded herbal medicine dermovix in the management of patients with atopic dermatitis versus allopathic medicine

Atopic dermatitis [AD] is defined as a chronic, highly pruritic inflammatory condition of skin. It is estimated that this disease may lead significant morbidity and also adversely affects the quality of life. Atopic dermatitis responds well to home treatment. Proper skin care reduces the need for medicines. Topical creams and oral antihistamines can be used to suppress the symptoms. The clinical trial was conducted on 60 patients in which 30 are control and 30 are test by taking written consent from them. Dermovix significantly improved skin symptoms associated with AD. This Dermovix ointment was safe and well tolerated in specified age group patients. Overall results of individual group were analyzed by using Paired sample t-test and level of significance of all the symptoms was calculated. Both the drugs showed similar efficacy and the calculated p value was p<0.05. Except in case of dry skin the test drug had shown not significant p value i.e. 0.407. When we compare all these and their effects and patients' complaints then Test group have shown better results because of no side effects

Pharyngocutaneousfistula; its causes and management

Objective: to study the various causes and management of Pharyngocutaneous fistula in total laryngectomy

Material and Methods: 40 patients underwent total laryngectomy in service hospital Lahore from May 2003 to December 2014. The patients were prospectively studied regarding formation of Pharyngocutaneous fistula in the following aspects age, tumor site, and stage of disease, primary repair, infection and recurrence of tumor

Results: pharyngocutaneous fistula was diagnosed in 9 patients [22%] out of 40. Fistula developed in 2 patients [22%] on 3rd day due to rent in repair. 5 patients [55%] had fistulae due to infection on 8th day and 2 patients [23%] due to presence of residual tumor on 15th day. Pharyngocutaneous fistula is common complication which occurs after total laryngectomy. Three patients previously submitted to tracheostomy had fistula out of 5patients 6O %[ higher incidence] as compared to the 6 patients out of 35[17%] without tracheostomy. The reported incidence ofpharyngocutaneous fistula is extremely variable in literature ranging from 13% to 25% and in our series it is about 22 %

Conclusions: spontaneous closure is possible with proper wound care, good nutrition and antibiotics. 7 cases out of 9 in our series heeled with conservative treatment. Incidence of Pharyngocutaneous fistula formation is more in supraglottic, previously tracheostomised patients and also in advanced stage. In some patients surgical intervention is needed to close the fistula by flap. We used deltopectoral flapin two patients

Peritonsillar abscess: a new approach for its management

Objective: to see the effectiveness of various treatment modalities in peritonsillar abscess

Material and Methods: 250 patients were admitted in ENT department services hospital Lahore through emergency and opd having symptoms of unilateral severe throat pain, trismus, drolling, earache, and change of voice [hot potato voice]. Patients having peritonsillitis can be differentiated from peritonsillar abscess by intraoral ultrasonography

Results: 50 Patients having peritonsillitis are treated by IV antibiotic, pain killer and IV fluids. In patients having peritonsillar abscess needdle aspiration done in 15 patients [6%] and incision and drainage done in 85 patients [34%]. In 100 patients having history of recurrent acute tonsillitis[fourto five attack per year] and sleep apnea interval tonsillectomy done

Conclusion: peritonsillitis can be mananged conservatively. Incision drainage is gold standard for peritonsillar abscess. In tonsillectomy when indicated early interval tonsillectomy is better option than delayed interval tonsillectomy

Hepatocellular carcinoma; different child-pugh classes based on alpha-fetoprotein level

To determine the frequency of hepatocellular carcinoma in different Child-Pugh classes based on Alfa fetoprotein level. Case series study. Six months. Medical Unit-I of Liaquat University Hospital, Hyderabad Sindh Pakistan. A total of 100 patients admitted [inpatients] in Medical Unit I with the diagnosis of cirrhosis were enrolled in the study. Patients with cirrhosis of liver [more than six month duration] of either gender were included. If patients had metastatic lesion of the liver, liver abscess, or acute liver failure then they were excluded. Child-Pugh score was calculated which included ascites, encephalopathy, prothrombin time, albumin and serum bilirubin. The levels of alpha-fetoprotein were measured and HCC was diagnosed. The primary outcome variable was presence of HCC in cirrhotic patients. The proportion of males [53%] was higher as compared to females [47%]. The mean age of the study patients was 40.47 years with a standard deviation of 11.5. At the beginning patients were categorized according to Child Pugh Classes [A= up to 6, B=7-9 and C=10-11], age groups [15-30 years, 31-50 years and 51- 70 years respectively]. The mean Child Pugh score was 6.83 with +/- 1.8 S.D. The majority of the cases of HCC [75.61%] occurred in the Child Class A, whereas 21.95% occurred in Child Class B and finally only one case of HCC [2.44%] was present in Child Class C. This study comprehensively demonstrated that hepatocellular carcinoma [HCC] is far more common in compensated cirrhosis [Child Pugh Class A] vs. decompensated cirrhosis [Child Pugh Class B and C]

Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy

Cough at extubation and postoperative sore throat are common complications in patients receiving general anesthesia with trachea! intubation. Different strategies have been used to reduce these effects. In this double blind controlled trial, we evaluated the effects of lidocaine sprayed onto the larynx and injected into tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat in patients undergoing total abdominal hysterectomy [TAH] under general anesthesia. One hundred women, aged 40-60 years, scheduled for TAH under general anesthesia were included in this randomized double blind prospective study. After induction of general anesthesia, just before tracheal intubation, glottus was sprayed by 4% lidocaine or 0.9% saline through a syringe with 4 ml volume. After tracheal intubation, the tracheal tube cuff was filled with 4 ml of 2% lidocaine solution or 0.9% saline. In this way four groups were formed; spray-cuff group [lidocaine spray and lidocaine in cuff], spray-saline group [lidocaine spray and saline in cuff], saline-cuff group [saline spray and lidocaine in cuff], and saline-saline group [saline spray and saline in cuff], having 25 patients in each groups. The primary outcome was the incidence of cough at extubation. The incidence and severity of sore throat was recorded at 15 min, 60 min and 24 hrs post-extubation using visual analogue scale [VAS, 0=no pain, 10= worst pain imaginable] as a secondary outcome. All patients completed the study. Cough was noted in 20%, 16%, 76%, and 84% of patients in the spray-cuff group, spray-saline group, saline-cuff group and saline-saline group respectively. The spray of lidocaine onto the larynx resulted in decreased incidence of cough at extubation [P value < 0.001]. But the intracuff lidocaine did not show any decrease in the occurrence of cough or reduction in the incidence and severity of sore throat as it remained low in all groups. Use of lidocaine spray onto the larynx resulted in significantly decreased incidence of cough at tracheal extubation in patients undergoing TAH. However, the use of lidocaine into endotracheal tube cuffs had no effect on the incidence of cough or sore throat

Radiological evaluation of the stability of crossed-pins versus lateral-pins fixation in displaced supracondylar fractures of humerus

To compare the radiological evaluation of stability of closed reduction of supracondylar fractures of humerus treated by percutaneous two-crossed-pin fixation and 2-lateral pin fixation. Randomized controlled trial. Orthopedic Unit Hayatabad Medical Complex Peshawar, from January 2008 to July 2009. Fifty patients with displaced supracondylar fracture of humerus presented between ages 1-12 year were randomly allocated in two groups of 25 patients each and were subjected to crossed-pin fixation and 2-lateral pin-fixation. Primary outcome measure was determined with the help of Baumann angle. Secondary outcome measure was determined with the help of Metaphyseal-Diaphyseal [MD] angle. Mean age of patients was 7.02 +/- 2.25 year. Mean loss of Baumann angle and Metaphyseal Diaphyseal angles were 5.360 +/- 2.220 and 2.420 +/- 1.250 respectively. The mean Baumann angle loss in the two cross pins fixation group and the 2-lateral pins fixation group were 5.56° +/- 1.80° and 5.16° +/- 2.64° respectively. The mean MD angle loss in the two crossed pins fixation group and the 2-lateral pins fixation group was 2.440 +/- 1.220 and 2.400 +/- 1.230 respectively. When loss of Baumann and Metaphyseal-Diaphyseal angles were compared between two methods of fixation using Student t test, no significant difference in the stability of two methods of pin fixation was observed. Radiological analysis showed that both the techniques were effective in terms of stability

Effect of gabapentin on opioid requirements in patients undergoing total abdominal hysterectomy

Gabapentin possesses antihyperalgesic and antiallodynia properties and has a definite role in neuropathic pain relief. In this study, we tried to determine whether preemptive use of gabapentin can result in reduction of intra and postoperative pain and narcotic [nalbuphine] requirements in patients undergoing total abdominal hysterectomy [TAH]. In this randomized, double-blind controlled trial, 35 patients [study group] undergoing TAH received gabapentin 1200 mg and 35 patients [control group] received placebo orally two hours before induction of anesthesia. Intra-operatively, an increase in blood pressure and heart rate were taken as an indicator of pain during surgery and nalbuphine at 0.05-mg/kg body weight was administered as a rescue analgesia. Postoperatively, for the initial 24 hours, pain was assessed on a Visual Analogue Scale [VAS score 1-10, score 1-3 considered mild pain, 4-7 moderate pain and 8-10 as severe pain]. If score was more than 3 a top up dose of nalbuphine 0.05 mg/kg was administered intravenously. Total nalbuphine consumption during the intraoperative period and initial 24 hours postoperative period was recorded for each patient. Thirty four patients in the gabapentin group [study group] and 35 patients in the Placebo group [control group] completed the study. Overall, pain scores in the gabapentin group were significantly lower as compared to the Placebo group. The total nalbuphine consumption was 13.2 +/- 4.7 mg [mean +/- SD] in the gabapentin group versus 24.3 +/- 9.2 mg in the Placebo group [P < 0.001]. Preemptive use of gabapentin resulted in reduction of intra and postoperative narcotic [Nalbuphine] requirements in patients undergoing total abdominal hysterectomy

Comparison of mean tooth attrition score in psychiatric patients with healthy individuals

The objective of the study was to compare the Mean Tooth Attrition Score in psychiatric patients with depression, with healthy individuals of same age groups. A Case control study was carried out in the Department of Prosthodontics, Armed Forces Institute of Dentistry and Psychiatric Department, Armed Forces Institute of Mental Health, Rawalpindi, from August 2010 to March 2011. Seventy patients were divided into two equal groups, A and B. Group A comprised of 35 psychiatric patients with depression under treatment since one year having minimum ten natural teeth in oral cavity including first molars and incisors selected from Armed Forces Institute of Mental Health while group B comprised of 35 otherwise healthy individuals of same age range reported to AFID for routine dental treatment. They were included by Non probability consecutive sampling method. The patients with history of facial trauma, hormonal disease or neoplasm, having carious or restored molar teeth and malocclusion were excluded from the study. Smith and Knight[1] index with scores ranging from 0 [No loss of enamel] to 4 [Complete loss of enamel] used to measure tooth attrition score of central, lateral incisors and first molars. The data were analyzed with SPSS version 16. In this study, a significant difference between groups for mean tooth attrition score was found. Psychiatric patients with depression and anxiety revealed the highest degree of tooth wear, many of them requiring complex treatment

External fixation: daily versus weekly pin site care

To determine whether there were any differences in the frequency and severity of pin site infections by performing pin site care daily or once a week. cross sectional descriptive study. This study was carried out at Department of Orthopaedics and Traumatology, Khyber Teaching Hospital, Peshawar during the period from Dec 2011 to Jun 2013. This study included 96 patients who were selected by convenient [non probability] sampling technique. Patients were divided into two groups. The mean infection rate during the study in group 1 was grade I in 16% and grade II in 7%, grade III in 1% versus grade I in 12% and grade II in 5%, grade III in 5% in group 2. No grade IV-VI infections were noted. Antibiotics were prescribed for a mean of 60 days [SD 15] in group 1 and 45 days [SD 30] in group 2. The relative risk [RR] of positive cultures at the proximal pin sites was 1.5 [95% CI 1.2-1.9] No difference was found between the groups. No differences between daily and weekly pin site care were observed as regards the severity of infections, frequency of infection rate, of positive cultures, except in week 6, and in use of antibiotics or analgesics

Safety of single layer continuous extra mucosal gut anastomosis in emergency

To evaluate the safety and complications of a single layer continuous extra mucosal gut anastomosis in emergency. This descriptive study was conducted in emergency department of Lady Reading Hospital Peshawar over a period of ten months from September 2007 to July 2008. Study comprised of fifty consecutive patients after fulfilling the inclusion and exclusion criteria. The safety of anastomosis technique was analysed by postoperative complications of morbidity and mortility. Among 50 patients 80% were male and 20% were female, mainly young adults. Patients with anastomotic leakage were 8%. The rate of wound infection was 34%. Mean hospital stay was 7.22 days. Mortality was 8% due to septicemia and hypovolemic shock. Single layer continuous extra mucosal anastomosis is safe and with less anastomosis-related morbidity and mortality

Cervical lymphadenopathy: a common diagnostic dilemma

To determine the diagnostic accuracy of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy using histopathologic examination of the excised lymph node as gold standard. Cross sectional study. Combined Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Pathology [AFIP] Rawalpindi, from January 2007 to January 2008. A total of 70 patients suffering from cervical lymphadenopathy were selected. After obtaining informed consent FNAC was obtained from the lymph node. Afterwards same lymph node was removed under local anesthesia for histopathology. All specimens were sent to AFIP for histopathology reporting. Sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the modalities were calculated. Data was analyzed using SPSS version 10. Mean and standard deviation for age and gender were calculated. Mean age of the patients was 38.14 +/- 16.88 year. FNAC findings showed a sensitivity of 79.5%, specificity 47.61%, positive predictive value 78%, negative predictive value 50% and diagnostic efficacy 70%. FNAC appears well established method of diagnosis, as its results compared favorably in many respects with those obtained from traditional surgical biopsy.